DOI: 10.1002/jcu.70444 ISSN: 0091-2751

Ipsilateral Versus Contralateral Femoral Access for Inferior Epigastric Artery Embolization: Impact of Patient Age on Procedural Efficiency

Claudio Carrubba, Ernesto Punzi, Felice D′Antuono, Francesco Giurazza, Fabio Corvino, Francesco Pane, Noemi Brignola, Giulio Lombardi, Raffaella Niola
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ABSTRACT

Purpose

Abdominal wall hematomas ( AWHs ) are relatively uncommon causes of acute abdominal pain but may represent potentially life‐threatening vascular emergencies, particularly in elderly patients receiving anticoagulant therapy or in the setting of significant hemorrhage. Transcatheter arterial embolization of the inferior epigastric artery is the recommended first‐line therapy. The contralateral femoral approach may be technically demanding in elderly patients with iliac tortuosity, calcifications, or diffuse atherosclerosis. This bicentric retrospective study compared ipsilateral versus contralateral femoral access for inferior epigastric artery embolization, evaluating procedural efficiency, radiation exposure, and clinical outcomes.

Material and Methods

A bicentric retrospective study included 48 patients treated in emergency settings for epigastric artery bleeding between June 2022 and June 2025. Patients were divided into ipsilateral ( n  = 23) or contralateral ( n  = 25) femoral access groups, with further stratification by age (< 60 vs. ≥ 60 years). Technical and clinical success, total angiographic procedure duration, fluoroscopic dose (Air Kerma, mGy ), access‐site complications, transfusion requirements, rebleeding, and 30‐day/3‐month survival were analyzed. A subgroup analysis in patients ≥ 60 years ( n  = 33) assessed the impact of vascular anatomy on procedural metrics.

Results

Technical success was 100% in both groups, whereas clinical success was comparable between the contralateral and ipsilateral groups (96.00% vs. 95.65%, respectively). In patients ≥ 60 years, ipsilateral access significantly reduced procedure time (27.90 ± 6.40 vs. 33.30 ± 8.30 min, p  = 0.046) and radiation dose (254.00 [ IQR 219.00–272.00] vs. 283.50 [ IQR 248.80–310.80] mGy , p  = 0.023). No major complications or significant between‐group differences in rebleeding or survival were observed. In exploratory multivariable analysis, ipsilateral access was associated with lower Air Kerma ( β  = −56.43 mGy ; 95% CI , −91.91 to −20.95; p  = 0.002), whereas the adjusted estimate for procedure duration was less precise and did not reach statistical significance.

Conclusions

Both femoral access routes are safe and effective. In patients aged ≥ 60 years, ipsilateral access was associated with shorter procedure duration and lower radiation exposure in unadjusted analyses. Exploratory adjusted analyses suggested an association between ipsilateral access and lower radiation exposure, whereas the adjusted association with procedure duration was not statistically significant. These findings require confirmation in larger prospective cohorts.

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