03:09 PM Abstract No. 64 Switching from transfemoral to transradial approach for uterine artery embolization: is there a learning curve?

Abstract

Uterine artery embolization (UAE) has been traditionally performed with transfemoral approach (TFA) with very low complication rate and great technical and clinical success. Transradial approach (TRA) has now been shown to be feasible for uterine artery embolization. However, there is a need to show that TRA is non-inferior in terms of technical and clinical success and complication rates as compared to established practice. In this IRB-approved, HIPAA-compliant retrospective study, consecutive patients that underwent UAE to treat fibroid-related symptoms in a single tertiary academic hospital between 05/2014 – 06/2018 were included. In 11/2016 routine access for UAE was changed from TFA to TRA. Patient’s and procedure characteristics, clinical and technical success and complications rates were compared. There were 91 patients (45±5 yrs) in TFA group and 91 patients (46±5 yrs) in TRA with one case of crossover to TFA due to vasospasm. There was no difference in fluoroscopy time (41±16 vs. 40±14min, p=0.56) or radiation exposure (660±711 vs. 679±998mGy, p=0.88) between TFA and TRA groups. More women were discharged home the same day with TRA (30/91, 33%) than with TFA (4/91, 4%), p=0.002. Only 2 patients (2/30, 7%) represented to ED for pain control among patients who were discharged home the same day in TRA group vs. 1/4, 25% in TFA group. There was a similar low rate of minor access site complication in each group: in TFA group (6/91, 7%): 5 patients with groin hematomas and 2 patients with groin pain vs. in TRA group (4/91, 4%): 3 patients with transient focal occlusion of the radial artery and one patient with focal pain, all resolved with conservative management. Imaging at 3 months showed similar rate of uterine volume reduction: 38±17% in TFA vs. 33±19% in TRA group, p=0.18. No residual enhancement was noted in 43/52, 83% in TFA vs. 65/76, 85% in TRA group in patients with MRI at 3 months, p=0.66. In this retrospective study transradial approach was shown to have similar technical and clinical success rate with similar very low rate of access site complications as compared to transfemoral approach. TRA allowed same day discharge in 33% of patients.