Uterine Artery Embolization – Radial or Femoral?

Fibroid Embolization: Radial vs. Femoral Approach

Uterine fibroid embolization is a procedure that shrinks or eliminates uterine fibroids without surgery. It can effectively address all types of fibroids that are located in the uterus.  It is an outpatient procedure so it does not require a hospital stay and requires minimal recovery time. This is why our website ATLii.com states, “Freedom from Fibroids, Without Surgery!”.

There are two different techniques that can be used to perform the UFE procedure.  Dr. R. Mitchell Ermentrout, MD of the Atlanta Fibroid Center® explains these different techniques and answers some frequently asked questions.

UFE Using Radial or Femoral Access: What’s the Difference?

Uterine Fibroid Embolization (UFE) can be performed by accessing an artery in the wrist or the leg. Here I’ll break down the similarities and differences between these two ways to do the same procedure.

What Does Embolization Mean?

Embolization is a procedure that is used to block blood flow in very targeted areas while leaving the surrounding areas unaffected. Uterine fibroid embolization (UFE) is a vascular procedure that works by placing a small catheter (tube) into the arteries that supply blood to the uterus. Once the catheter is in place, small particles are injected through the catheter into the network of arteries that supply each and every fibroid within the uterus.

How Does the Uterine Fibroid Embolization Procedure Work?

Specifically-sized particles become lodged within the small vessels within each fibroid, blocking the flow of blood. The network of vessels supplying the uterus itself remains open, but the fibroids no longer have a blood supply.

This deprives the fibroids of necessary oxygen and nutrients, and the muscle cells within them die. Fibroids will then shrink by 50-60% or more and fibroid-related symptoms including heavy menstrual cycles, anemia, pelvic pain, bloating, and frequent urination will resolve in more than 90% of patients.

What Will Happen to the Fibroids After UFE?

Most women with fibroids have no symptoms and therefore need no treatment. We refer to these fibroids as “passenger fibroids”. For women with symptomatic fibroids that undergo UFE, the fibroids will “shrivel up” and become dead passenger fibroids.

Occasionally, submucosal fibroids on the inner lining of the uterus will break away from the uterus and pass during a menstrual cycle. Other fibroids within the wall of the uterus so-called intramural fibroids shrink and soften, but will not grow back as they do not have the ability to re-establish a new blood supply.

Types of uterine fibroids: submucosal, subserosal, intramural, and cervical
Types of uterine fibroids: submucosal, subserosal, intramural, and cervical

Which Artery is Used to Perform UFE?

Since we cannot access the arteries to the uterus directly, we reach them using very long catheters that enter an artery in a distant location. The safest and most frequently used places to access the body’s arteries are in the top of the leg, i.e. femoral access, and the wrist, i.e. radial access.

What Is Femoral Access?

The femoral artery is located in the triangle-shaped area at the top of the thigh just below the groin and was the first location to be used for vascular procedures. Because of this, the tools to access this artery have been around the longest, have the widest variety of shapes and sizes, and are the most well studied. This is a large major artery and can be safely and easily accessed by a trained physician either with or without ultrasound guidance.

What to Expect From the Femoral Access UFE Procedure?

  1. All patients at the Atlanta Fibroid Center® are sedated during the procedure, but we also use a local numbing agent so the access is painless.
  2. A small hole is created in the vessel that is only 2 millimeters and a tiny incision is made on the top of the leg that is only about 5 millimeters or less than a ¼ of an inch.
  3. The procedure takes approximately 30-40 minutes, and when complete, all of the catheters are removed.
  4. The 2 mm hole in the artery will close on its own, but we speed up the process by placing a small collagen patch on the outside of the artery.

Recovery From Femoral Artery UFE

Patients will continue to rest in recovery with their leg straight for at least 2 hours to help start the process of healing. The only thing needed by the patient before being released is a band-aid placed over the small entry point. Patients can normally resume their usual activities after a week to 10 days.

radial vascular access
Accessing femoral artery

Will I Have Stitches After Uterine Fibroid Embolization?

There are no sutures required after UFE. A bandaid at the top of the leg is the only evidence of the access, and the tiny incision heals within 2-3 days.  Since there are no stitches, it eliminates the need for a special trip to the doctor’s office to have them removed.  Also, the patient is not left with any unwanted scarring on the abdomen from a surgical procedure.

What Is Radial Access?

The radial artery in the wrist has been widely used for vascular procedures since the 1990s, as advances in catheter technology produced smaller devices. Most of the doctors using this technique in the 1990s and 2000s were performing procedures on the heart, and they found that performing the procedure from the wrist was faster, easier, and much safer with less risk of bleeding. Today, 80-90% of all heart procedures are performed this way and it can also be used during UFE procedures.

What to Expect From the Radial Access UFE Procedure

  1. Catheters long enough for performing UFE from the wrist first became available during the 2010s as technology continued to improve. This technique is now offered by Dr. Ermentrout at the Atlanta Fibroid Center® for added patient comfort and to reduce risk in patients who have a higher bleeding risk.
  2. The left wrist is most often used, because it is slightly closer to the uterus than the right, measuring along the blood vessels.
  3. Patients at the Atlanta Fibroid Center® are sedated during the procedure, but a local numbing agent is also used so that the access is painless.
  4. Access into the radial artery is performed with a small needle and ultrasound guidance so that it may be done faster and more accurately.
  5. There is no incision but just a very small access point in the skin and the artery that are approximately 2 millimeters in size.

How Can My Uterus Be Reached Through My Wrist to Perform UFE?

It may seem like a long distance from the wrist to the pelvis, but advancing the catheter takes only about 10-20 seconds. Once the catheter is in place, the treatment portion of the UFE procedure is the same.

Recovery From Radial Access UFE

One of the main differences between femoral and radial access is the process of removing the catheter at the end of the procedure. When the catheter is removed from the radial artery, a wrist band with a small balloon is used to hold pressure for approximately 90 minutes. This is then removed and replaced with a small bandaid and The tiny puncture wound heals within 2 days.

Unlike after having UFE performed using femoral access, where a patient must lie with their leg straight for 2 hours, patients can get up and walk around immediately and recover in any position they find comfortable, i.e. on their side, curled up with knees to the chest, or sitting up. They may get up to walk or use the restroom as soon as they wake up from sedation.

Patients will wear a wrist splint until the morning after the procedure and can normally resume their usual activities after a week to 10 days.

Is Radial Access Safer Than Femoral Access During UFE?

Historically, radial access has been proven to be safer in heart patients.  There are fewer bleeding complications related to radial access and most heart patients are on blood thinners which increases the chance of bleeding.

Most patients having uterine fibroid embolization are not on blood thinners, and bleeding complications in UFE patients at the femoral or radial access sites is rare.  However, for patients who may take aspirin or any blood thinner, radial access is the preferred approach.

Does Radial Access During UFE Take More Time Than Femoral Access?

Regardless of whether femoral or radial access is used for UFE, the procedure takes the same amount of time 30-40 minutes and the results of the fibroid treatment are no different.

Will My Uterine Fibroid Embolization Be Done Through My Wrist Or My Leg?

The choice of femoral access (leg) or radial access (wrist) is up to you and the physician performing the procedure. During your initial consultation access options will be discussed in detail and decided upon between you and your doctor.

R. Mitchell Ermentrout, MD, performs procedures from both femoral and radial access. He was one of the first Interventional Radiologists in Georgia to regularly use radial access for embolization procedures and has performed well over a thousand radial procedures. Dr. Ermentrout has taught radial access techniques to over 100 residents, fellows, and practicing Interventional Radiologists since 2015.

The team of Dr. John Lipman and Dr. Mitchell Ermentrout at Atlanta Fibroid Center® combines over 35 years of academic excellence and extensive medical expertise in treating uterine fibroids. It is our privilege to provide a first-class experience to every one of our patients at Atlanta Fibroid Center®, and we look forward to the opportunity to serve YOU!

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