Prostatic Artery Embolization: Equipment, Procedure Steps, and Overcoming Technical Challenges

• Published in: Techniques in vascular and interventional radiology 2020-09, Vol.23 (3), p.100691-100691, Article 100691
• Main Authors: Carnevale, Francisco Cesar, de Assis, André Moreira, Moreira, Airton Mota
• Format: Article
• Language: English
• Subjects: Benign prostatic hyperplasia; Catheters; Cone-beam computed tomography; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - instrumentation; Equipment Design; Humans; Lower urinary tract symptoms; Lower Urinary Tract Symptoms - diagnostic imaging; Lower Urinary Tract Symptoms - physiopathology; Lower Urinary Tract Symptoms - therapy; Male; Prostate - blood supply; Prostatic artery embolization; Prostatic Hyperplasia - diagnostic imaging; Prostatic Hyperplasia - physiopathology; Prostatic Hyperplasia - therapy; Proximal Embolization First; Radiography, Interventional - adverse effects; Radiography, Interventional - instrumentation; Risk Factors; Then Embolize Distal (PErFecTED) technique; Treatment Outcome
• ISSN: 1089-2516; 1557-9808
• DOI: 10.1016/j.tvir.2020.100691

In the last decade, prostatic artery embolization (PAE) established itself as a safe and effective treatment option for lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH), with reproducible results across multiple centers and endorsement by important international societies. However, PAE is also known to be a technically demanding procedure. Accompanying the prevalence of benign prostate hyperplasia, the procedure is usually performed in older patients, in whom atherosclerosis and comorbidities are common features. Also, prostatic vascular anatomy is described to be complex and variable, and pelvic structures are deeply interconnected by anastomosis. Thus, PAE demands a deep familiarization with materials and devices, intraprocedure imaging techniques, microcatetherization skills and with the pelvic vascular anatomy. Especially in the beginning of the learning curve, the procedure can be time-consuming and related to high radiation exposure for both medical team and the patient. In this article, the main points of technical concern during PAE are described and discussed, such as the equipment needed, the effect of different embolic materials, patient's preparation for the procedure, arterial access sites, identifying and catheterizing the prostatic arteries, the embolization techniques, among others. Finally, the most frequent technical challenges are presented, and the possible strategies to overcome them are exemplified and discussed.