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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 4/2018

01-04-2018 | Clinical Investigation

Planning Prostate Artery Embolisation: Is it Essential to Perform a Pre-procedural CTA?

Authors: Drew Maclean, Ben Maher, Mark Harris, Jonathan Dyer, Sachin Modi, Nigel Hacking, Timothy Bryant

Published in: CardioVascular and Interventional Radiology | Issue 4/2018

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Abstract

Purpose

A highly variable prostatic artery origin coupled with frequent anastomoses to adjacent organs makes prostate artery embolisation a challenging procedure. Despite CT angiography facilitating procedural planning, it is not performed in all centres. Therefore, we explored the utility of prostatic CT angiography by assessing its capacity to identify the prostatic arteries and highlight troublesome anastomoses.

Materials and Methods

A retrospective review of patients undergoing prostate artery embolisation for symptoms of benign prostatic obstruction between June 2012 and October 2016 was conducted, with analysis of the pre-procedural CT angiography. CT findings were compared with subsequent intraprocedural angiography to assess the accuracy with which CT angiography predicts the origin of prostatic arteries and identifies anastomoses.

Results

In total, 110 patients underwent prostate artery embolisation, with pre-procedural CT angiography acquired in all patients, enabling assessment of 220 pelvic sides of hemiprostatic arterial supply. Mean dose length product was 808.4 mGycm. CT angiography successfully identified prostatic arterial supply in 214/220 pelvic sides, an accuracy of 97.3%. Anastomoses of prostatic vessels were suggested by CT angiography in 52 pelvic sides. These were confirmed by angiogram in 49/52 sides (94.2%). CT angiography demonstrated a sensitivity of 59.0% and specificity of 94.2% for anastomoses detection.

Conclusion

CT angiography prior to embolisation reliably predicts the arterial anatomy and facilitates procedural planning. Therefore, it should be a considered as a pre-procedural investigation for patients undergoing prostate artery embolisation. Sensitivity is low for predicting anastomoses, so careful periprocedural evaluation of the target vessels is still required.
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Metadata
Title
Planning Prostate Artery Embolisation: Is it Essential to Perform a Pre-procedural CTA?
Authors
Drew Maclean
Ben Maher
Mark Harris
Jonathan Dyer
Sachin Modi
Nigel Hacking
Timothy Bryant
Publication date
01-04-2018
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 4/2018
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-017-1842-7

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