Uterine artery embolization feasible through wrist

A new way to access a woman’s fibroids to nonsurgically shrink noncancerous growths in the muscular wall of the uterus has been developed by interventional radiologists, according to a report published in the March issue of the Journal of Vascular and Interventional Radiology.

Uterine fibroids, which can cause a host of issues for women 35 and older, are typically treated with a catheter threaded through the femoral artery. Uterine fibroid embolization (UAE) through these means, however, can be a painful and traumatic experience for women. Lead author Neil J. Resnick, MD, of the Mount Sinai Medical Center in New York City, and colleagues investigated alternate vascular access sites for transcatheter UAE and tested the feasibility of using transradial access (TRA) to successfully perform the procedure.

Rather than going through the femoral artery, TRA threads a catheter through one of two arteries in a patient’s left wrist. Real-time imaging then allows the doctor to guide the catheter through the artery as it releases particles into the uterine arteries that provide blood to the fibroid tumor. Blood flow to the tumor is blocked, causing it to shrink and symptoms to subside.

Resnick and colleagues treated 29 women, ages 23 to 56, by transradial UAE after self-referral at their institution. Results indicated that TRA UFE was technically successful in all patients. The catheter by itself was capable of cannulating the horizontal segment of the uterine arteries in 17 of the cases. Twelve needed additional microcatheter system use. No access-site complications were identified.

The procedure took an average of 55 minutes, with a mean fluoroscopy time of 18.9 minutes and a mean radiation dose of 499 Gy·cm2. Women who underwent embolization through the wrist were able to immediately sit up afterwards and did not require an overnight stay. In addition to these patient benefits, the procedure is also more cost effective than wrist UAE.

“In summary, the present limited initial investigation suggests that TRA offers a feasible alternative to TFA for patients undergoing UAE,” wrote the report’s authors. “A much larger-scale prospective, randomized trial will be needed to validate conclusions about potential clinical benefits of this novel transradial approach compared with existing transfemoral UAE techniques.”

The researchers hope that this technique could also lead to improved interventional radiology treatments in other areas, such as those for cancer patients.