Amouyal Gregory, Chague Pierre, Pellerin Olivier, Pereira Helena, Del Giudice Costantino, Dean Carole, Thiounn Nicolas, Sapoval Marc
Faculté de Médecine, Université Paris Descartes - Sorbonne - Paris - Cité, Paris, France.
Interventional Radiology Department, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75015, Paris, France.
Cardiovasc Intervent Radiol. 2016 Sep;39(9):1245-55. doi: 10.1007/s00270-016-1412-4. Epub 2016 Jul 12.
During PAE, preembolization angiography of the prostatic artery can show large extra-prostatic shunts, at high risk, if embolized, of rectal or penile necrosis. We report our experience with 11 consecutive patients who underwent protective embolization of large extra-prostatic shunts before successful PAE.
We treated 11 consecutive male patients (mean age 67 years), part of a series of 55 consecutive male patients referred for PAE to treat LUTS due to BPH, between December 2013 and January 2015. The procedure involved the exclusion of an extra-prostatic shunt originating from the PA, prior to complete bilateral PAE. We compared the safety and efficacy of the 11 shunt exclusions followed by embolization of the PA to the other 44 basic PAE. Clinical success was defined as a decrease of 25 % or eight points of IPSS, QoL <3 or a one-point decrease, and a Qmax improvement of 25 % or 2.5 mL/s.
We had a 100 % rate of occlusion of the anastomosis. Bilateral embolization of the PA was performed in all patients with no additional time of procedure (p = 0.18), but a significant increase of dose area product (p = 0.03). Distal (PErFecTED) embolization was possible in 64 %. There was no worsening of erectile dysfunction, no rectal or penile necrosis, no immediate or late other clinical complications. Clinical success was 91 % (mean follow-up: 3.5 months), compared to 78 % for the entire PAE group.
PAE using the protection technique in case of large extra-prostatic shunts is as safe and effective as basic procedures and does not induce any additional time of procedure.
在前列腺动脉栓塞术（PAE）期间，前列腺动脉的栓塞前血管造影可能显示大的前列腺外分流，如果进行栓塞，有导致直肠或阴茎坏死的高风险。我们报告了11例连续患者的经验，这些患者在成功进行PAE之前接受了大的前列腺外分流的保护性栓塞。
我们治疗了11例连续男性患者（平均年龄67岁），他们是2013年12月至2015年1月期间因良性前列腺增生（BPH）导致下尿路症状（LUTS）而转诊进行PAE的55例连续男性患者系列的一部分。该手术包括在完成双侧PAE之前排除源自前列腺动脉的前列腺外分流。我们将11例分流排除后进行前列腺动脉栓塞的安全性和有效性与其他44例基本PAE进行了比较。临床成功定义为国际前列腺症状评分（IPSS）降低25%或8分，生活质量（QoL）<3或降低1分，以及最大尿流率（Qmax）提高25%或2.5 mL/s。
吻合口闭塞率为100%。所有患者均进行了前列腺动脉的双侧栓塞，手术时间无额外增加（p = 0.18），但剂量面积乘积显著增加（p = 0.03）。64%的患者可行远端（完美）栓塞。勃起功能障碍没有恶化，没有直肠或阴茎坏死，没有即时或晚期的其他临床并发症。临床成功率为91%（平均随访：3.5个月），而整个PAE组为78%。
在存在大的前列腺外分流的情况下使用保护技术进行PAE与基本手术一样安全有效，并且不会导致任何额外的手术时间。
