Transradial versus transfemoral access in uterine artery embolization for fibroids: a systematic review and...

Uterine artery embolization (UAE) is a well-established, minimally invasive treatment for symptomatic uterine fibroids. Traditionally performed through transfemoral access (TFA), there has been growing interest in the transradial approach (TRA) due to its reported benefits in other interventional procedures. This systematic review and meta-analysis aim to compare TRA and TFA in UAE for uterine fibroids.

A systematic search of PubMed, Ovid MEDLINE, and Google Scholar was conducted from their date of inception to April 2025. Data were synthesized and analyzed using Review Manager. Risk of bias was assessed using the MINORS and RoB 2 tools.

Six studies (n = 639 patients) met the inclusion criteria. Of these, 324 (50.7%) patients were assigned to the TRA group, with a mean age of 43.48 ± 6.23 years, and 315 (49.3%) patients to the TFA group, with a mean age of 42.97 ± 6.33 years. TRA was associated with significantly lower radiation exposure (MD = -207.54 mGy, 95% CI [-262.42, -152.67], p < 0.00001), shorter procedure time (MD = -7.38 min, 95% CI [-10.09, -4.66], p < 0.00001), and a greater likelihood of same-day discharge (RR = 9.50, 95% CI [3.76, 24.03], p < 0.00001). TRA also showed fewer access-site complications (RR = 0.55, 95% CI [0.31, 0.97], p = 0.04), particularly hematomas (RR = 0.32, 95% CI [0.14, 0.74], p = 0.007). No significant difference was found in fluoroscopy time. Moreover, the TRA failure rate was low (0.3%).

TRA is a safe and effective alternative to TFA for UAE in selected settings, providing reduced radiation exposure, shorter procedure times, faster recovery, and fewer access-site complications.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251027231, CRD420251027231.