Maintaining Bilateral Arterial Catheters to Achieve Delayed Endpoint Embolization in Uterine Artery Embolization and...

It is common to see renewed arterial flow minutes after achieving a conventional endpoint during embolization procedures due to particle redistribution. This technique describes a method of leaving a catheter in place so that a repeat angiogram can be performed later during the procedure to assess the arterial flow and to allow for delayed endpoint assessment and top-up embolization in the setting of uterine and prostatic artery embolization.

Between 2014 and 2024, 140 uterine artery embolizations and 50 prostatic artery embolizations were performed using bilateral common femoral artery access under ultrasound guidance. Simultaneous catheterization enabled alternating embolization and passive redistribution of embolic material, with the ability to deliver additional embolic load following delayed reassessment, including waits for hypogastric nerve block or gel foam preparation. This "swapping sides" strategy allowed flow reassessment and top-up before completion.

Delayed angiographic reassessment demonstrated renewed perfusion in vascular territories that had previously met conventional endpoints, facilitating additional flow-directed embolization in all cases without prolonging procedure time or increasing contrast volume. In the uterine artery embolization cohort, the mean fibroid infarction rate was 97%, with 96% of patients reporting symptomatic improvement; long-term hysterectomy was required in 7.1%. In the prostatic artery embolization cohort, the mean reduction in International Prostate Symptom Score was 11 points, with a quality-of-life improvement of two points. No major access-site complications were observed.

Bilateral femoral access facilitates a novel embolization workflow, "embolize-wait-reassess-top-up", without significant access-related penalty. These findings warrant reconsideration of dual femoral access in pelvic embolization.