A sub-analysis of the prospective RAVI (Radial Access and Visceral Interventions) registry suggests that uterine fibroid embolization (UFE) performed via radial artery access is associated with high procedural success, low access-site complication rates, and sustained symptom improvement through 12 months of follow-up.
These results were reported by Jessica K Stewart (University of California, Los Angeles, Los Angeles, USA) at the Global Embolization Oncology Symposium Technologies (GEST) annual meeting (14–17 May, New York, USA).
Presenting the findings, Stewart shared outcomes from patients enrolled in the multicentre registry who underwent UFE using ultrasound-guided left radial artery access. The registry, sponsored by Terumo, prospectively enrolled patients across six academic centres in the USA between February 2020 and January 2022.
The overall RAVI registry included 99 patients undergoing embolization procedures for fibroids, prostate disease, liver tumours, and other hypervascular tumours. The current analysis focused specifically on the 70 women treated with UFE, who had a mean age of 44 years.
According to the presenter, all procedures were performed using ultrasound-guided left radial artery access and HydroPearl (Terumo) microspheres. The primary effectiveness endpoint was procedural success, defined as completion of the embolization procedure via radial access without conversion to femoral access.
Investigators reported a procedural success rate of 100%, with no patients requiring crossover to femoral access. Technical success, defined as successful bilateral embolization using the embolic particles, was achieved in 98.7% of cases, with one patient requiring a repeat embolization procedure.
The study population was predominantly African American (63%), which Stewart noted reflects the “disproportionate burden of fibroid disease within this patient population”. Mean procedure time was 88 minutes, with most patients discharged on the same day as treatment.
Safety outcomes were also favourable, Stewart told the GEST 2026 audience. The primary safety endpoint included death, myocardial infarction, stroke, or hand ischaemia related to radial access. No myocardial infarction, stroke, hand ischaemia or major access-site complications were reported.
Further, one patient died 34 days after the procedure due to multi-organ failure associated with pre-existing renal failure secondary to hydronephrosis caused by extensive fibroid disease. Stewart stated however that the death was not procedure related.
Secondary safety outcomes included access-related complications occurring within 30 days. Reported complications were minor and self-limited highlighted the speaker, including transient radial artery spasm in approximately 6% of patients, small haematomas in approximately 6% and mild wrist discomfort in 4%.
Long-term follow-up data were available for a subset of patients, which included twenty-six of the 70 women (37%) who completed 12-month follow-up surveys. Investigators acknowledged this as a limitation of the study, attributing the low follow-up rate in part to challenges associated with the COVID-19 pandemic.
Among patients who completed follow-up assessments, 56% reported complete resolution of bleeding symptoms and 41% reported complete resolution of bulk-related symptoms at 12 months. The investigators also observed statistically significant improvements in symptom severity scores at both six months and 12 months.
Quality-of-life measures, including sexual function, self-consciousness, and overall health-related quality of life, also improved significantly at 180 days and 365 days following treatment.
Magnetic resonance imaging (MRI) follow-up was performed at physician discretion and was therefore available only in a limited number of patients. However, imaging data demonstrated high rates of fibroid infarction, with Stewart reporting approximately 90–100% infarction at 12 months in assessed patients.
Summarising the findings, Stewart told GEST 2026 attendees that this multicentre prospective registry analysis adds to the existing evidence base, which has largely consisted of single-centre studies. She concluded that radial-access UFE demonstrated high procedural and technical success, no major access-site complications, and meaningful improvements in symptom burden and quality of life through one year of follow-up.
