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Alarayedh A, Abdulwahab S, Mubarak M. Super-Selective Trans-Catheter Arterial Embolization (TAE) of the Vesical Arteries in the Management of Intractable Hematuria Secondary to Advanced Bladder and Prostate Cancers. Cureus 2024; 16:e58016. [PMID: 38738021 PMCID: PMC11087881 DOI: 10.7759/cureus.58016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/14/2024] Open
Abstract
This article was previously presented as an abstract at the 18th UAA Congress, Seoul, October 15-17, 2020, and the abstract was published in The International Journal of Urology. It was also presented as an e-poster at the 2021 BAUS Annual Meeting on June 22, 2021. Introduction In frail patients intractable hematuria secondary to advanced pelvic malignancies is a clinical challenge. Super-selective TAE of the vesical arteries is a suitable minimally invasive option. We present our experience in this patient cohort. Patients and methods All patients who underwent TAE from January 2014 to December 2019 were included. Super-selective TAE of the superior and inferior vesical arteries was done using 300-500µ polyvinyl alcohol (PVA) particles. Demographic data, cancer stage, associated urinary system obstruction, pre-embolization palliative treatment, chemotherapy, and radiotherapy were recorded. Technical and clinical success, time to cessation of hematuria, recurrence of hematuria, and complications were recorded. Data are presented as mean ± standard deviation, and statistical significance is set at p<0.05. Results From 2014 to 2019, seven patients underwent eight procedures. The average patient's age was 60.6±10.3 years. All presented with gross hematuria, six due to locally advanced and/or metastatic bladder cancer, and one due to prostate cancer. The average time of hematuria clearance was 60 hours. The average hemoglobin levels at the time of the procedure, one month, and six months post-embolization were 9.6±1.7 g/dL, 10.6±1.5 g/dL (p<0.05), and 9.6±0.9 g/dL, respectively (p>0.05). Packed red blood cell (PRBC) requirements decreased from 7±2 units to 5±3 units after the procedure (p >0.05). The patients were followed up for an average of 13.6 months and four had a recurrence at an average of four months post-embolization. Conclusion Super-selective TAE is an effective palliative method in controlling intractable hematuria. The risks of major surgery and anesthesia are omitted, and the procedure can be repeated as needed. Furthermore, post-embolization complications, using this technique, are minor and manageable.
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Migliorini F, Cocconi F, Schipper I, Ten Duis K, Marzi I, Komadina R, Hildebrand F, Wendt K. Arterial angioembolisation versus pre-peritoneal pelvic packing in haemodynamically unstable patients with complex pelvic fractures: a meta-analysis. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02389-4. [PMID: 37962595 DOI: 10.1007/s00068-023-02389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Angioembolisation (AE) and/or pre-peritoneal pelvic packing (PPP) may be necessary for patients with complex pelvic fractures who are haemodynamically unstable. However, it remains unclear whether AE or PPP should be performed as an initial intervention and ongoing debates exist. This meta-analysis aimed to compare AE versus PPP in haemodynamically unstable patients with acute pelvic fractures. The primary outcomes of interest were to compare in-hospital mortality rate and number of blood units transfused. Secondary outcomes included evaluating differences in the time from diagnosis to treatment, as well as the length of stay in the intensive care unit (ICU) and hospital. METHODS All clinically relevant studies comparing AE versus PPP in patients with complex pelvic fractures and haemodynamic instability were accessed. The 2020 PRISMA guidelines were followed. In September 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase, without constraint. RESULTS Data from 320 patients were collected (AE: 174; PPP: 146). The mean age on admission was 47.4 ± 7.2 years. The mean Injury Severity Score (ISS) on admission was 43.5 + 5.4 points. Baseline comparability was observed in ISS (P = 0.5, Table 3) and mean age (P = 0.7, Table 3). No difference was reported in mortality rate (P = 0.2) or rate of blood units transfused (P = 0.3). AE had a longer mean time to the procedure of 44.6 min compared to PPP (P = 0.04). The mean length of ICU and hospital stay were similar in both groups. CONCLUSION Despite the longer mean time from admission to the procedure, no significant differences were found between AE and PPP in terms of in-hospital mortality, blood units transfused, or length of ICU, and hospital stay. These findings should be interpreted considering the limitations of the present study. High-quality comparative research is strongly warranted. LEVEL OF EVIDENCE Level IV, meta-analysis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Federico Cocconi
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy
| | - Inger Schipper
- Department of Orthopaedic and Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Kaj Ten Duis
- Department of Orthopaedic and Trauma Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Ingo Marzi
- Department of Orthopaedic and Trauma Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Radko Komadina
- Department of Orthopaedic and Trauma Surgery, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Klaus Wendt
- Department of Orthopaedic and Trauma Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Curtin P, Chang C, Uflacker A. Prostatic Arterial Embolization for Treatment of Lower Urinary Tract Symptoms Associated with Benign Prostatic Enlargement. Curr Urol Rep 2023; 24:427-441. [PMID: 37314610 DOI: 10.1007/s11934-023-01170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW Prostatic artery embolization (PAE) is an emerging minimally invasive technique for lower urinary tract symptom reduction from benign prostatic hypertrophy (BPH). While the technique is becoming increasingly popular with patients and interventional radiologists, most urologists remain skeptical of the PAE's long-term efficacy and comparative success to the gold standard transurethral resection of the prostate. RECENT FINDINGS PAE has been found in multiple meta-analyses to perform similarly to the gold standard transurethral resection of the prostate (TURP) with regard to patient-driven measures like IPSS and IPSS-QoL, while also performing favorably in objective measurements including Qmax and PVR out to at least 12 months post intervention. Furthermore, PAE has a demonstrated shorter hospital length of stay and fewer adverse events when compared to TURP. PAE provides patients with an alternative to transurethral options for the management of LUTS in the setting of bladder outlet obstruction. While long-term evidence demonstrating the durability of PAE is still forthcoming, the procedure has been demonstrated to be safe according to multiple meta-analyses. Patients deserve to be counseled on PAE as an alternative to surgery and made aware that while the overall treatment effect may not be as robust or durable, the procedure carries a favorable adverse event profile that is attractive to patients wishing to avoid a trans-urethral approach.
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Affiliation(s)
- Patrick Curtin
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA.
| | | | - Andre Uflacker
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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4
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Yamamoto K, Yamamoto K, Nakai G, Fujitani T, Omura S, Azuma H, Osuga K. Detection of the Vesical Arteries Using Three-dimensional Digital Subtraction Angiography Relevant to Intra-arterial Infusion Chemotherapy for Bladder Cancer Using Double-balloon Catheters. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:64-69. [PMID: 37485483 PMCID: PMC10359176 DOI: 10.22575/interventionalradiology.2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 07/25/2023]
Abstract
Purpose This study aims to assess and measure the origin of the superior vesical artery and its distance from the anterior trunk of the internal iliac artery, to which the anticancer drug is infused via double-balloon-occluded arterial infusion bladder-preserving therapy for locally invasive bladder cancer. Material and Methods The 160 pelvic sides of 80 patients were analyzed. Double-balloon catheters were bilaterally introduced into the contralateral superior gluteal artery via the internal iliac arteries using a bilateral transfemoral approach. The proximal balloon is placed at the internal iliac artery, proximally from superior gluteal artery bifurcation, whereas the distal balloon at the origin of the superior gluteal artery to isolate the anterior trunk of the internal iliac artery discharging to the targeted vesical arteries between the balloons. The side hole between the distal and proximal balloons was adjusted at the origin of the anterior trunk of the internal iliac artery to allow clear visualization of the angiographic flow into the bladder. After the distal and proximal balloons were inflated, three-dimensional rotational digital subtraction angiography was performed by simultaneous contrast injection from one extension tube connected to bilateral catheters. The distance (X) between the origins of anterior trunk of the internal iliac artery and superior vesical artery was measured on three-dimensional digital subtraction angiography images, and the origin of the inferior vesical artery was investigated. Results All superior vesical artery originated from anterior trunk of the internal iliac artery. The mean x was 7.2 mm (range 1.0-22.0 mm). All inferior vesical arterys branched from anterior trunk of the internal iliac artery or its branches. Conclusions Superior vesical artery commonly originates from the proximal portion of anterior trunk of the internal iliac artery close to superior gluteal artery bifurcation.
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Affiliation(s)
- Kiyohito Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhiro Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Go Nakai
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Tomohiro Fujitani
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Shoko Omura
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical and Pharmaceutical University, Japan
| | - Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
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5
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Sume BW, Mulu A. Anatomical variations of obturator artery and its clinical significances: A systematic review and meta-analysis. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
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6
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Bilhim T. Prostatic Artery Embolization: An Update. Korean J Radiol 2023; 24:313-323. [PMID: 36788767 PMCID: PMC10067687 DOI: 10.3348/kjr.2022.0814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Tiago Bilhim
- Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal.,Department of Interventional Radiology, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
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Bilhim T, Costa NV, Torres D. Prostatic Artery Embolization for Benign Prostatic Hyperplasia—A Primer for Interventional Radiologists. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0041-1739302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractMale patients over 50 years with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are potential candidates for prostatic artery embolization (PAE). PAE is not a perfect fit for all BPH patients. Careful pre- and postpostprocedural evaluation/consultation with correct selection of patients should be tailored on an individual basis. Evaluated parameters include the following: LUTS severity quantification with validated questionnaires as the international prostate symptom score (IPSS) and quality of life (QoL), erectile and ejaculatory evaluation with validated questionnaires, blood tests including full blood count, coagulation profile, renal function and total/free prostate-specific antigen (PSA), prostate volume measured by multiparametric magnetic resonance (mpMR) of the prostate and/or transrectal ultrasound, uroflowmetry measuring the peak urinary flowrate (Qmax), and postvoid residual urine (PVR). Correct arterial anatomy identification with either computed tomography (CT) angiography, MR angiography, or intraprocedural cone-beam CT (CBCT) are suggested for a confident procedure and avoiding potential complications. The minimally invasive nature of PAE with a faster recovery, preserving the sexual function, and comparable results to standard prostatic surgery make the procedure an attractive choice for many male patients suffering with this condition. Patients should be informed about the potential for higher retreatment rates and shorter duration of treatment effect when compared with standard prostatic surgery. In this comprehensive review, we provide an updated toolbox for all interventional radiologists interested in the PAE practice for patients with BPH. We explain how to evaluate patients during consultation before and after PAE, describe the preprocedural imaging required, explain the technique, and narrate how to optimize outcomes. Finally, we review the level of evidence of PAE for BPH.
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Affiliation(s)
- Tiago Bilhim
- Angiography Unit, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Saint Louis Hospital, Portugal and Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - Nuno V. Costa
- Angiography Unit, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Saint Louis Hospital, Portugal and Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - Daniel Torres
- Angiography Unit, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Saint Louis Hospital, Portugal and Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
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8
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Sharbidre KG, Aziz MU, Mohd Z. Review of Abdominal Vascular Variations: Imaging and Clinical Implications. Radiographics 2022; 42:E27-E28. [PMID: 34990313 DOI: 10.1148/rg.210093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kedar G Sharbidre
- From the Section of Abdominal Imaging, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N357, Birmingham, AL 35249
| | - Muhammad U Aziz
- From the Section of Abdominal Imaging, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N357, Birmingham, AL 35249
| | - Zahid Mohd
- From the Section of Abdominal Imaging, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N357, Birmingham, AL 35249
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9
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Khan R, Naidoo N, Lazarus L. Unique vascular patterns of the internal iliac artery and its clinical import in pelvic surgery. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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10
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Wadhwa V, McClure TD. Role of Imaging in Prostate Artery Embolization. Semin Roentgenol 2021; 56:410-415. [PMID: 34688344 DOI: 10.1053/j.ro.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Vibhor Wadhwa
- Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
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11
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Weir A, Kennedy P, Joyce S, Ryan D, Spence L, McEntee M, Maher M, O'Connor O. Endovascular management of pelvic trauma. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1196. [PMID: 34430637 PMCID: PMC8350659 DOI: 10.21037/atm-20-4591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/18/2020] [Indexed: 11/06/2022]
Abstract
Traumatic pelvic injuries are an important group of acquired pathologies given their frequent association with significant vascular compromise. Potentially fatal as a consequence of rapid hemorrhage, achievement of early hemostasis is a priority; endovascular management of traumatic pelvic arterial injuries is an important potential option for treatment. Precipitated by any number of mechanisms of trauma, pelvic vascular injury necessitates timely patient assessment. Variable patterns of arterial injury may result from blunt, penetrating or iatrogenic trauma. Selection of the most appropriate imaging modality is a priority, ensuring streamlined access to treatment. In the case of CT, this is complemented by acquisition of the most appropriate phase of imaging; review of both arterial and delayed phase imaging improves the accuracy of detection of low-flow hemorrhage. In cases where surgical intervention is not deemed appropriate, endovascular treatment provides an alternative means for cessation of hemorrhage associated with pelvic injuries. This may be achieved in a selective or nonselective manner depending on the patient's clinical status and time constraints. Consequently, a detailed understanding of vascular anatomy is essential, including an appreciation of the normal variant anatomy between males and females. Additional consideration must be given to variant anatomy which may co-exist in both sexes. This review article aims to provide a synopsis of endovascular management of pelvic vascular injury. Through case examples, available treatment options will be discussed, including thrombin injection and transcatheter arterial embolization. Furthermore, potential adverse complications of pelvic arterial embolization will be highlighted. Finally, in view of the potential severity of these injuries, a brief overview of initial management of the hemodynamically unstable patient is provided.
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Affiliation(s)
- Arlene Weir
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Padraic Kennedy
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Stella Joyce
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - David Ryan
- School of Medicine, University College Cork, Cork, Ireland
| | - Liam Spence
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Mark McEntee
- School of Medicine, University College Cork, Cork, Ireland
| | - Michael Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - Owen O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
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12
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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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13
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Tummala S, Everstine A, Acharya V, Bhatia S. Prostate Arterial Anatomy: A Primer for Interventional Radiologists. Tech Vasc Interv Radiol 2020; 23:100689. [PMID: 33308529 DOI: 10.1016/j.tvir.2020.100689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Identification of the prostatic arteries (PAs) is one of the most challenging aspects of prostate artery embolization for treatment of benign prostatic hyperplasia-associated lower urinary tract symptoms. Operators require a detailed understanding of the prostate arterial anatomy to ensure technical and clinical success with minimal complications. Due to substantial variability in internal iliac artery branch patterns and specifically the origin of the PA, we focus on 3 clinically relevant classification systems used to categorize the pelvic vasculature. These include classification systems to understand the internal iliac artery branching pattern, PA origin variation, and intraprostatic branching.
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Affiliation(s)
- Srini Tummala
- University of Miami Miller School of Medicine, Department of Interventional Radiology, Miami, FL.
| | | | - Vedant Acharya
- University of Miami Miller School of Medicine, Miami, FL
| | - Shivank Bhatia
- University of Miami Miller School of Medicine, Department of Interventional Radiology, Miami, FL
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14
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Frequency and Clinical Review of the Aberrant Obturator Artery: A Cadaveric Study. Diagnostics (Basel) 2020; 10:diagnostics10080546. [PMID: 32751771 PMCID: PMC7459979 DOI: 10.3390/diagnostics10080546] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022] Open
Abstract
The occurrence of an aberrant obturator artery is common in human anatomy. Detailed knowledge of this anatomical variation is important for the outcome of pelvic and groin surgeries requiring appropriate ligation. Familiarity with the occurrence of an aberrant obturator artery is equally important for instructors teaching pelvic anatomy to students. Case studies highlighting this vascular variation provide anatomical instructors and surgeons with accurate information on how to identify such variants and their prevalence. Seven out of eighteen individuals studied (38.9%) exhibited an aberrant obturator artery, with two of those individuals presenting with bilateral aberrant obturator arteries (11.1%). Six of these individuals had an aberrant obturator artery that originated from the deep inferior epigastric artery (33.3%). One individual had an aberrant obturator artery that originated directly from the external iliac artery (5.6%).
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15
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Abstract
The visceral organs of the male pelvis have complex anatomic relationships with the surrounding extraperitoneal spaces, supplying arteries and adjacent pelvic musculature. Since various neoplastic, vascular, and traumatic pathologies can often involve multiple organs and spread into adjacent pelvic spaces, a keen understanding of this intricate anatomy can help radiologists to accurately characterize findings and improve recognition of the routes in which these conditions can spread. The purpose of this review is to examine the relationships between the anatomic compartments of the pelvic extraperitoneal space, summarize the pelvic arterial anatomy, and identify the pelvic muscles that support normal genitourinary function.
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16
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Qiu S, Wei X, Hu H, Zhao X, Wen X, Zhong LM. Superselective Arterial Embolization of Arteriovenous Malformation of Internal Pudendal Artery, a Rare Cause of Hematuria: A Case Report. Am J Mens Health 2020; 14:1557988320923913. [PMID: 32865100 PMCID: PMC7466900 DOI: 10.1177/1557988320923913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Arteriovenous malformation (AVM) is a common form of vascular malformation, an abnormal direct communication between an artery and a vein without passing through the capillaries. AVM may just present as hematuria without plain or other symptoms. The article presents a case of a 52-year-old male with gross hematuria diagnosed as AVM of internal pudendal artery, which was successfully managed with superselective arterial embolization using temporary embolization materials.
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Affiliation(s)
- Shixiang Qiu
- School of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Xin Wei
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Hong Hu
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Xiaowei Zhao
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Xiaoxia Wen
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Li-Ming Zhong
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
- Li-Ming Zhong, Professor, Chief Physician, Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, 97 Renmin South Road, Central Hospital of Nanchong, Nanchong, Sichuan Province 637000, P.R. China.
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17
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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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Prostatic Artery Embolization for Control of Gross Hematuria in Patients with Benign Prostatic Hyperplasia: A Single-Center Retrospective Study in 20 Patients. J Vasc Interv Radiol 2019; 30:661-667. [DOI: 10.1016/j.jvir.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 11/19/2022] Open
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19
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Angiographic Findings during Repeat Prostatic Artery Embolization. J Vasc Interv Radiol 2019; 30:645-651. [DOI: 10.1016/j.jvir.2018.12.734] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 12/21/2022] Open
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20
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Li L, Wu K, Liu Y, Lai H, Zeng Z, Zhang B. Angiographic evaluation of the internal iliac artery branch in pelvic tumour patients: Diagnostic performance of multislice computed tomography angiography. Oncol Lett 2019; 17:4305-4312. [PMID: 30944625 PMCID: PMC6444342 DOI: 10.3892/ol.2019.10084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/31/2019] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to explore the classification of the internal iliac artery (IIA) and the diagnostic value of the pelvic tumour-feeding artery by multislice computed tomography angiography (MSCTA) compared with digital subtraction angiography (DSA). A total of 43 patients with pelvic tumours were enrolled between January 2013 and August 2017. The classification of the IIA and the quality of the feeding artery of the pelvic tumours were analysed by Yamaki's classification (Groups A-D according to IIA branching) and the 5-point scoring system. The degree of feeding artery stenosis, caused by tumour compression or invasion, was analysed by a 4-point scoring system. The Wilcoxon signed-rank test was used to determine the vascular diagnostic quality identified by MSCTA and DSA. MSCTA of the pelvic arteries was successfully performed in all patients. The main classifications of the IIA were Group A, followed by Group C, then Group B and with no cases of Group D. There was no significant difference in the classification of the IIA between the left and right sides on MSCTA and DSA. The visualization quality of the IIA and its main branches showed excellent consistency, but the difference in the terminal branches of the feeding arteries in the pelvic tumours was statistically significant between MSCTA and DSA. MSCTA has great advantages in evaluating the classification of the IIA, the imaging quality evaluation of the IIA and its main branches, and in the evaluation of the pelvic tumour-feeding artery. However, in the display of the terminal arterial branches of the pelvic tumours, DSA remains irreplaceable, particularly in cases of interventional embolization.
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Affiliation(s)
- Lin Li
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Ketong Wu
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Yang Liu
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Haiyang Lai
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Zhaofei Zeng
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Bo Zhang
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
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21
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Repair of Sacral and Ischial Region Defects With Lateral Sacral Artery Perforator Flaps. Ann Plast Surg 2019; 82:304-309. [PMID: 30633022 DOI: 10.1097/sap.0000000000001737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Reconstructive choices for the defects of the sacral and ischial regions include various steps of the reconstructive ladder from primary closure to free flaps. This study aimed to present repair of sacral and ischial region defects with lateral sacral artery perforator (LSAP) flaps. METHODS We enrolled a total of 18 patients with sacral and ischial region defects reconstructed with LSAP flaps in the study between September 2014 and October 2015. The patients were evaluated in terms of age, sex, neurological situation, etiology, defect size, defect region, flap size, perforator number, and postoperative complications. RESULTS No patient had hematoma, seroma, and complications of the donor area. In the postoperative period, 2 patients were observed to have short-term complications (11.1%) including a partial flap loss (5.5%) due to distal venous failure (flap survival rate, 95%) and a wound site infection (5.5%). Duration of follow-up of the patients ranged between 26 and 38 months. Recurrence was observed from long-term complications of 4 patients' pressure sores (22%). CONCLUSIONS The LSAP flap has not been frequently described in the literature. We believe that LSAP flap is a flap of choice that should be considered preferably for sacral and ischial defects, which can be reliably elevated over pedicles and has short surgery duration and low surgical morbidity.
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22
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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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23
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Tannast M, Wolfer N, Ryan MK, Nuss KM, von Rechenberg B, Steppacher SD. Vascular supply of the femoral head in sheep-Implications for the ovine femoroacetabular impingement model. J Orthop Res 2018; 36:2340-2348. [PMID: 29575173 DOI: 10.1002/jor.23897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 03/15/2018] [Indexed: 02/04/2023]
Abstract
Sheep hips have a natural non-spherical head similar to a cam-type deformity in human beings. By performing an intertrochanteric varus osteotomy, cam-type femoroacetabular impingement can be induced experimentally. In sheep, the aspherical portion is located superiorly-exactly matching the region where the superior retinacular vessels enter the femoral head-neck junction in human beings. In order to fully exploit the potential of this experimental FAI model, a safe osteochondroplasty of the superior asphericity would need to be done without the risk of avascular necrosis. The aim of this study was to describe the vascular anatomy of the femoral head in sheep from the aorta to the retinacular vessels in order to perform safe femoral osteochondroplasty of the superior femoral asphericity in sheep. Sixty-two ovine hips were analyzed using CT angiography (30 hips), post mortem intravascular latex injection (6 hips), vascular corrosion casting (6 hips), and analysis of the distribution of vascular foramina around the femoral head-neck junction in macerated ovine femora (20 hips). The ovine femoral head receives its blood supply from anterior retinacular arteries from the lateral femoral circumflex artery, and from posterior retinacular arteries from the medial femoral circumflex artery. The superior aspherical portion is free of vessels. Detailed knowledge about vascular anatomy of sheep hips is of clinical significance since it allows to perform osteochondroplasty of the superior aspherical portion in the experimental ovine FAI model safely without the risk of osteonecrosis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2340-2348, 2018.
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Affiliation(s)
- Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.,Musculoskeletal Research Unit, University of Zurich, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadja Wolfer
- Musculoskeletal Research Unit, University of Zurich, Zurich, Switzerland
| | - Michael K Ryan
- Andrews Sports Medicine and Orthopaedic Center, American Sports Medicine Institute, Birmingham, Alabama
| | - Katja M Nuss
- Musculoskeletal Research Unit, University of Zurich, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, University of Zurich, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
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24
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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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25
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Petrillo M, Pesapane F, Fumarola EM, Emili I, Acquasanta M, Patella F, Angileri SA, Rossi UG, Piacentini I, Granata AM, Ierardi AM, Carrafiello G. State of the art of prostatic arterial embolization for benign prostatic hyperplasia. Gland Surg 2018; 7:188-199. [PMID: 29770312 PMCID: PMC5938262 DOI: 10.21037/gs.2018.03.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/25/2018] [Indexed: 12/15/2022]
Abstract
Prostatectomy via open surgery or transurethral resection of the prostate (TURP) is the standard treatment for benign prostatic hyperplasia (BPH). Several patients present contraindication for standard approach, individuals older than 60 years with urinary tract infection, strictures, post-operative pain, incontinence or urinary retention, sexual dysfunction, and blood loss are not good candidates for surgery. Prostatic artery embolization (PAE) is emerging as a viable method for patients unsuitable for surgery. In this article, we report results about technical and clinical success and safety of the procedure to define the current status.
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Affiliation(s)
- Mario Petrillo
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Filippo Pesapane
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Emili
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Marzia Acquasanta
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesca Patella
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Igor Piacentini
- Interventional Radiology Unit, E.O. Ospedale Galliera, Genova, Italy
| | | | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
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26
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Chen CB, Chou CT, Chen YL. Cone-beam CT findings during prostate artery embolization for benign prostatic hyperplasia-induced lower urinary tract symptoms: a case report. BMC Urol 2017; 17:120. [PMID: 29258481 PMCID: PMC5738155 DOI: 10.1186/s12894-017-0311-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 12/11/2017] [Indexed: 12/04/2022] Open
Affiliation(s)
- Chia-Bang Chen
- Department of Radiology, Changhua Christian Hospital, No. 135, Nan-Hsiao Street, Changhua, 500, Taiwan
| | - Chen-Te Chou
- Department of Radiology, Changhua Christian Hospital, No. 135, Nan-Hsiao Street, Changhua, 500, Taiwan.,Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, No.155, Sec. 2, Linong Street, Taipei, 112, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Li Chen
- Transplant Medicine and Surgery Research Centre, Changhua Christian Hospital, No. 135, Nan-Hsiao Street, Changhua, 500, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung City, 40201, Taiwan. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of General Surgery, Changhua Christian Hospital, No. 135, Nan-Hsiao Street, Changhua, 5006, Taiwan.
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27
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Kisilevzky N, Laudanna Neto C, Cividanes A. Ischemia of the Glans Penis following Prostatic Artery Embolization. J Vasc Interv Radiol 2017; 27:1745-1747. [PMID: 27926408 DOI: 10.1016/j.jvir.2016.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 01/28/2023] Open
Affiliation(s)
- Nestor Kisilevzky
- Endovascular Center and, Hospital Centro Especializado em Cirurgias Minimamente Invasivas, Rua Guararapes, 682, São Paulo, SP 05077051, Brazil
| | - Cyro Laudanna Neto
- Endovascular Center and, Hospital Centro Especializado em Cirurgias Minimamente Invasivas, Rua Guararapes, 682, São Paulo, SP 05077051, Brazil; Department of Urology, Hospital Centro Especializado em Cirurgias Minimamente Invasivas, Rua Guararapes, 682, São Paulo, SP 05077051, Brazil
| | - Arnaldo Cividanes
- Department of Urology, Hospital Centro Especializado em Cirurgias Minimamente Invasivas, Rua Guararapes, 682, São Paulo, SP 05077051, Brazil
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28
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Pereira K, Halpern JA, McClure TD, Lewis NA, Kably I, Bhatia S, Hu JC. Role of prostate artery embolization in the management of refractory haematuria of prostatic origin. BJU Int 2016; 118:359-65. [DOI: 10.1111/bju.13524] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Keith Pereira
- Department of Interventional Radiology; St. Louis University Hospital; St. Louis MO USA
| | - Joshua A. Halpern
- Department of Urology; Weill Cornell Medical College; New York NY USA
| | | | | | - Isaam Kably
- Department of Interventional Radiology; Jackson Memorial Hospital/University of Miami Hospital; Miami FL USA
| | - Shivank Bhatia
- Department of Interventional Radiology; Jackson Memorial Hospital/University of Miami Hospital; Miami FL USA
| | - Jim C. Hu
- Department of Urology; Weill Cornell Medical College; New York NY USA
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29
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Bilhim T, Pisco J, Pereira JA, Costa NV, Fernandes L, Campos Pinheiro L, Duarte M, Oliveira AG. Predictors of Clinical Outcome after Prostate Artery Embolization with Spherical and Nonspherical Polyvinyl Alcohol Particles in Patients with Benign Prostatic Hyperplasia. Radiology 2016; 281:289-300. [PMID: 27223621 DOI: 10.1148/radiol.2016152292] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess predictors of outcome after prostate artery embolization (PAE) for benign prostatic hyperplasia with spherical particle polyvinyl alcohol (sPVA) and compare outcomes with the use of nonspherical particle polyvinyl alcohol (nsPVA). Materials and Methods This was a single-center retrospective institutional review board-approved study conducted from 2009 to 2015 in patients undergoing PAE with sPVA (n = 186; mean age ± standard deviation, 65.5 years ± 7.7) and nsPVA (n = 300; mean age, 65.3 years ± 7.6). The two cohorts were compared and analyzed for predictors of outcome with a Cox proportional hazards model and linear regression. Post-PAE prostate ischemia was measured with contrast material-enhanced magnetic resonance (MR) imaging in 23 patients with nsPVA and 25 patients with sPVA. The 24-hour post-PAE prostate-specific antigen (PSA) level was registered in 133 patients with sPVA. Prognostic values of MR imaging and PSA levels 24 hours after PAE were assessed with Cox and random-effects regressions. Results Predictors of clinical failure were older age (age over 65 years, P = .002), unilateral procedure (P = .002), and higher baseline International Prostate Symptom Score (IPSS, P = .033). Adjusted hazard ratio for clinical failure of sPVA was 1.273 (P = .16). Acute urinary retention was a predictor of lower IPSS after PAE (P = .002). The mean proportion of prostate ischemia was 11% with sPVA and 10% with nsPVA (P = .65). Lower IPSS after PAE was associated with a higher proportion of prostate ischemia (P = .009). Patients with a PSA level of at least 75 ng/mL (75 μg/L) 24 hours after PAE had a greater decrease in IPSS (P = .01). Prostate ischemic volume and PSA level 24 hours after PAE were correlated (Pearson r = 0.64, P = .014). Conclusion Clinical outcome was similar after PAE with sPVA and nsPVA. Younger age (up to 65 years), bilateral PAE, lower baseline IPSS, and acute urinary retention were predictors of better clinical outcome. The PSA level 24 hours after PAE correlated with prostate ischemia, and both correlated with clinical outcome. (©) RSNA, 2016.
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Affiliation(s)
- Tiago Bilhim
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - João Pisco
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - José A Pereira
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - Nuno Vasco Costa
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - Lúcia Fernandes
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - Luís Campos Pinheiro
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - Marisa Duarte
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
| | - António G Oliveira
- From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.)
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30
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31
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Pelvic trauma and vascular emergencies. Diagn Interv Imaging 2015; 96:717-29. [DOI: 10.1016/j.diii.2015.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 04/22/2015] [Accepted: 05/21/2015] [Indexed: 11/21/2022]
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32
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de Assis AM, Moreira AM, de Paula Rodrigues VC, Harward SH, Antunes AA, Srougi M, Carnevale FC. Pelvic Arterial Anatomy Relevant to Prostatic Artery Embolisation and Proposal for Angiographic Classification. Cardiovasc Intervent Radiol 2015; 38:855-61. [PMID: 25962991 DOI: 10.1007/s00270-015-1114-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/03/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe and categorize the angiographic findings regarding prostatic vascularization, propose an anatomic classification, and discuss its implications for the PAE procedure. METHODS Angiographic findings from 143 PAE procedures were reviewed retrospectively, and the origin of the inferior vesical artery (IVA) was classified into five subtypes as follows: type I: IVA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery (SVA); type II: IVA originating from the anterior division of the IIA, inferior to the SVA origin; type III: IVA originating from the obturator artery; type IV: IVA originating from the internal pudendal artery; and type V: less common origins of the IVA. Incidences were calculated by percentage. RESULTS Two hundred eighty-six pelvic sides (n = 286) were analyzed, and 267 (93.3%) were classified into I-IV types. Among them, the most common origin was type IV (n = 89, 31.1%), followed by type I (n = 82, 28.7%), type III (n = 54, 18.9%), and type II (n = 42, 14.7%). Type V anatomy was seen in 16 cases (5.6%). Double vascularization, defined as two independent prostatic branches in one pelvic side, was seen in 23 cases (8.0%). CONCLUSIONS Despite the large number of possible anatomical variations of male pelvis, four main patterns corresponded to almost 95% of the cases. Evaluation of anatomy in a systematic fashion, following a standard classification, will make PAE a faster, safer, and more effective procedure.
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Affiliation(s)
- André Moreira de Assis
- Interventional Radiology and Endovascular Surgery Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255 Cerqueira César, São Paulo, SP, 05403-000, Brazil,
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