Semin intervent Radiol 2022; 39(06): 555-561
DOI: 10.1055/s-0042-1759690
Review Article

Prostatic Artery Embolization: Technical Pearls

Ansh Bhatia
1   Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, India
,
Aneesha Maini
2   M2 at Georgetown University School of Medicine, Washington, District of Columbia
,
Shivank Bhatia
3   Department of Interventional Radiology, University of Miami, Miami, Florida
› Author Affiliations

Abstract

Benign prostatic hyperplasia (BPH) is a condition that primarily affects men between the fourth and seventh decades of life, occurring due to enlargement of the prostate which subsequently causes compression of the prostatic urethra causing chronic obstruction of the urinary outflow tract. BPH can cause significant quality-of-life issues such as urinary hesitancy, intermittency, decreased urinary stream, a sensation of incomplete emptying, dysuria, urinary retention, hematuria, and nocturia. Several medical and surgical treatment modalities are available for the treatment of lower urinary tract symptoms and other BPH-related sequela; however, increasingly prostate artery embolization is being utilized in this patient population. Technical demands for this procedure in this population can be significant. This article describes the optimal techniques, tricks, and advanced imaging techniques that can be used to achieve desired technical outcomes.



Publication History

Article published online:
20 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Lepor H. Pathophysiology of benign prostatic hyperplasia: insights from medical therapy for the disease. Rev Urol 2009; 11 (Suppl. 01) S9-S13
  • 2 Patel ND, Parsons JK. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol 2014; 30 (02) 170-176
  • 3 Huang SW, Tsai CY, Tseng CS. et al. Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis. BMJ 2019; 367: l5919
  • 4 McWilliams JP, Bilhim TA, Carnevale FC. et al. Society of Interventional Radiology Multisociety Consensus Position Statement on prostatic artery embolization for treatment of lower urinary tract symptoms attributed to benign prostatic hyperplasia: from the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology: endorsed by the Asia Pacific Society of Cardiovascular and Interventional Radiology, Canadian Association for Interventional Radiology, Chinese College of Interventionalists, Interventional Radiology Society of Australasia, Japanese Society of Interventional Radiology, and Korean Society of Interventional Radiology. J Vasc Interv Radiol 2019; 30 (05) 627-637.e1
  • 5 Gayed A, Yamada R, Bhatia S. et al. Society of Interventional Radiology Quality Improvement Standards on radial artery access. J Vasc Interv Radiol 2021; 32 (05) 761.e1-761.e21
  • 6 Dias Jr US, de Moura MRL, Viana PCC. et al. Prostatic artery embolization: indications, preparation, techniques, imaging evaluation, reporting, and complications. Radiographics 2021; 41 (05) 1509-1530
  • 7 Rampoldi A, Barbosa F, Secco S. et al. Prostatic artery embolization as an alternative to indwelling bladder catheterization to manage benign prostatic hyperplasia in poor surgical candidates. Cardiovasc Intervent Radiol 2017; 40 (04) 530-536
  • 8 de Assis AM, Moreira AM, de Paula Rodrigues VC. et al. Pelvic arterial anatomy relevant to prostatic artery embolisation and proposal for angiographic classification. Cardiovasc Intervent Radiol 2015; 38 (04) 855-861
  • 9 Bilhim T, Pisco JM, Rio Tinto H. et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol 2012; 23 (11) 1403-1415
  • 10 Carnevale FC, Moreira de Assis A, Moreira AM, Embolization PA. Equipment, procedure steps, and overcoming technical challenges. Techniques in vascular and interventional radiology. 2020; 23 (03) 100691
  • 11 Picel AC, Hsieh TC, Shapiro RM, Vezeridis AM, Isaacson AJ. Prostatic artery embolization for benign prostatic hyperplasia: patient evaluation, anatomy, and technique for successful treatment. Radiographics 2019; 39 (05) 1526-1548
  • 12 Maclean D, Maher B, Harris M. et al. Planning prostate artery embolisation: Is it essential to perform a pre-procedural CTA?. Cardiovasc Intervent Radiol 2018; 41 (04) 628-632
  • 13 Pilan BF, de Assis AM, Moreira AM, Rodrigues VCP, Carnevale FC. Protection of nontarget structures in prostatic artery embolization. Radiol Bras 2022; 55 (01) 6-12
  • 14 Hashem E, Elsobky S, Khalifa M. Prostate artery embolization for benign prostate hyperplasia review: patient selection, outcomes, and technique. Semin Ultrasound CT MR 2020; 41 (04) 357-365
  • 15 Hoffmann JC, Minkin J, Primiano N, Yun J, Eweka A. Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency. CVIR Endovasc 2019; 2 (01) 35
  • 16 Cornelis FH, Bilhim T, Hacking N, Sapoval M, Tapping CR, Carnevale FC. CIRSE standards of practice on prostatic artery embolisation. Cardiovasc Intervent Radiol 2020; 43 (02) 176-185
  • 17 Carnevale FC, Moreira AM, de Assis AM. et al. Prostatic artery embolization for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: 10 years' experience. Radiology 2020; 296 (02) 444-451
  • 18 Ayyagari R, Powell T, Staib L. et al. Prostatic artery embolization using 100-300-μm Trisacryl gelatin microspheres to treat lower urinary tract symptoms attributable to benign prostatic hyperplasia: a single-center outcomes analysis with medium-term follow-up. J Vasc Interv Radiol 2020; 31 (01) 99-107
  • 19 Insausti I, Galbete A, Lucas-Cava V. et al. Prostatic artery embolization (PAE) using polyethylene glycol microspheres: safety and efficacy in 81 patients. Cardiovasc Intervent Radiol 2022; 45 (09) 1339-1348
  • 20 Bilhim T, Pisco J, Pinheiro LC, Rio Tinto H, Fernandes L, Pereira JA. The role of accessory obturator arteries in prostatic arterial embolization. J Vasc Interv Radiol 2014; 25 (06) 875-879
  • 21 Little MW, Macdonald AC, Boardman P. et al. Effects of sublingual glyceryl trinitrate administration on the quality of preprocedure CT angiography performed to plan prostate artery embolization. J Vasc Interv Radiol 2018; 29 (02) 225-228
  • 22 Isaacson AJ, Burke LMB. Utility of pelvic computed tomography angiography prior to prostatic artery embolization. Semin Intervent Radiol 2016; 33 (03) 224-230
  • 23 Bilhim T, Tinto HR, Fernandes L, Martins Pisco J. Radiological anatomy of prostatic arteries. Tech Vasc Interv Radiol 2012; 15 (04) 276-285
  • 24 Gil R, Shim DJ, Kim D, Lee DH, Kim JJ, Lee JW. Prostatic artery embolization for lower urinary tract symptoms via transradial versus transfemoral artery access: single-center technical outcomes. Korean J Radiol 2022; 23 (05) 548-554
  • 25 Bhatia S, Harward SH, Sinha VK, Narayanan G. Prostate artery embolization via transradial or transulnar versus transfemoral arterial access: technical results. J Vasc Interv Radiol 2017; 28 (06) 898-905
  • 26 Powell T, Bhatia S, Ayyagari R. Current debates regarding optimal patient evaluation and procedural technique for prostatic artery embolization. Tech Vasc Interv Radiol 2020; 23 (03) 100696
  • 27 Mason PJ, Shah B, Tamis-Holland JE. et al; American Heart Association Interventional Cardiovascular Care Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Peripheral Vascular Disease; and Council on Genomic and Precision Medicine. An update on radial artery access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: a scientific statement from the American Heart Association. Circ Cardiovasc Interv 2018; 11 (09) e000035
  • 28 Acharya V, Jalaeian H, Tummala S, Shah K, Kumar J. , S Bhatia, et al. Cone beam CT with automatic vessel detection software versus conventional 2D fluoroscopy with overlay for prostate artery embolization: a comparison of prostatic artery catheterization time and radiation exposure. J Clin Interv Radiol ISVIR 2022; 06 (02) 090-97
  • 29 Carnevale FC, McClure T, Cadour F. et al. Advanced image guidance for prostatic artery embolization - a multicenter technical note. CVIR Endovasc 2021; 4 (01) 63
  • 30 Uflacker A, Haskal ZJ, Patrie J. et al. Improving cone-beam CT angiography for prostatic artery embolization: Is a low-dose protocol equivalent to the standard?. J Vasc Interv Radiol 2021; 32 (04) 562-568
  • 31 Torres D, Costa NV, Pisco J, Pinheiro LC, Oliveira AG, Bilhim T. Prostatic artery embolization for benign prostatic hyperplasia: prospective randomized trial of 100-300 μm versus 300-500 μm versus 100- to 300-μm + 300- to 500-μm embospheres. J Vasc Interv Radiol 2019; 30 (05) 638-644
  • 32 Hwang JH, Park SW, Chang IS. et al. Comparison of nonspherical polyvinyl alcohol particles and microspheres for prostatic arterial embolization in patients with benign prostatic hyperplasia. BioMed Res Int 2017; 2017: 8732351
  • 33 Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M. Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic-controlled analysis. Cardiovasc Intervent Radiol 2016; 39 (01) 44-52
  • 34 de Assis AM, Moreira AM, Carnevale FC. Angiographic findings during repeat prostatic artery embolization. J Vasc Interv Radiol 2019; 30 (05) 645-651
  • 35 Bhatia S, Sinha V, Bordegaray M, Kably I, Harward S, Narayanan G. Role of coil embolization during prostatic artery embolization: incidence, indications, and safety profile . J Vasc Interv Radiol 2017; 28 (05) 656-664.e3
  • 36 Bilhim T, Pisco J, Campos Pinheiro L. et al. Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study. J Vasc Interv Radiol 2013; 24 (11) 1595-602.e1
  • 37 Ayyagari R, Powell T, Staib L. et al. Case-control comparison of conventional end-hole versus balloon-occlusion microcatheter prostatic artery embolization for treatment of symptomatic benign prostatic hyperplasia. J Vasc Interv Radiol 2019; 30 (09) 1459-1470
  • 38 Bilhim T, Costa NV, Torres D, Pisco J, Carmo S, Oliveira AG. Randomized clinical trial of balloon occlusion versus conventional microcatheter prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol 2019; 30 (11) 1798-1806
  • 39 Bilhim T, Pisco J, Rio Tinto H. et al. Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Intervent Radiol 2013; 36 (02) 403-411
  • 40 Costa NV, Torres D, Pisco J. et al. Repeat prostatic artery embolization for patients with benign prostatic hyperplasia. J Vasc Interv Radiol 2020; 31 (08) 1272-1280