Prostatic artery embolization is taking the world by storm

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There is some real interest from interventional radiologists all over the world in learning about prostatic artery embolization. Right from using social media and messaging services to get a second opinion or a bit of advice, there are plans in the offing to launch an online chat helpline for those who need a tip or two. Hugo Rio Tinto from Lisbon, Portugal, has been busy flying all over Europe, but also further afield to Russia, China and India to help train those interested in the procedure. He writes an account for Interventional News

There is certainly a worldwide interest in prostatic artery embolization training. This is a new minimally invasive procedure that can be used to treat symptomatic benign prostatic hyperplasia (BPH). In the last few years, interest in this procedure has grown widely after pioneering groups such as ours in Lisbon, Portugal and in São Paulo, Brazil have presented results.

Despite the fact that we still have limited studies and results on this procedure, interest in it has spread across Europe, America, Asia and Australia.

In Europe, I have been mostly working on proctoring teams in many different countries on protocols and studies as it is critical to collect data from to compare results with the available literature. Besides the interest in Europe, I have been to Morocco and Algeria, where there is a keen interest in the procedure.

Since it is difficult to assist every team during their first procedures, in some cases I have been helping online. by using some applications or simply via “WhatsApp”. Interventionalists from various parts of the world send me images and questions that I can answer in real time. It is one of the easiest ways to help them. Despite the lack of punctuation, bad grammar and social media speak that is used, many colleagues have told me that this is very helpful!

I have also been proctoring different teams in this procedure in different places like India, China, USA and Russia. During the Interventional Radiology Society of Australasia meeting last year, I had the opportunity to present our work and vision for the procedure. Colleagues in Australia and New Zealand were not only interested in the procedure but some already had protocols to begin pilot studies.

Colleagues from India and Nepal have also shown their interest during the Asia-Pacific Vascular and Interventional Course, in Delhi. This was a very interesting experience because India has a different reality and availability of resources from Europe. A couple of months after the course, one of the groups in New Delhi have begun offering the procedure with success.

In Russia, there are teams now performing prostatic artery embolization and some have accumulated considerable data. The most common questions interventional radiologists have are related to recruitment and technical aspects concerning the procedure, particularly the anatomical aspects of the prostatic arteries and how to recognise variants. In fact, although this can be difficult during the first cases, it gets much easier with some tips.

Workshops are a very good opportunity to discuss the technique and to see procedures but they have a serious limitation: how can colleagues carry on from there to manage in their own departments? The reality is that the first cases can be challenging. Quite often, after a workshop, interventionists feel that they are not ready to start the procedure and need some assistance during the first cases.

 

Top tips:

  • Use a 4F or 5F catheter to assess the anterior division of the internal iliac arteries
  • Do not forget to choose the best oblique projection to identify the prostatic artery (30-40 degrees ipsilateral)
  • Try to identify the prostatic artery, usually the most tortuous artery and often parallel to the internal pudendal in that projection
  • Use a microcatheter, sized between 2-2.5F, to smoothly insert it into the prostatic artery
  • Use cone-beam CT to confirm the position of your microcatheter and embolize in a controlled fashion to avoid non-target embolization


Hugo Rio Tinto is with the Department of Interventional Radiology, Hospital São Luís, Lisbon, Portugal. He has reported no disclosures pertaining to the article

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