Outcome of Trans-radial Uterine Artery Fibroid Embolisation: a Kenyan Experience.

Abstract

Background: Uterine leiomyomas are the most frequent cause of non-cancerous pelvic tumours in women. In Kenyatta National Hospital and the Karen Hospital, most patients are treated medically and surgically with myomectomy or hysterectomy. However, for cases where surgery is contraindicated, Uterine fibroid embolization (UFE), a minimally invasive interventional radiology procedure, is used to treat symptomatic uterine fibroids. Using the trans-radial approach (TRA) instead of the femoral approach for UFE, there is a significant reduction in hospital stay, complications, and patient comfort. However, the evidence of the technical success rate and complications of TRA UFE has not been evaluated locally. Broad objective: The study sought to determine the characteristics, technical success rates and complications in patients undergoing trans-radial UFE at Kenyatta National Hospital and Karen Hospital. Participants and methods: This was a retrospective and prospective cross-sectional study carried out at Kenyatta National Hospital and Karen Hospital. Medical records of patients who underwent trans-radial UFE at Kenyatta National Hospital and Karen Hospital were retrieved. The Census sampling approach was used with a sample of 48 TRA UFE required. Data was extracted from the patients' records. Information collected included the patient's age, parity, last menstrual period, symptomatology – bleeding, cramps, bloating, pelvic fullness, urinary tract symptoms, MRI – fibroids, and Haemoglobin level, INR, working diagnosis and management undertaken, data on the trans-radial access UFE including the technical outcome of uterine fibroid embolization, complications related to uterine artery embolization, and access. The data was entered into Epi Info software, from where it was cleaned and coded, and any missing data was sought from the files. The hard copies were stored in a lockable file cabinet while the soft copies were entered into a password-protected laptop. Frequencies and percentages were used for categorical data analysis, while mean and standard deviation or median and interquartile ranges were used for continuous variables. Results: A total of 48 patients underwent UAE at the two facilities with a mean age of 43.3 (SD= 6.8) years. Half, 24 (50.0%), had anaemia. Only 5 (10.4%) had received prior treatment for the condition. On imaging, the mean number of fibroids was 5.4 (SD=2.8). The procedure was technically successful in all 48 (100%) patients. All the patients had pain and cramping with some degree of post embolization syndrome, consisting of the following symptoms (nausea, fever, headache, and malaise). From the trans-radial approach, access site complications included hematoma (3; 6.3%), pain (2;4.2%) and bleeding from the puncture site (1; 2.1%). After the procedure, all the patients were discharged after monitoring. Conclusion: Trans radial uterine artery embolization is a viable and successful treatment option for fibroids with few complications. TRA is a feasible, effective, and safe approach to UAE. Besides, it has the advantage of same-day discharge from the hospital. Randomised studies are needed to validate its effectiveness and clinical benefits compared to existing approaches such as TFA.