Treating Fibroids from the Wrist
Alicia Armeli

For over 20 years, interventional radiologists have performed uterine fibroid embolization (UFE), providing women a nonsurgical option to treat their fibroids. Recently, some of these doctors have started taking a different approach to this decades-old procedure. Instead of accessing fibroids through the groin, patients are offered a safe and effective alternative—the wrist. A growing number of interventional radiologists report that this technique has improved patient care and comfort both during the UFE procedure and recovery.

Uterine fibroids affect up to 40 percent of women 35 years of age and older1 and
Femoralaccess-340x281can cause symptoms such as heavy painful periods, pelvic pressure, painful intercourse, and urinary incontinence. But in order to treat these noncancerous growths, interventional radiologists have to reach them first.

Traditionally, the femoral artery in the groin has been the go-to access site when performing UFE. Making a small incision in the skin, an interventional radiologist threads a thin catheter through the femoral artery into the uterine arteries that feed blood to the fibroids. Tiny particles are injected into the uterine arteries, blocking blood flow to the fibroids, causing them to significantly shrink and scar down into the surrounding tissues. Studies show that UFE can offer an approximate 90 percent cure rate.2

With a continuous drive to improve UFE, interventional radiologists have now found they can just as easily access fibroids using the radial artery in the wrist.UFE_History
This approach, formally known as percutaneous transradial access, was first used in 1989 to perform a coronary angiography (a test that uses dye and special x-rays to show the arteries supplying blood to a patient’s heart). Today, in some parts of the world, transradial access is used for 80 percent or more of interventional coronary procedures.3

“Transradial access provides many benefits for patients,” said Dr. Neil Resnick, Chief of the Division of Interventional Radiology at NYC Health + Hospitals/Harlem, and Assistant Clinical Professor of Radiology at Columbia University Medical Center in New York. “My UFE patients may assume the most comfortable positions during recovery without worrying about major bleeding complications if they bend at their hip. They may sit up right away and are able to move around much earlier. Issues related to patient modesty, religious preferences, and groin sensitivity are minimized.”

These advantages reflect the results of large multicenter studies that have revealed more than 90 percent of patients who have experienced both transfemoral and transradial access for cardiovascular care would choose transradial if they had to undergo another procedure.4

Initially, data on transradial safety and efficacy were mainly limited to interventional cardiology studies. But the many benefits of the transradial approach are transferrable to procedures that treat conditions beyond the heart—and research is emerging to support this.

“Cardiologists have studied thousands of these procedures, which have been shown to be safer compared with their traditional transfemoral counterparts,” Dr. Resnick explained. “Transradial access is presumably safer still during interventional radiology procedures, especially UFE, given that these patients tend to have significantly less cardiovascular disease and aren’t routinely given high doses of blood thinning medications.”

A 2016 clinical study published in the Journal of Vascular and Interventional Radiology5 followed the recovery of over 900 patients who underwent more than 1500 transradial access interventional procedures—UFE being one such procedure. Fischman and a team of experts at Icahn School of Medicine at Mount Sinai evaluated patient progress after 30 days and found transradial access to have a success rate of greater than 98 percent with virtually negligible complications reported.

These results mirrored those seen in a smaller study where success rates reached 100 percent with no immediate major or minor complications.6

However, just as with any medical procedure—albeit minimal—transradial access does have its risks. According to Dr. Resnick, the more common risks include slight bruising at the puncture site, inflammation of the radial artery, arterial spasm, and, very rarely, silent arterial blockage.

“Major complications involving significant bleeding or injury to the radial artery requiring repair are exceedingly rare events,” he added. “Any risk to the fingers is minimized when [specific tests] are performed ahead of time.” Stroke is another risk associated with transradial access, but “to date, there are no published reports of stroke caused by transradial interventional radiology procedures.”

Most importantly, patients now have options when it comes to choosing an access site for UFE—transfemoral or transradial. This can be especially important for women with fibroids. “Over the years I’ve received a number of calls from patients who sought to reschedule their UFE on account of having their period at the time they are to undergo the procedure,” Dr. Resnick explained. “My transradial patients are quite pleased when I remind them that I won’t be working from the groin and we may proceed as scheduled.”

For patients who have chosen UFE through their wrist, Dr. Resnick said the reviews have been positive. “Patients are amazed by transradial access, and they love it.” This technique is becoming increasingly available to patients, reported Dr. Resnick. “There will always be resistance to change among physicians who have been performing a procedure the same way for many years. However, I’m seeing more and more interventional radiologists undertake transradial access once they learn of its many benefits.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.

ABOUT THE DOCTOR Neil J. Resnick MD is Chief of the Division of Interventional Radiology at NYC Health + Hospitals/Harlem, and Assistant Clinical Professor of Radiology at Columbia University Medical Center in New York. Through his research and diverse experience in Interventional and Diagnostic Radiology, Dr. Resnick strives to improve the field of Interventional Radiology with the goal of providing patients with the best care possible.

REFERENCES

1. Society of Interventional Radiology. (2016). Uterine Fibroid Symptoms, Diagnosis and Treatment. Retrieved February 9, 2016, from http://www.sirweb.org/patients/uterine-fibroids/
2. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.

3. Global Radial Adoption. Taken from https://thinkradial.com/for-patients/the-basics

4. Jolly S.S., Amlani S., Hamon M., Yusuf S., Mehta S.R. (2009) Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and metanalysis of randomized trials. American Heart Journal. 157:132-140.

5. Posham, R., Biederman, D. M., Patel, R. S., Kim, E., Tabori, N. E., Nowakowski, F. S., Lookstein, R. A., Fischman, A. M. (2016). Transradial approach for noncoronary interventions: a single-center review of safety and feasibility in the first 1500 cases. Journal of Vascular and Interventional Radiology, 27(2): 159-166. doi: 10.1016/j.jvir.2015.10.026

6. Resnick, N. J., Kim, E., Patel, R. S., Lookstein, R. A., Nowakowski, F. S., &Fischman, A. M. (2014). Uterine artery embolization using a transradial approach: initial experience and technique. Journal of Vascular and Interventional Radiology, 25: 443-447. doi:http://dx.doi.org/10.1016/j.jvir.2013.11.010