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Sapoval MR, Bhatia S, Déan C, Rampoldi A, Carnevale FC, Bent C, Tapping CR, Bongiovanni S, Taylor J, Brower JS, Rush M, McWilliams JP, Little MW. Two-Year Outcomes of Prostatic Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: An International, Multicenter, Prospective Study. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03802-0. [PMID: 39230672 DOI: 10.1007/s00270-024-03802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/25/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE To describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE). MATERIALS AND METHODS This was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR. Secondary outcome measures included changes in IPSS at 3 and 24 months, changes in quality of life (QoL), changes in the Sexual Health Inventory for Men (SHIM) questionnaire, technical success rate, and adverse events (AEs). Data were summarized using descriptive statistics. RESULTS Four hundred seventy-eight consecutive patients underwent PAE (bothersome LUTS: N = 405; AUR: N = 73), mean age was 70 years. For patients treated for bothersome LUTS, mean total IPSS at baseline was 21.8 and decreased to 9.3, 10.6, and 11.2 at 3, 12, and 24 months following PAE, respectively (all p < 0.001); QoL at baseline was 4.7 and decreased to 2.0, 2.1, and 2.3 at 3, 12, and 24 months, respectively (all p < 0.001). The mean SHIM score at baseline and 12 months following PAE was 13.8 and 13.9, respectively. Of the 73 patients treated for AUR, 48 (65.8%) had their indwelling catheter removed within 3 months of PAE and remained catheter free at 24 months. Fifty-five patients (11.5%) experienced ≥ 1 AE and 10 (2.1%) experienced a serious AE. CONCLUSION PAE is a safe and effective treatment for symptomatic BPH and LUTS. Level of Evidence Level 3 Trial registration ClinicalTrials.gov NCT03527589.
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Affiliation(s)
- Marc R Sapoval
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.
| | - Shivank Bhatia
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Carole Déan
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Antonio Rampoldi
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Francisco César Carnevale
- Department of Radiology, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clare Bent
- Department of Interventional Radiology, Royal Bournemouth and Christchurch Hospital, Bournemouth, UK
| | | | - Simone Bongiovanni
- Department of Radiology, Azienda Ospedaliera S. Croce E Carle, Cuneo, Italy
| | - Jeremy Taylor
- Department of Interventional Radiology, Frimley Park Hospital, Surrey, UK
| | - Jayson S Brower
- Department of Radiology, Providence Sacred Heart, Spokane, WA, USA
| | - Michael Rush
- Holy Cross South Florida Medical Imaging, Fort Lauderdale, FL, USA
| | - Justin P McWilliams
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark W Little
- University Department of Radiology, Royal Berkshire Hospital, Reading, UK
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Tsukagoshi J, Bhuyan A, Secemsky EA, Shirasu T, Nakama T, Jujo K, Wiley J, Kuno T. Procedural Feasibility and Peri-procedural Outcomes of Peripheral Endovascular Therapy via Transradial versus Transfemoral Access: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00650-6. [PMID: 39111535 DOI: 10.1016/j.ejvs.2024.07.036] [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: 10/05/2023] [Revised: 06/30/2024] [Accepted: 07/31/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to evaluate the safety and feasibility of transradial access for peripheral vascular interventions. DATA SOURCES MEDLINE and Embase. REVIEW METHODS MEDLINE and Embase databases were searched to June 2023 to identify studies investigating the outcomes of lower extremity, carotid, and visceral artery vascular interventions via transradial vs. transfemoral access. The primary outcome was procedural failure rate. Secondary outcomes were total access site complications, minor and major bleeding, stroke, access vessel occlusion, procedure time, fluoroscopy time, and contrast volume. RESULTS Eight randomised controlled trials and 29 observational studies yielded a total of 70 882 patients treated via transradial (n = 2 616) vs. transfemoral access (n = 68 338). The overall failure rate was 2.3 ± 0.7%, and the transradial approach was associated with a statistically significantly higher procedural failure rate than the transfemoral approach (3.9 ± 0.7% vs. 1.0 ± 0.3%; odds ratio [OR] 3.07, 95% confidence interval [CI] 1.84 - 5.12; I2 = 32%; p < .001). Subgroup analysis showed the highest failure rate in lower extremity interventions with 12.4 ± 4.9% for transradial vs. 4.0 ± 1.2% for transfemoral access. Conversely, procedural complications were statistically significantly fewer with transradial access for total access site complications (OR 0.64, 95% CI 0.45 - 0.91; I2 = 36%; p = .010). Minor bleeding was statistically significantly less with the transradial approach (OR 0.52, 95% CI 0.31 - 0.86; I2 = 30%; p = .010), whereas major bleeding and stroke rates were similar. Transradial access had more access vessel occlusion than transfemoral access (1.9% ± 0.5% vs. < 0.1% ± 0.0%; p = .004), although most remained asymptomatic. Procedure time, fluoroscopy time, and contrast volume were all comparable. GRADE certainty was low to moderate in most outcomes. CONCLUSION The transradial approach was associated with a higher procedural failure rate. Total access site complications and minor bleeding were lower with the transradial approach, albeit with more frequent access vessel occlusion. Transradial access may be a feasible and safe approach; however, appropriate patient selection is imperative.
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Affiliation(s)
- Junji Tsukagoshi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. https://twitter.com/jt_TeamWADA
| | - Arijit Bhuyan
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Eric A Secemsky
- Division of Cardiology, Beth Israel Deaconess Medical Centre, Boston, MA, USA. https://twitter.com/EricSecemskyMD
| | - Takuro Shirasu
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Centre, Urayasu, Japan. https://twitter.com/tatsuya_nakama
| | - Kentaro Jujo
- Department of Cardiology, Saitama Medical University, Iruma, Japan. https://twitter.com/jujo85553842
| | - Jose Wiley
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, Los Angeles, CA, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Centre, Albert Einstein College of Medicine, New York, NY, USA; Department of Cardiology, Jacobi Medical Centre, Albert Einstein College of Medicine, New York, NY, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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McNamara KL, Picel AC. Commentary on the "Safety of Prostatic Artery Embolization via Transradial Access versus Transfemoral Access". J Vasc Interv Radiol 2024; 35:548-549. [PMID: 38103864 DOI: 10.1016/j.jvir.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/02/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Katherine L McNamara
- Division of Interventional Radiology, Department of Radiology, Stanford University, Stanford, California
| | - Andrew C Picel
- Division of Interventional Radiology, Department of Radiology, Stanford University, Stanford, California.
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Richardson AJ, Kumar J, Richardson K, Bhatia A, Pennix T, Shah K, Maini A, Jalaeian H, Bhatia S. Safety of Prostatic Artery Embolization via Transradial Access versus Transfemoral Access. J Vasc Interv Radiol 2024; 35:541-547. [PMID: 38103863 DOI: 10.1016/j.jvir.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To compare prostatic artery embolization (PAE) via transradial access (TRA-PAE) versus transfemoral access (TFA-PAE) to assist access selection. MATERIAL AND METHODS Procedural outcomes and adverse events were evaluated in 998 patients who underwent PAE at a single center from April 2014 to August 2022; 821 (82%) underwent TRA-PAE (Group R) and 177 (18%) underwent TFA-PAE (Group F). Mean age and prostate size of Groups R and F were 69.2 years (SD ± 8.4) and 117.4 g (SD ± 63.1) and 75.2 years (SD ± 12.1) and 127.2 g (SD ± 83.6), respectively (P < .01 and P = .16; postpropensity matching: P = .38 and P = .35, respectively). Indications for PAE included lower urinary tract symptoms, acute or chronic urinary retention, and hematuria. Procedural and patient-specific metrics were reviewed. Technical success was defined as bilateral PAE. Adverse events were recorded according to the Society of Interventional Radiology (SIR) adverse events classification. Statistical significance was defined as P < .05. RESULTS Technical success was achieved in 798 (97.2%) patients in Group R and 165 (93.2%) patients in Group F. Mean procedural time, single- and continuous-rotation fluoroscopy time, dose area product, and air kerma were significantly lower in Group R than in Group F (P < .001). Moreover, 6 (0.7%) patients in Group R and 9 (5.5%) patients in Group F had access site ecchymoses, whereas 5 (0.6%) patients in Group R and 6 (3.6%) in Group F had access site hematomas. Two patients experienced transient ischemic attacks (TIAs) after TRA-PAE and recovered without intervention. Two occult radial artery occlusions were noted, but no patient experienced hand ischemia. CONCLUSIONS In a large single interventional radiologist cohort, TRA-PAE demonstrated similar technical success to that of TFA-PAE with lower access site hemorrhagic complications and radiation requirements; however, TIA and occult radial artery occlusions remain a concern.
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Affiliation(s)
- Andrew J Richardson
- Department of Interventional Radiology, Jackson Memorial Hospital, Miami, Florida.
| | - Jessica Kumar
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Kenneth Richardson
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ansh Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas Pennix
- Department of Interventional Radiology, Jackson Memorial Hospital, Miami, Florida
| | - Khushi Shah
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Aneesha Maini
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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Moramarco L, Grande AM, Vertemati M, Aseni P. Prostate Artery Embolization in the Treatment of Massive Intractable Bleeding from Prostatic Neoplasms: A Case Report and Systematic Review. J Clin Med 2023; 13:65. [PMID: 38202072 PMCID: PMC10780233 DOI: 10.3390/jcm13010065] [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: 11/21/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Lower urinary tract symptoms (LUTS) and hematuria are common symptoms in men with neoplasms, mainly affecting the elderly population. Prostatic arterial embolization (PAE) is a minimally invasive procedure that has shown promising results in managing LUTS and massive intractable prostatic hematuria in patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A few studies, however, have provided valuable insights into the durability and efficacy of PAE focusing on the long-term effectiveness, quality of life, and cancer-specific control of hemostasis and urinary symptoms. As a result of concomitant cardiovascular conditions, these patients often take anticoagulants or antithrombotics, which can worsen their hematuria and clinical status. Transurethral resection of the prostate (TURP) is considered a very high-risk procedure, even without massive bleeding, and requires discontinuation of vitamin K antagonists and antiplatelet therapies. Such patients usually have their surgery postponed, and PAE should be considered a safe alternative treatment. We aimed to report a narrative review from 1976 to June 2023 of the current state of PAE for massive and intractable hematuria, highlighting recent developments in this technique, including prospective cohort studies, and focusing on long-term outcome, safety, and complication management of patients with prostatic neoplasms who develop significant hemorrhagic symptoms. Additionally, we present a case report and a simple algorithm for treating intractable bleeding in a 92-year-old man with PCa and massive hematuria.
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Affiliation(s)
- Lorenzo Moramarco
- Radiologia—Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Antonino M. Grande
- Divisione Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Paolo Aseni
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
- Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda Hospital, 20162 Milan, Italy
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Abstract
Benign prostatic hyperplasia (BPH) is a condition that primarily affects men between the fourth and seventh decades of life, occurring due to enlargement of the prostate which subsequently causes compression of the prostatic urethra causing chronic obstruction of the urinary outflow tract. BPH can cause significant quality-of-life issues such as urinary hesitancy, intermittency, decreased urinary stream, a sensation of incomplete emptying, dysuria, urinary retention, hematuria, and nocturia. Several medical and surgical treatment modalities are available for the treatment of lower urinary tract symptoms and other BPH-related sequela; however, increasingly prostate artery embolization is being utilized in this patient population. Technical demands for this procedure in this population can be significant. This article describes the optimal techniques, tricks, and advanced imaging techniques that can be used to achieve desired technical outcomes.
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Affiliation(s)
- Ansh Bhatia
- Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Aneesha Maini
- M2 at Georgetown University School of Medicine, Washington, District of Columbia
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miami, Florida
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