CardioVascular and Interventional Radiology

, Volume 42, Issue 3, pp 441–447 | Cite as

Prospective Study on Total Fluoroscopic Time in Patients Undergoing Uterine Artery Embolization: Comparing Transradial and Transfemoral Approaches

  • Chloe MortensenEmail author
  • John Chung
  • David Liu
  • Stephen Ho
  • Gerald Legiehn
  • Lindsay Machan
  • Darren Klass
Clinical Investigation Radiation Protection
Part of the following topical collections:
  1. Radiation Protection



Comparing total fluoroscopy time (FT) to perform uterine artery embolization (UAE) with transradial approach (TRA) versus transfemoral approach (TFA). Our hypothesis was that there would be no significant procedural time penalty incurred, despite the learning curve associated with adopting a new approach.

Materials and Methods

A cohort study was undertaken including 66 consecutive patients undergoing UAE with either TRA/TFA between January and September 2015. Total FT was recorded prospectively for each procedure, and data subsequently analyzed retrospectively. Each operator had at least 2 years of experience as an interventional radiologist having performed at least 200 TFA UAEs. All operators had recently incorporated TRA into their practice.


A total of 39 TFA and 27 TRA cases were included in the study; mean age for TFA group was 44.4 years (± 4.9) and for TRA group was 45.1 years (± 4.9) (p = 0.59). Mean FTs were comparable between the two groups (p = 0.86) despite a learning curve associated with TRA: The mean total FT with TFA was 20.36 min (± 9.48) compared to TRA 20.12 min (± 7.67).


FTs for TRA UAE were comparable to TFA UAE, even though TRA had been recently adopted as a new approach. Despite the learning curve associated with developing a novel technique, operators should not expect the efficiency of their service to be significantly compromised. Introducing this safe and effective method of vascular access should therefore be considered.


Uterine fibroid embolization Uterine artery embolization Transradial Fluoroscopic time 

List of Abbreviations


Dose area product


Uterine artery embolization


Transradial approach


Transfemoral approach


Fluoroscopy time


Interventional radiology


Uterine artery


Radial artery




Percutaneous coronary interventions


Compliance with Ethical Standards

Conflict of interest

Dr. Mortensen, Dr. Ho and Dr. Legiehn declare that they have nothing to disclose. Dr. Chung reports personal fees from Merit Medical, personal fees from Boston Scientific, outside the submitted work. Dr. Liu reports other (independent director) from Merit Medical, grants from Seimens Medical, outside the submitted work. Dr. Machan reports other (medical advisory board) from Boston Scientific Corp, other (scientific advisory committee) from Cook Inc, outside the submitted work. Dr. Klass reports personal fees from Merit Medical, personal fees from Cook Medical, personal fees from Phillips Healthcare, personal fees from Liva Nova, grants from Biolife, outside the submitted work.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Feldman DN, Swaminathan RV, Kaltenbach LA, Baklanov DV, Kim LK, Wong SC, Minutello RM, Messenger JC, Moussa I, Garratt KN, Piana RN, Hillegass WB, Cohen MG, Gilchrist IC, Rao SV. Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention an updated report from the national cardiovascular data registry (2007–2012). Circulation. 2013;127(23):2295–306.CrossRefGoogle Scholar
  2. 2.
    Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J. 2009;157(1):132–40.CrossRefGoogle Scholar
  3. 3.
    Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P, Budaj A, Niemelä M, Valentin V, Lewis BS, Avezum A, Steg PG, Rao SV, Gao P, Afzal R, Joyner CD, Chrolavicius S, Mehta SR. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377(9775):1409–20.CrossRefGoogle Scholar
  4. 4.
    Agostoni P, Biondi-Zoccai GGL, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, Vassanelli C, Zardini P, Louvard Y, Hamon M. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44(2):349–56.CrossRefGoogle Scholar
  5. 5.
    Kedev S, Kalpak O, Dharma S, Antov S, Kostov J, Pejkov H, Spiroski I. Complete transitioning to the radial approach for primary percutaneous coronary intervention: a real-world single-center registry of 1808 consecutive patients with acute ST-elevation myocardial infarction. J Invasive Cardiol. 2014;26(9):475–82.Google Scholar
  6. 6.
    Kolluri R, Fowler B, Nandish S. Vascular access complications: diagnosis and management. Curr Treat Options Cardiovasc Med. 2013;15(2):173–87.CrossRefGoogle Scholar
  7. 7.
    Oren O, Oren M, Turgeman Y. Transradial versus transfemoral approach in peripheral arterial interventions. Int J Angiol. 2016;25(3):148–52.CrossRefGoogle Scholar
  8. 8.
    Resnick NJ, Kim E, Patel RS, Lookstein RA, Nowakowski FS, Fischman AM. Uterine artery embolization using a transradial approach: initial experience and technique. J Vasc Interv Radiol. 2014;25(3):443–7.CrossRefGoogle Scholar
  9. 9.
    Bishay VL, Biederman DM, Ward TJ, van der Bom IM, Patel RS, Kim E, Nowakowski FS, Lookstein RA. Transradial approach for hepatic radioembolization: initial results and technique. AJR Am J Roentgenol. 2016;207(5):1112–21.CrossRefGoogle Scholar
  10. 10.
    Roy AK, Garot P, Louvard Y, Neylon A, Spaziano M, Sawaya FJ, Fernandez L, Roux Y, Blanc R, Piotin M, Champagne S, Tavolaro O, Benamer H, Hovasse T, Chevalier B, Lefèvre T, Unterseeh T. Comparison of transradial vs transfemoral access for aortoiliac and femoropopliteal interventions: a single-center experience. J Endovasc Ther. 2016;23(6):880–8.CrossRefGoogle Scholar
  11. 11.
    Kis B, Mills M, Hoffe SE. Hepatic radioembolization from transradial access: initial experience and comparison to transfemoral access. Diagn Interv Radiol. 2016;22(5):444–9.CrossRefGoogle Scholar
  12. 12.
    Roussanov O, Wilson SJ, Henley K, Estacio G, Hill J, Dogan B, Henley WF, Jarmukli N. Cost-effectiveness of the radial versus femoral artery approach to diagnostic cardiac catheterization. J Invasive Cardiol. 2007;19(8):349–53.Google Scholar
  13. 13.
    Applegate R, Sacrinty M, Schafer P, Smith J, Gandhi S, Kutcher M, Santos R, Cecile A, Little W. Cost effectiveness of radial access for diagnostic cardiac catheterization and coronary intervention. Catheter Cardiovasc Interv. 2013;82(4):E375–84.Google Scholar
  14. 14.
    Mamas MA, Tosh J, Hulme W, Hoskins N, Bungey G, Ludman P, de Belder M, Kwok CS, Verin N, Kinnaird T, Bennett E, Curzen N, Nolan J. No title health economic analysis of access site practice in England during changes in practice: insights from the British cardiovascular interventional society. Circ Cardiovasc Qual Outcomes. 2018;11(5):e004482.CrossRefGoogle Scholar
  15. 15.
    Thakor A, Alshammari M, Liu D, Chung J, Ho S, Legiehn G, Machan L, Fischman A, Patel R. Transradial access for interventional radiology: single-centre procedural and clinical outcome analysis. Can Assoc Radiol J. 2017;68(3):318–27.CrossRefGoogle Scholar
  16. 16.
    Barbeau GR, Arsenault F, Dugas L, Simard S, Lariviere MM. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen’s test in 1010 patients. Am Heart J. 2004;147(3):489–93.CrossRefGoogle Scholar
  17. 17.
    Carrington C, Mann R, El-Jack S. An accelerated hemostasis protocol following transradial cardiac catheterization is safe and may shorten hospital stay: a single-center experience. J Interv Cardiol. 2009;22(6):571–5.CrossRefGoogle Scholar
  18. 18.
    Valgimigli M, Gagnor A, Calabrò P, Rubartelli P, Garducci S, Andò G, Santarelli A, Galli M, Garbo R, Bramucci E, Ierna S, Briguori C, Cortese B, Limbruno U, Violini R, Presbitero P, De Cesare N, Sganzerla P, Ausiello A, Tosi P, Sardella G, Sabate M, Brugaletta S, Saccone G, Vandoni P, Zingarelli A, Liso A, Rigattieri S, Di Lorenzo E, Vigna C, Palmieri C, Falcone C, De Caterina R, Caputo M, Esposito G, Lupi A, Mazzarotto P, Varbella F, Zaro T, Nazzaro M, Rao SV, Van ‘T Hof AWJ, Omerovic E, Uguccioni L, Tamburino C, Ferrari F, Ceravolo R, Tarantino F, Casu G, Mazzarotto P, Cremonesi A, Saia F, Guiducci V, Dellavalle A, Curello S, Mangiacapra F, Evola R, Liistro F, Creaco M, Colombo A, Perkan A, De Servi S, Fischetti D, Pucci E, Romagnoli E, Moretti C, Moretti L, Turturo M, Bonmassari R, Penzo C, Loi B, Mauro C, Gabrielli G, Micari A, Petronio AS, Comeglio M, Fresco C, Pasquetto G, Belloni F, Amico F. Design and rationale for the minimizing adverse haemorrhagic events by transradial access site and systemic implementation of angioX program. Am Heart J. 2014;168(6):838–45.CrossRefGoogle Scholar
  19. 19.
    Chase AJ, Fretz EB, Warburton WP, Klinke WP, Carere RG, Pi D, Berry B, Hilton JD. Association of the arterial access site at angioplasty with transfusion and mortality: the M.O.R.T.A.L study (Mortality benefit of Reduced Transfusion after percutaneous coronary intervention via the Arm or Leg). Heart. 2008;94(8):1019–25.CrossRefGoogle Scholar
  20. 20.
    Stuart S, Mayo JR, Ling A, Schulzer M, Klass D, Power MA, Roberton BJ, Wan JM, Liu DM. Retrospective study of the impact of fellowship training on two quality and safety measures in uterine artery embolization. J Am Coll Radiol. 2014;11(5):471–6.CrossRefGoogle Scholar
  21. 21.
    Yamada R, Bracewell S, Bassaco B, Camacho J, Anderson MB, Conrad A, Lynn C, Burns P, Collins H, Guimaraes M. Transradial Versus Transfemoral Arterial Access in Liver Cancer Embolization: randomized Trial to Assess Patient Satisfaction. J Vasc Interv Radiol. 2018;29(1):38–43.CrossRefGoogle Scholar
  22. 22.
    Sirker A, Kwok CS, Kotronias R, Bagur R, Bertrand O, Butler R, Berry C, Nolan J, Oldroyd K, Mamas MA. Influence of access site choice for cardiac catheterization on risk of adverse neurological events: a systematic review and meta-analysis. Am Heart J. 2016;181:107–19.CrossRefGoogle Scholar
  23. 23.
    Rao SV, Turi ZG, Wong SC, Brener SJ, Stone GW. Radial versus femoral access. J Am Coll Cardiol. 2013;62(17 Suppl):S11–20. Scholar
  24. 24.
    Abazid RM, Smettei OA, Mohamed MZ, Kattea MO, Suresh A, Bashir Y, Sakr H. Radial artery ultrasound predicts the success of transradial coronary angiography. Cardiol J. 2017;24(1):9–14.CrossRefGoogle Scholar
  25. 25.
    Rigattieri S, Sciahbasi A, Drefahl S, Mussino E, Cera M, Di Russo C, Fedele S, Pugliese FR. Transradial access and radiation exposure in diagnostic and interventional coronary procedures. J Invasive Cardiol. 2014;26(9):469–74.Google Scholar
  26. 26.
    Lo TS, Ratib K, Chong AY, Bhatia G, Gunning M, Nolan J. Impact of access site selection and operator expertise on radiation exposure; A controlled prospective study. Am Heart J. 2012;164(4):455–61.CrossRefGoogle Scholar
  27. 27.
    Jolly SS, Cairns J, Niemela K, Steg PG, Natarajan MK, Cheema AN, Rao SV, Cantor WJ, Dzavik V, Budaj A, Sheth T, Valentin V, Fung A, Widimsky P, Ferrari E, Gao P, Jedrzejowski B, Mehta SR. Effect of radial versus femoral access on radiation dose and the importance of procedural volume: a substudy of the multicenter randomized RIVAL trial. JACC Cardiovasc Interv. 2013;6(3):258–66.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Brighton and Sussex University Hospitals NHS TrustBrightonUK
  2. 2.University of British ColumbiaVancouverCanada

Personalised recommendations