Intentionally unilateral prostatic artery embolization: Patient selection, technique and potential benefits.

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING World journal of radiology Pub Date : 2024-09-28 DOI:10.4329/wjr.v16.i9.380
Hippocrates Moschouris, Konstantinos Stamatiou
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引用次数: 0

Abstract

Background: Prostatic artery embolization (PAE) is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia. Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries (PAs) and with the systematic attempts to catheterize the PAs of both pelvic sides. Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE. The authors hypothesized that, in selected patients, these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.

Aim: To describe the authors' approach for intentionally unilateral PAE (IU-PAE) and its potential benefits.

Methods: This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years. IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA (subgroup A), or with markedly asymmetric prostatic enlargement, with the dominant prostatic lobe occupying at least two thirds of the entire gland (subgroup B). All patients treated with IU-PAE also fulfilled at least one of the following criteria: Severe tortuosity or severe atheromatosis of the pelvic arteries, non-visualization, or visualization of a tiny (< 1 mm) contralateral PA on preprocedural computed tomographic angiography. Intraprocedural contrast-enhanced ultrasonography (iCEUS) was applied to monitor prostatic infarction. IU-PAE patients were compared to a control group treated with bilateral PAE.

Results: IU-PAE was performed in a total 13 patients (subgroup A, n = 7; subgroup B, n = 6). Dose-area product, fluoroscopy time and operation time in the IU-PAE group (9767.8 μGy∙m2, 30.3 minutes, 64.0 minutes, respectively) were significantly shorter (45.4%, 35.9%, 45.8% respectively, P < 0.01) compared to the control group. Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group. In the 2 clinical failures of IU-PAE (both in subgroup A), the extent of prostatic infarction (demonstrated by iCEUS) was significantly smaller compared to the rest of the IU-PAE group.

Conclusion: In selected patients, IU-PAE is associated with comparable outcomes, but with lower radiation exposure and a shorter procedure compared to bilateral PAE. iCEUS could facilitate patient selection for IU-PAE.

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有意单侧前列腺动脉栓塞术:患者选择、技术和潜在益处。
背景:前列腺动脉栓塞术(PAE)是治疗无症状良性前列腺增生的一种前景广阔但技术要求较高的介入放射疗法。前列腺动脉栓塞术的许多技术难题与前列腺动脉(PA)的复杂解剖结构以及对骨盆两侧前列腺动脉进行导管插入的系统性尝试有关。这些尝试往往导致手术时间长和辐射剂量大,被认为是 PAE 的重大缺点。作者假设,在选定的患者中,通过有意栓塞仅一侧骨盆的 PA,可以减轻这些缺点。目的:描述作者有意单侧 PAE(IU-PAE)的方法及其潜在优势:这是一项单中心回顾性研究,研究对象是两年内接受过 IU-PAE 治疗的患者。IU-PAE适用于同侧PA血管造影后对侧前列腺叶一半以上不透明的患者(A亚组),或前列腺明显不对称增大,优势前列腺叶至少占整个腺体三分之二的患者(B亚组)。所有接受 IU-PAE 治疗的患者还至少符合以下一项标准:盆腔动脉严重迂曲或严重粥样化,术前计算机断层扫描血管造影未显示或显示对侧微小(< 1 毫米)PA。术中造影剂增强超声检查(iCEUS)用于监测前列腺梗塞。将IU-PAE患者与接受双侧PAE治疗的对照组进行比较:共有 13 名患者接受了 IU-PAE 治疗(A 子组,n = 7;B 子组,n = 6)。与对照组相比,IU-PAE组的剂量-面积乘积、透视时间和手术时间(分别为9767.8 μGy∙m2、30.3分钟、64.0分钟)显著缩短(分别为45.4%、35.9%、45.8%,P < 0.01)。IU-PAE 组与对照组的临床和影像学结果无明显差异。在2例临床失败的IU-PAE患者(均为A亚组)中,前列腺梗死的范围(iCEUS显示)明显小于其他IU-PAE组患者:结论:在经过选择的患者中,IU-PAE 与双侧 PAE 相比,结果相当,但辐射量更低,手术时间更短。
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来源期刊
World journal of radiology
World journal of radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
自引率
8.00%
发文量
35
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