Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 9/2016

01-09-2016 | Clinical Investigation

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

Authors: Gregory Amouyal, Pierre Chague, Olivier Pellerin, Helena Pereira, Costantino Del Giudice, Carole Dean, Nicolas Thiounn, Marc Sapoval

Published in: CardioVascular and Interventional Radiology | Issue 9/2016

Login to get access

Abstract

Introduction

During PAE, preembolization angiography of the prostatic artery can show large extra-prostatic shunts, at high risk, if embolized, of rectal or penile necrosis. We report our experience with 11 consecutive patients who underwent protective embolization of large extra-prostatic shunts before successful PAE.

Materials and Methods

We treated 11 consecutive male patients (mean age 67 years), part of a series of 55 consecutive male patients referred for PAE to treat LUTS due to BPH, between December 2013 and January 2015. The procedure involved the exclusion of an extra-prostatic shunt originating from the PA, prior to complete bilateral PAE. We compared the safety and efficacy of the 11 shunt exclusions followed by embolization of the PA to the other 44 basic PAE. Clinical success was defined as a decrease of 25 % or eight points of IPSS, QoL <3 or a one-point decrease, and a Qmax improvement of 25 % or 2.5 mL/s.

Results

We had a 100 % rate of occlusion of the anastomosis. Bilateral embolization of the PA was performed in all patients with no additional time of procedure (p = 0.18), but a significant increase of dose area product (p = 0.03). Distal (PErFecTED) embolization was possible in 64 %. There was no worsening of erectile dysfunction, no rectal or penile necrosis, no immediate or late other clinical complications. Clinical success was 91 % (mean follow-up: 3.5 months), compared to 78 % for the entire PAE group.

Conclusion

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.
Literature
1.
Carnevale FC, Antunes AA, da Motta Leal Filho JM, de Oliveira Cerri LM, Baroni RH, Marcelino AS, et al. Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol. 2010;33(2):355–61.CrossRefPubMed
2.
Pisco JM, Pinheiro LC, Bilhim T, Duarte M, Mendes JR, Oliveira AG. Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol. 2011;22(1):11–9 quiz 20.CrossRefPubMed
3.
Antunes AA, Carnevale FC, da Motta, Leal Filho JM, Yoshinaga EM, Cerri LM, Baroni RH, et al. Clinical, laboratorial, and urodynamic findings of prostatic artery embolization for the treatment of urinary retention related to benign prostatic hyperplasia. A prospective single-center pilot study. Cardiovasc Intervent Radiol. 2013;36(4):978–86.CrossRefPubMed
4.
Carnevale FC, da Motta-Leal-Filho JM, Antunes AA, Baroni RH, Marcelino AS, Cerri LM, et al. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol. 2013;24(4):535–42.CrossRefPubMed
5.
Kurbatov DG, Dubskii SA, sitkin, II, Lepetukhin AE. X-ray guided endovascular occlusion of prostate arteries—alternative innovative method of treatment for patients with large prostatic adenomas. Urologiia. 2013(2): 35–6, 8–40.
6.
Moreira AM, Marques CF, Antunes AA, Nahas CS, Nahas SC, de Gregorio Ariza MA, et al. Transient ischemic rectitis as a potential complication after prostatic artery embolization: case report and review of the literature. Cardiovasc Intervent Radiol. 2013;36(6):1690–4.CrossRefPubMed
7.
Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, et al. Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol. 2013;23(9):2561–72.CrossRefPubMed
8.
Bagla S, Martin CP, van Breda A, Sheridan MJ, Sterling KM, Papadouris D, et al. Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol. 2014;25(1):47–52.CrossRefPubMed
9.
Carnevale FC, Moreira AM, Antunes AA. The “PErFecTED Technique”: proximal embolization first, then embolize distal for benign prostatic hyperplasia. Cardiovasc Intervent Radiol. 2014;37(6):1602–5.CrossRefPubMed
10.
Gao YA, Huang Y, Zhang R, Yang YD, Zhang Q, Hou M, et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate—a prospective, randomized, and controlled clinical trial. Radiology. 2014;270(3):920–8.CrossRefPubMed
11.
Kurbatov D, Russo GI, Lepetukhin A, Dubsky S, Sitkin I, Morgia G, et al. Prostatic artery embolization for prostate volume greater than 80 cm3: results from a single-center prospective study. Urology. 2014;84(2):400–4.CrossRefPubMed
12.
Schreuder SM, Scholtens AE, Reekers JA, Bipat S. The role of prostatic arterial embolization in patients with benign prostatic hyperplasia: a systematic review. Cardiovasc Intervent Radiol. 2014;37(5):1198–219.CrossRefPubMed
13.
de Assis AM, Moreira AM, de Paula Rodrigues VC, Yoshinaga EM, Antunes AA, Harward SH, et al. Prostatic artery embolization for treatment of benign prostatic hyperplasia in patients with prostates > 90 g: a prospective single-center study. J Vasc Interv Radiol. 2015;26(1):87–93.CrossRefPubMed
14.
Grosso M, Balderi A, Arno M, Sortino D, Antonietti A, Pedrazzini F, et al. Prostatic artery embolization in benign prostatic hyperplasia: preliminary results in 13 patients. Radiol Med. 2015;120(4):361–8.CrossRefPubMed
15.
Lin YT, Amouyal G, Thiounn N, Pellerin O, Pereira H, Del Giudice C, et al. Intra-vesical prostatic protrusion (IPP) can be reduced by prostatic artery embolization. Cardiovasc Intervent Radiol. 2015;39(5):690–5.CrossRefPubMed
16.
Amouyal G, Thiounn N, Pellerin O, Yen-Ting L, Del Giudice C, Dean C, et al. Clinical results after prostatic artery embolization using the perfected technique: a single-center study. Cardiovasc Intervent Radiol. 2016;39(3):367–75.CrossRefPubMed
17.
Garcia-Monaco R, Garategui L, Kizilevsky N, Peralta O, Rodriguez P, Palacios-Jaraquemada J. Human cadaveric specimen study of the prostatic arterial anatomy: implications for arterial embolization. J Vasc Interv Radiol. 2014;25(2):315–22.CrossRefPubMed
18.
Bilhim T, Pisco JM, Rio Tinto H, Fernandes L, Pinheiro LC, Furtado A, et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol. 2012;23(11):1403–15.CrossRefPubMed
19.
Isaacson AJ, Bhalakia N, Burke CT. Coil embolization to redirect embolic flow during prostatic artery embolization. J Vasc Interv Radiol. 2015;26(5):768–70.CrossRefPubMed
20.
Laborda A, De Assis AM, Ioakeim I, Sanchez-Ballestin M, Carnevale FC, De Gregorio MA. Radiodermitis after prostatic artery embolization: case report and review of the literature. Cardiovasc Intervent Radiol. 2015;38(3):755–9.CrossRefPubMed
21.
Bagla S, Smirniotopolous JB, Vadlamudi V. Crossing a prostatic artery chronic total occlusion to perform prostatic arterial embolization. J Vasc Interv Radiol. 2016;27(2):295–7.CrossRefPubMed
22.
Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14(9 Pt 2):S199–202.CrossRefPubMed
23.
Bilhim T, Pisco J, Pereira JA, Costa NV, Fernandes L, Campos Pinheiro L, et al. Predictors of clinical outcome after prostate artery embolization with spherical and nonspherical polyvinyl alcohol particles in patients with benign prostatic hyperplasia. Radiology. 2016. doi:10.​1148/​radiol.​2016152292
24.
Zhang G, Wang M, Duan F, Yuan K, Li K, Yan J, et al. Radiological findings of prostatic arterial anatomy for prostatic arterial embolization: preliminary study in 55 chinese patients with benign prostatic hyperplasia. PLoS One. 2015;10(7):e0132678.CrossRefPubMedPubMedCentral
25.
Martins Pisco J, Pereira J, Rio Tinto H, Fernandes L, Bilhim T. How to perform prostatic arterial embolization. Tech Vasc Interv Radiol. 2012;15(4):286–9.CrossRefPubMed
26.
Carnevale FC, Antunes AA. Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia. How I do it. Cardiovasc Intervent Radiol. 2013;36(6):1452–63.CrossRefPubMed
27.
Bagla S, Rholl KS, Sterling KM, van Breda A, Papadouris D, Cooper JM. Utility of cone-beam CT imaging in prostatic artery embolization. J Vasc Interv Radiol. 2013;24(11):1603–7.CrossRefPubMed
28.
Bagla S, Sterling KM. Pitfalls of cone beam computed tomography in prostate artery embolization. Cardiovasc Intervent Radiol. 2014;37(6):1430–5.CrossRefPubMed
29.
Louail B, Sapoval M, Bonneau M, Wasseff M, Senechal Q, Gaux JC. A new porcine sponge material for temporary embolization: an experimental short-term pilot study in swine. Cardiovasc Intervent Radiol. 2006;29(5):826–31.CrossRefPubMed
30.
Vidal V, Sapoval M, Sielezneff Y, De Parades V, Tradi F, Louis G, et al. Emborrhoid: a new concept for the treatment of hemorrhoids with arterial embolization: the first 14 cases. Cardiovasc Intervent Radiol. 2015;38(1):72–8.CrossRefPubMed
Metadata
Title
Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH
Authors
Gregory Amouyal
Pierre Chague
Olivier Pellerin
Helena Pereira
Costantino Del Giudice
Carole Dean
Nicolas Thiounn
Marc Sapoval
Publication date
01-09-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 9/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1412-4

Other articles of this Issue 9/2016

CardioVascular and Interventional Radiology 9/2016 Go to the issue

Clinical Investigation

TACE Combined with Implantation of Irradiation Stent Versus TACE Combine with Bare Stent for HCC Complicated by IVCTT

Letter to the Editor

Endovascular Repair of a Type 1a Endoleak After Ch-EVAR with a b-EVAR

Case Report

Splenic Pregnancy: A New Minimally Invasive Approach to Treatment

Technical Note

Combined Endoscopic-Radiological Rendezvous for Distal Tail Postoperative Pancreatic Fistula (POPF)

Review

Image-Guided Spinal Ablation: A Review

Letter to the Editor

Traumatic Pseudoaneurysm of the Inferior Mesenteric Artery Branch: A Rare Cause of Lower GI Bleeding and Treatment with Selective Coil Embolization