Anatomical factors affecting prostatic artery embolization

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Alessandro Cannavale

A study presented at the European Congress of Radiology (2–6 March, Vienna, Austria) set out to investigate any procedural or anatomical factors that might affect the technical outcome of prostatic artery embolization.

 

Alessandro Cannavale, Canterbury, UK, presented data from a study conducted with the team from Southampton, UK. The investigators established that the anatomical factors that can affect the perfomance of the procedure include: severe aorto-atherosclerotic disease, tortuous prostatic arteries and the presence of anastomotic vessels.

The researchers performed a retrospective review of 55 patients (110 pelvic sides) who underwent prostatic artery embolization from June 2012 to December 2014. All selected patients underwent complete urological assessment. They recorded the following characteristics, detected on CTA, on a diagrammatic template: prostate volume, grade of vascular ectasia, degree of calcification (mild, moderate, severe), presence of common gluteal trunk, gluteal-pudendal trunk, replaced obturator artery, number of prostatic arteries including origin, prostatic arteries tortuosity, presence of connections with nearby visceral arteries. Cannavale and colleagues then used uni and multivariate analysis to relate the anatomical factors to the technical success, procedure time, fluoroscopy time and radiation dose.

Cannavale said: “According to the univariate/multivariate analysis severe arterial ectasia and calcified atheroma did not affect technical success. Calcified atheroma hindered the cannulation of the prostatic artery in 12.5% of cases. The presence of common gluteal trunk, gluteal-pudendal trunk or replaced obturator artery did not prove to be a significant adverse anatomical factor. However, the presence of the tortuous pattern of prostatic arteries demonstrated reduced technical success of 84.7% (7/46 sides failed). When compared with the technical success associated with the straight pattern, which was 95.3% (3/64 failed), there was a significant difference (p=0.05). The procedure and fluoroscopy times were significantly higher in tortuous prostatic arteries. Further, anastomotic vessels did not affect the technical success, but increased the use of Dyna-CT.”

UK-ROPE

In November 2015, Nigel Hacking, chairman and clinical lead for the UK-ROPE (Registry of Prostate Embolisation) standing committee, Southampton, UK, reported on the progress of the registry on the British Society of Interventional Radiology (BSIR) website. “UK-ROPE started recruiting patients in July 2014 and is well on its way to recruit the target of 150 prostate artery embolization patients by the end of 2015. Surgical patient recruitment for transurethral resection of the prostate (TURP) and Holmium Laser Enucleation of the prostate (HoLEP) has been slower. In November, just over 50 patients have been recruited for the surgical cohort and the Steering Committee is considering whether an extension into 2016 will be necessary,” he noted. The final report is expected to be published in 2017.