Radial versus Femoral UAE

Uterine Artery Embolization – Radial or Femoral?

There are two ways of performing the UAE procedure.

To perform uterine artery embolization a tiny nick in the skin is made and a small tube called a “sheath” is placed in the main blood vessel to allow a working access. Then using smaller catheters, the beads are delivered to the abnormal tissues.

Traditionally this procedure has been performed through the groin, known as the “femoral approach.” The femoral artery is a large vessel that can be easily accessed, even without ultrasound. However, there are some downsides:

Disadvantages of femoral UAE:

• Bleeding: The risk of bleeding is higher with this approach as the vessel is larger. Lengthy compression may be required to prevent post-procedure bleeding if the closure device fails.
• Need for closure device: Due to the larger vessel size, a closure device needs to be used to close the hole in the blood vessel.
• Immobility: Patients are required to lie flat for 2 hours with use of a closure device, and 4-6 hours if there is failure of the closure device.
• Vascular injury: Blood vessel injury can result in a tear or bleeding into the groin, vascular closure devices can also have their own set of complications to the vessel depending on the type used.
• Limitation: Not ideal in patients that are obese as it is difficult to access this deep artery and stop bleeding if it occurs.

As medicine advanced and catheters became smaller, a new approach was developed through the arm. This is called the “radial approach.” There are key advantages to recovery and lower risk with radial access.

Advantages of radial UAE:

• Faster recovery: Patients can sit up and be discharged without prolonged bed rest.
• Faster ambulation: Patients can walk right away.
• Preserved modesty: Only the arm is exposed (no undressing or groin exposure).
• Lower risk of bleeding: Smaller superficial vessel, which is easier to control any bleeding if it occurs; ideal for elderly, patients on blood thinner or those with anemia.
• No need for vascular closure devices: A special wrist band is worn for 1 hour to achieve closure of the access into the blood vessel.
• Vascular injury: In the event of an injury to the radial artery there is less risk as the hand has a dual blood supply.

Disadvantages of radial UAE:

• Not everyone is a candidate: See below.
• Technical difficulty: Radial artery is much smaller and more challenging to access. Not all doctors are trained and experienced in this approach.
• Learning curve: Radial access requires ultrasound imaging, there is a learning curve to this technique that many clinicians struggle with

Our fibroid specialist performs over 95% of the UAE procedures through the radial approach with a 100% technical success rate. Make sure your UAE specialist has experience in ultrasound guided procedures with the technical know-how to successfully perform the radial UAE.

Good Candidate for Radial UAE

Before starting the procedure, our specialist will evaluate your arm to make sure the vessel is large enough to accommodate the sheath, and that there is adequate dual blood supply to the hand. If you pass both tests, then you are a good candidate for the radial approach. In rare circumstances, a very tall patient may not be a candidate if the catheters cannot reach the pelvis from the arm. If you are not a good candidate for the radial approach, then UAE will be performed through the traditional femoral approach.

Radial vs Femoral UAE – Results

Both approaches have similar success rates as the treatment is ultimately the same, beads are placed into the fibroid and/or adenomyosis arteries. The only difference is how the catheter is delivered to the pelvis. Both also have low rates of vascular access complication.² However, the radial approach is less traumatic and less painful for patients and has a lower risk.³ The radial approach via the arm also allows patients to sit up and move soon after the procedure, which increases patient satisfaction and comfort.

Experts and staff report the radial approach UAE to be superior for uterine artery embolization due to its safety profile and patient satisfaction. Did you know that cardiologists now perform most coronary angiogram procedures using the radial approach?