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Richardson AJ, Acharya V, Kably I, Bhatia S. Prostatic Artery Embolization: Variant Origins and Collaterals. Tech Vasc Interv Radiol 2020; 23:100690. [PMID: 33308535 DOI: 10.1016/j.tvir.2020.100690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prostate artery embolization (PAE) is a minimally invasive treatment for benign prostatic hyperplasia associated lower urinary tract symptoms. The prostatic arterial anatomy, origins and collaterals, are highly variable and can lead to technical pitfalls and suboptimal results during PAE. In this paper we aim to discuss the variant prostate artery origins and collateral circulation to provide a primer on relevant anatomy for interventional radiologists performing PAE.
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Affiliation(s)
- Andrew J Richardson
- Department of Interventional and Diagnostic Radiology, Jackson Memorial Hospital, Miami, FL.
| | - Vedant Acharya
- University of Miami Miller School of Medicine, Miami, FL
| | - Issam Kably
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL
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Hashem E, Elsobky S, Khalifa M. Prostate Artery Embolization for Benign Prostate Hyperplasia Review: Patient Selection, Outcomes, and Technique. Semin Ultrasound CT MR 2020; 41:357-365. [DOI: 10.1053/j.sult.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Picel AC, Hsieh TC, Shapiro RM, Vezeridis AM, Isaacson AJ. Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment. Radiographics 2019; 39:1526-1548. [PMID: 31348735 DOI: 10.1148/rg.2019180195] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Symptomatic benign prostatic hyperplasia is a common condition in the aging population that results in bothersome lower urinary tract symptoms and decreased quality of life. Patients often are treated with medication and offered surgery for persistent symptoms. Transurethral resection of the prostate is considered the traditional standard of care, but several minimally invasive surgical treatments also are offered. Prostatic artery embolization (PAE) is emerging as an effective treatment option with few reported adverse effects, minimal blood loss, and infrequent overnight hospitalization. The procedure is offered to patients with moderate to severe lower urinary tract symptoms and depressed urinary flow due to bladder outlet obstruction. Proper patient selection and meticulous embolization are critical to optimize results. To perform PAE safely and avoid nontarget embolization, interventional radiologists must have a detailed understanding of the pelvic arterial anatomy. Although the prostatic arteries often arise from the internal pudendal arteries, several anatomic variants and pelvic anastomoses are encountered. Prospective cohort studies, small randomized controlled trials, and meta-analyses have shown improved symptoms after treatment, with serious adverse effects occurring rarely. This article reviews the basic principles of PAE that must be understood to develop a thriving PAE practice. These principles include patient evaluation, review of surgical therapies, details of pelvic arterial anatomy, basic principles of embolization, and an overview of published results. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Andrew C Picel
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
| | - Tung-Chin Hsieh
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
| | - Rachel M Shapiro
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
| | - Alex M Vezeridis
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
| | - Ari J Isaacson
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
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Duplicated Prostate Artery Central Gland Blood Supply: A Retrospective Analysis and Classification System. J Vasc Interv Radiol 2018; 29:1595-1600.e9. [DOI: 10.1016/j.jvir.2018.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/14/2018] [Accepted: 07/15/2018] [Indexed: 11/20/2022] Open
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Brown N, Walker D, McBean R, Pokorny M, Kua B, Gianduzzo T, Dunglison N, Esler R, Yaxley J. Prostate artery Embolisation Assessment of Safety and feasibilitY (P-EASY): a potential alternative to long-term medical therapy for benign prostate hyperplasia. BJU Int 2018; 122 Suppl 5:27-34. [DOI: 10.1111/bju.14504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Nicholas Brown
- Wesley Medical Imaging; The Wesley Hospital; Auchenflower Queensland Australia
| | - Duncan Walker
- Wesley Medical Imaging; The Wesley Hospital; Auchenflower Queensland Australia
| | - Rhiannon McBean
- Wesley Medical Imaging; The Wesley Hospital; Auchenflower Queensland Australia
| | - Morgan Pokorny
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Boon Kua
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Troy Gianduzzo
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Nigel Dunglison
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Rachel Esler
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - John Yaxley
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
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Bhatia S, Sinha VK, Abdul-Rahim O, Harward S, Narayanan G. Rare Prostatic Artery Origins and the Importance of Collateral Circulation in Prostate Artery Embolization: A Pictorial Essay. Can Assoc Radiol J 2018; 69:220-229. [DOI: 10.1016/j.carj.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/16/2017] [Accepted: 11/07/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shivank Bhatia
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Vishal K. Sinha
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Osama Abdul-Rahim
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Sardis Harward
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Govindarajan Narayanan
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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