Rare Prostatic Artery Origins and the Importance of Collateral Circulation in Prostate Artery Embolization: A Pictorial Essay

Bhatia, Shivank; Sinha, Varsha; Abdul-Rahim, Osama; Harward, Sardis; Narayanan, Govindarajan

doi:10.1016/j.carj.2017.11.003

Cited by 10 publications

(8 citation statements)

References 17 publications

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“…The median time to advance the microcatheter from the internal iliac artery to the prostatic artery was 10.5 s. This is notable as PAE is considered to be a challenging procedure as prostatic artery anatomy is often variable, tortuous, and angulated. Further, as intra-prostatic collaterals require coil embolization in up to 20% of PAE cases, the ability to select and embolize these collaterals to prevent non-target embolization is important (Bhatia et al 2018;Moreira 2017). The SM was able to be advanced into distal prostatic arterial vasculature bilaterally in each case, despite its 2.4F size.…”

Section: Discussionmentioning

confidence: 99%

Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency

et al. 2019

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Background/purpose: To study steerable microcatheter (SM) use in moderate and highly difficult vessel selection compared to conventional pre-shaped microcatheter (CM) use. Material and methods: An IRB approved, single institution analysis of 40 complex angiographic procedures with and without superselective microcatheter use during an eight-month period in 2017 was performed. Target vessels were deemed moderate or highly difficult to select based on vessel size, tortuosity, and/or angulation during nonselective initial angiography. Data collected included type of microcatheter used (SM or CM), number of microcatheters and microwires used, procedure time, radiation exposure index (dose area product/DAP), target vessel location, and time to target vessel selection (TTVS; time from device placement to vessel selection). Comparison between the SM and CM groups was performed using Wilcoxon test. Results: A SM (SwiftNinja, Merit Medical, South Jordan, UT, USA) was used to select 46 vessels in 20 patients. One or more CMs were used in 20 patients to select 34 vessels. Median TTVS, number of microwires used, total procedure time, and DAP (microGray. m 2) were 12 vs. 462.5 s (p < 0.0001), 0 vs. 2 (p < 0.001), and 26,948 vs. 30,904 (p = 0.15) in the SM vs. CM groups, respectively. When adjusted for body mass index (BMI) using a linear model for radiation exposure, patients in the SM group had lower radiation exposure than those in the CM group (p = 0.05). Conclusions: Utilization of a steerable microcatheter, without or with a guidewire, leads to easier and faster target vessel selection with shorter procedure times in complex vessel anatomy.

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Section: Discussionmentioning

confidence: 99%

Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency

et al. 2019

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“…The prostatic arteries typically arise from the anterior division of the internal iliac artery; however, the specific origin branch may vary, and may be asymmetric between sides of the gland. [12][13][14]18 This variability has led to various angiographic classifcations 13,14,19 based on the branching pattern. Thus, knowledge of the vascular anatomy is critical to technical success.…”

Section: Cone Beam Ctmentioning

confidence: 99%

“…If these vessels are not clearly identified, there is an increased risk of nontarget embolization, and subsequent adverse events. 13 Collateral extraprostatic supply is common and therefore should be interrogated prior to embolization of the PA. Several authors have demonstrated that coil embolization of these vessels is both safe and technically successful in preventing nontarget embolization. 20,21 To prevent nontarget embolization, meticulous technique is necessary.…”

Section: Cone Beam Ctmentioning

confidence: 99%

“…[5][6][7][8][9] These initial shortcomings were subsequently overcome by more standardization of techniques, 10,11 and better understanding of patient selection and arterial anatomy. 3,7,[12][13][14] Utilizing this refined anatomical and procedural expertise, the goal of this article is to provide a standardized approach to PAE to overcome technical challenges described in the literature.…”

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confidence: 99%

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Prostate Artery Embolization

Mouli

Hohlastos

Salem

2019

Semin intervent Radiol

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“…There have also been few reports of coil embolization during PAE. Two of those reports were single-center studies including a small number of patients( 13 , 14 ), and the rest were case reports( 15 , 16 , 17 , 18 , 19 ). The present study expands the literature by describing a single-center experience of the efficacy and safety of PE during PAE.…”

Section: Introductionmentioning

confidence: 99%

Protection of nontarget structures in prostatic artery embolization

et al. 2022

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Objective: To describe the efficacy and safety of protective embolization during prostatic artery embolization, as well as to discuss its clinical relevance. Materials and Methods: This was a retrospective, observational, single-center study including 39 patients who underwent prostatic artery embolization to treat lower urinary tract symptoms related to benign prostatic hyperplasia between June 2008 and March 2018. Follow-up evaluations, performed at 3 and 12 months after the procedure, included determination of the International Prostate Symptom Score, a quality of life score, and prostate-specific antigen levels, as well as ultrasound, magnetic resonance imaging, and uroflowmetry. Results: Protective embolization was performed in 45 arteries: in the middle rectal artery in 19 (42.2%); in the accessory internal pudendal artery in 11 (24.4%); in an internal pudendal artery anastomosis in 10 (22.2%); in the superior vesical artery in four (8.9%); and in the obturator artery in one (2.2%). There was one case of nontarget embolization leading to a penile ulcer, which was attributed to reflux of microspheres to an unprotected artery. There were no complications related to the protected branches. All of the patients showed significant improvement in all of the outcomes studied (p < 0.05), and none reported worsening of sexual function during follow-up. Conclusion: Protective embolization can reduce nontarget embolization during prostatic artery embolization without affecting the results of the procedure. In addition, no adverse events other than those expected or previously reported were observed. Therefore, protective embolization of pudendal region is safe.

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Rare Prostatic Artery Origins and the Importance of Collateral Circulation in Prostate Artery Embolization: A Pictorial Essay

Cited by 10 publications

References 17 publications

Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency

Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency

Prostate Artery Embolization

Protection of nontarget structures in prostatic artery embolization

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