Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH

Abstract

PAE using the protection technique in case of large extra-prostatic shunts is as safe and effective as basic procedures and does not induce any additional time of procedure.

Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment

“…In a study of 11 patients, Amouyal et al (60) found penile or rectal shunts in 10% of catheterized PAs. Coils were placed distal to prostate branches and close to the extraprostatic anastomosis.…”

Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Anatomical Aspects and Radiation Considerations from a Case Series of 210 Patients

“…Although coils are most commonly used, Gelfoam use has also been reported in the literature. 20 If anastomosis is inaccessible, it is recommended to use intraprostatic vasodilators combined with very slow injection of particles. 21 After such maneuvers, the anastomoses are usually no longer visualized; however, they become more evident when the peripheral resistance increases, after saturation of prostatic vascular bed by particles.…”

Prostate Artery Embolization

“…These may be seen in 10 to 20% of patients. 30,31 However, a distinction must be made between small and large extraprostatic shunts. The former is frequently not visible on DSA unless a high-powered injection is employed.…”

“…In the context of slow-flow embolization utilized in PAE, nontarget delivery of particles to these vessels is not encountered due to preferential flow to the prostate. 20,30 In the case of larger shunts that are visible on DSA or low-pressure injection, these may either be avoided through advancement of the microcatheter distal to their takeoff or with coil embolization. The vessels at risk of nontarget embolization have been described extensively elsewhere, 30 and include superior vesicle, rectal, and pudendal branches.…”

“…20,30 In the case of larger shunts that are visible on DSA or low-pressure injection, these may either be avoided through advancement of the microcatheter distal to their takeoff or with coil embolization. The vessels at risk of nontarget embolization have been described extensively elsewhere, 30 and include superior vesicle, rectal, and pudendal branches. These anastomoses can be safely coil embolized without compromising therapeutic efficacy or increasing adverse events.…”