Bhatia Shivank, Harward Sardis H, Sinha Vishal K, Narayanan Govindarajan
Department of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, R-109, PO Box 016960, Miami, FL 33101.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
J Vasc Interv Radiol. 2017 Jun;28(6):898-905. doi: 10.1016/j.jvir.2017.02.029. Epub 2017 Apr 7.
To compare safety and feasibility of prostate artery embolization (PAE) via transradial/transulnar access (TR/UA) and transfemoral access (TFA).
A retrospective analysis was conducted for 3 cohorts: the first 32 consecutive PAE procedures performed via TFA (initial TFA, January 2014 to August 2015), the following 32 procedures performed via TFA (advanced TFA, August 2015 to February 2016), and the first 32 procedures performed via TR/UA (February 2016 to July 2016). Indications included lower urinary tract symptoms (n = 68), urinary retention (n = 24), and preoperative embolization before prostatectomy (n = 4). A single operator performed all procedures at a single institution.
Technical success was achieved in 29/32 (90.6%) initial TFA procedures, 31/32 (96.9%) advanced TFA procedures, and 30/32 (93.8%) TR/UA procedures. Mean procedure time was 110.0 minutes in TR/UA group, 155.1 min in initial TFA group, and 131.3 minutes in advanced TFA group (P < .01 and P = .03 relative to TR/UA); mean fluoroscopy time was 38.8 minutes in TR/UA group, 56.5 minutes in initial TFA group, and 48.0 minutes in advanced TFA group (P < .01 and P = .02 relative to TR/UA). Access site-related and overall adverse events did not vary significantly among study cohorts (P > .15 and P > .05, respectively).
TR/UA represents a safe and feasible approach to PAE with a comparable safety profile to TFA. Reduced procedure and fluoroscopy times might be attributable to the learning curve or method of arterial access.
比较经桡动脉/尺动脉入路（TR/UA）与经股动脉入路（TFA）行前列腺动脉栓塞术（PAE）的安全性和可行性。
对3个队列进行回顾性分析：前32例连续经TFA行PAE的手术（初始TFA组，2014年1月至2015年8月），接下来32例经TFA行PAE的手术（进阶TFA组，2015年8月至2016年2月），以及前32例经TR/UA行PAE的手术（2016年2月至2016年7月）。适应证包括下尿路症状（n = 68）、尿潴留（n = 24）以及前列腺切除术前栓塞（n = 4）。所有手术均由同一机构的同一名术者完成。
初始TFA组29/32例（90.6%）手术技术成功，进阶TFA组31/32例（96.9%）手术技术成功，TR/UA组30/32例（93.8%）手术技术成功。TR/UA组平均手术时间为110.0分钟，初始TFA组为155.1分钟，进阶TFA组为131.3分钟（相对于TR/UA组，P <.01且P =.03）；TR/UA组平均透视时间为38.8分钟，初始TFA组为56.5分钟，进阶TFA组为48.0分钟（相对于TR/UA组，P <.01且P =.02）。各研究队列间穿刺部位相关不良事件和总体不良事件差异均无统计学意义（分别为P >.15和P >.05）。
TR/UA是一种安全可行的PAE入路，其安全性与TFA相当。手术时间和透视时间缩短可能归因于学习曲线或动脉入路方法。
