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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Uflacker A, Haskal ZJ, Bilhim T, Patrie J, Huber T, Pisco JM. Meta-analysis of prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol. 2016;27(11):1686–97.
Wang X-Y, Zong H-T, Zhang Y. Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis. Clin Interv Aging. 2016;11(11):1609–22.
Kuang M, Vu A, Athreya S. A meta-analysis of prostatic artery embolization in the treatment of symptomatic benign prostatic hyperplasia. J Vasc Interv Radiol. 2016;27(3):S53.
Pisco JM, Bilhim T, Pinheiro LC, Fernandes L, Pereira J, Costa NV, et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol. 2016;27(8):1115–22.
Bagla S, Smirniotopoulos JB, Orlando JC, van Breda A, Vadlamudi V. Comparative analysis of prostate volume as a predictor of outcome in prostate artery embolization. J Vasc Interv Radiol. 2015;26(12):1832–8.
Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M. Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective urodynamic-controlled analysis. Cardiovasc Intervent Radiol. 2016;39(1):44–52.
Wang M, Guo L, Duan F, Yuan K, Zhang G, Li K, et al. Prostatic arterial embolization for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia: a comparative study of medium- and large-volume prostates. BJU Int. 2016;117(1):155–64.
de Assis AM, Moreira AM, de Paula Rodrigues VC, Harward SH, Antunes AA, Srougi M, et al. Pelvic arterial anatomy relevant to prostatic artery embolisation and proposal for angiographic classification. Cardiovasc Intervent Radiol. 2015;38(4):855–61.
Bagla S, Sterling KM. Pitfalls of cone beam computed tomography in prostate artery embolization. Cardiovasc Intervent Radiol. 2014;37(6):1430–5.
Wang MQ, Duan F, Yuan K, Zhang GD, Yan J, Wang Y. Benign prostatic hyperplasia: cone-beam ct in conjunction with DSA for identifying prostatic arterial anatomy. Radiology. 2017;282(1):271–80.
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.
Ros PR. CT & MRI of the abdomen and pelvis: a teaching file. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 217.
Huda W, Ogden KM, Khorasani MR. Converting dose-length product to effective dose at CT. Radiology. 2008;248(3):995–1003.
Risk X-R. xray risk [Internet]. [cited 2017 Feb 9]. Available from: http://www.xrayrisk.com/calculator/calculator-normal-studies.php.
Chiaradia M, Radaelli A, Campeggi A, Bouanane M, De La Taille A, Kobeiter H. Automatic three-dimensional detection of prostatic arteries using cone-beam CT during prostatic arterial embolization. J Vasc Interv Radiol. 2015;26(3):413–7.
Jones P, Rai BP, Nair R, Somani BK. Current status of prostate artery embolization for lower urinary tract symptoms: review of world literature. Urology. 2015;86(4):676–81.
Little MW, Boardman P, Macdonald AC, Taylor N, Macpherson R, Crew J, Tapping CR. Adenomatous-dominant benign prostatic hyperplasia (AdBPH) as a predictor for clinical success following prostate artery embolization: an age-matched case-control study. Cardiovasc Intervent Radiol. 2017;40(5):682–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Maclean, D., Maher, B., Harris, M. et al. Planning Prostate Artery Embolisation: Is it Essential to Perform a Pre-procedural CTA?. Cardiovasc Intervent Radiol 41, 628–632 (2018). https://doi.org/10.1007/s00270-017-1842-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-017-1842-7