Women undergoing uterine artery embolization with transradial vs transfemoral access: A systematic review and...

Uterine artery embolization (UAE) is a minimally invasive alternative to surgical intervention for symptomatic uterine fibroids. Transradial access (TRA) is gaining attention as a feasible approach compared with transfemoral access (TFA) due to its potential benefits in patient safety and comfort. However, comparative evidence regarding efficacy and safety remains limited.

This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines and was registered in PROSPERO. Databases including PubMed, Google Scholar and the Cochrane Library were searched. Studies comparing TRA and TFA in patients undergoing UAE were included. Data extraction and risk-of-bias assessment (using RoB 2.0 and Newcastle-Ottawa tools) were conducted. Statistical analyses were performed using RevMan 5.4.1 with random-effects models, and heterogeneity was assessed using the I² statistic. Sensitivity analyses were conducted where necessary.

Seven studies involving 710 patients (355 TRA, 355 TFA) were included. TRA demonstrated a comparable procedural time [mean difference (MD) -2.74 min, 95 % confidence interval (CI) -10.16 to 4.69; p = 0.47) and fluoroscopy time (MD 0.14 min, 95 % CI -2.32 to 2.61; p = 0.91) with TFA. Radiation exposure showed no significant difference overall; however, sensitivity analysis revealed a significant reduction with TRA (MD -0.16 Gy; 95 % CI -0.24 to -0.07; p = 0.0002). No significant difference in major access site complications was observed [risk ratio (RR) 0.85; p = 0.73], while a non-significant trend favoured TRA for fewer minor complications (RR 0.59; p = 0.07). Microcatheter use was slightly higher in the TRA group, but the difference was not significant (RR 1.13; p = 0.09) CONCLUSION: TRA is a safe and effective alternative to TFA for UAE, with potential advantages including reduced radiation exposure and fewer minor access site complications.