Uterine Fibroid Embolization (Radial access) 

Uterine fibroid embolization (UFE) is an image guided minimally invasive procedure utilized to treat symptomatic fibroids (myomas) of the uterus which are causing pain, irregular or heavy menstrual bleeding, and abdominal/pelvic pressure on the bladder or bowel.
This animation demonstrates how one of the most popular minimally invasive procedure, uterine fibroid embolization is performed step by step through a radial access. This procedure is commonly done by interventional radiologist.
As a first step, the left radial artery is accessed under ultrasound guidance using a micropuncture needle. Once the blood return is noted, a microwire is advanced through the needle into the left radial artery.
The needle is exchanged for a slim sheath.
Once the slim sheath is advanced over the microwire and properly placed, the microwire and inner dilator are removed.
A mixture of vasodilators is injected through the sheath to avoid arterial spasm at this point. Then, normal saline infusion is started through the sheath to avoid possible clot formation.
A combination of catheter and wire is advanced from the left radial artery to the aorta and subsequently to the internal iliac artery. Once, the tip of the catheter is placed at the origin of internal iliac artery.
Then, a long small gauge needle is advanced through the anterior abdominal wall to the anterior aspect of lumbar vertebra to preform hypogastric nerve block. After injecting the cocktail, the needle is removed.
Then, the wire is exchanged for a combination of microcatheter and microwire, which is advanced to the uterine artery.
Once unwanted collaterals are bypassed, the uterine artery is embolized using particles until the blood flow slows down, or in another word stasis is achieved.
Then, the microcatheter is pulled back in to the base catheter which is also pulled back to the aorta and thenadvanced to the contralateral internal iliac artery. The unwanted collaterals are bypassed in similar fashion, and particles are injected into the contralateral uterine artery until slow blood flow is noted.
All catheters and microcatheters are removed. Then, saline infusion is stopped.
The wrist is lifted. Then, a TR band is placed on the wrist, inflated with air, and the sheath is removed. Finally, the amount of air within the TR band is adjusted.
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