title: Transbrachial approach to the treatment of uterine leiomyomas with embolization of the uterine arteries: a preliminary technical experience.
abstract: BACKGROUND
  Uterine leiomyomas are benign tumours; recently they have been managed with embolization of the uterine arteries. We analysed the technical feasibility, safety and efficacy of this treatment performed via an innovative transbrachial approach, rather than the traditional transfemoral approach.
  
  
  METHODS
  Between 2009 and 2013, 115 patients were treated with embolization of the uterine arteries for one or more symptomatic leiomyomas. In 20 of these 115 patients, a transbrachial approach was used. Under ultrasound guidance, the left brachial artery was punctured. After having placed the tip of the angiography catheter at the level of L4 to check the aortic bifurcation, the uterine arteries were catheterised and embolized with calibrated particles. Data concerning exposure to radiation and the duration of the intervention were recorded for comparison between the two groups of subjects. Clinical controls and magnetic resonance imaging were complemented with echo-colour Doppler of the brachial artery to confirm the integrity and function of the vessel.
  
  
  RESULTS
  The uterine arteries were catheterised easily in a mean time of 25″, compared to 72″ using the femoral approach. As far as exposure to radiation was concerned, the mean fluoroscopy time for the femoral approach was 21.7' [range 14.4-42.7'] compared to 17.6' [range 7.7-25.5'] for the transbrachial approach. The time of occupation of the angiography suite was 118' (range 95-155') with the femoral approach, compared to 92' (range 65-123') with the transbrachial approach. No immediate complications involving the brachial artery were recorded.
  
  
  CONCLUSIONS
  In the treatment of symptomatic uterine fibromas, embolization of the uterine arteries performed via a transbrachial approach was shown to be safe and technically valid with regard to reducing the overall time of the intervention, ease of selective catheterisation, and shorter times spent in hospital, as well as being better accepted by patients.
authors: , c/o MAZZONE, V.F.Algarotti, n° 8, 00137, Rome, Italy, spieri@scamilloforlanini.rm.it.
authors: Stefano
authors: S
authors: Pieri
authors: Maurizio
authors: M
authors: Di Felice
authors: Emilo
authors: E
authors: Moreschi
authors: Patrizio
authors: P
authors: Damiani
authors: Edvige
authors: E
authors: Marasca
authors: Paolo
authors: P
authors: Agresti
authors: Barbara
authors: B
authors: Sessa
authors: Margherita
authors: M
authors: Trinci
authors: Guendalina
authors: G
authors: Menichini
authors: Ilenia
authors: I
authors: Di Giampietro
authors: Vittorio
authors: V
authors: Miele
mesh_terms: D000328:Adult; D001916:Brachial Artery; D003287:Contrast Media; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D059408:Pain Management; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional; D055357:Uterine Artery Embolization; D014594:Uterine Neoplasms / Q000628:therapy*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol
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