Enderlein Georg Friedrich, Lehmann Thomas, von Rundstedt Friedrich-Carl, Aschenbach René, Grimm Marc-Oliver, Teichgräber Ulf, Franiel Tobias
Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany.
Institut für Medizinische Statistik, Informatik und Dokumentation, Universitätsklinikum Jena, Jena, Germany.
J Vasc Interv Radiol. 2020 Mar;31(3):378-387. doi: 10.1016/j.jvir.2019.09.005. Epub 2019 Nov 15.
To determine if cone-beam CT and digital subtraction angiography analysis of pelvic arterial anatomy has predictive value for radiation exposure and technical success of prostatic artery embolization (PAE).
This prospective, nonrandomized, single-center study included 104 consecutive patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Cone-beam CT was performed in 160/208 (76.9%) hemipelves to determine prostatic artery (PA) origin. Classification of pelvic arterial tortuosity was possible in 73/104 (70.2%) patients. Learning curves of 2 interventionalists who performed 86.5% of PAEs were analyzed.
Tortuosity of pelvic arteries was classified as mild in 25 (34.2%) patients median age 64 years, moderate in 40 (54.8%) patients median age 69 years, and severe in 8 (11.0%) patients median age 70 years (mild vs moderate, P = .002; mild vs severe, P = .019); median fluoroscopy times were 24, 36, and 46 minutes (P = .008, P = .023); median contrast volumes were 105, 122.5, and 142 mL (P = .029, P = .064); and bilateral PAE rates were 84.0%, 77.5%, and 62.5% (P = .437), respectively. PA origin from superior vesical artery was most frequent (27.5%) and showed higher dose area product (median 402.4 vs 218 Gy ∙ cm, P = .033) and fluoroscopy time (median 42.5 vs 27 min, P = .01) compared with PA origin from obturator artery, which was least frequent. Interventionalist experience revealed significant impact on procedure times (median 159 vs 130 min, P = .006).
Tortuosity of pelvic arteries was more frequent in older patients and predicted worse technical outcomes of PAE. PA origin from obturator artery was associated with lower dose area product and fluoroscopy time, especially compared with PA origin from superior vesical artery. Interventionalist experience showed significant influence on technical outcome.
确定盆腔动脉解剖结构的锥形束CT和数字减影血管造影分析对前列腺动脉栓塞术（PAE）的辐射暴露和技术成功率是否具有预测价值。
这项前瞻性、非随机、单中心研究纳入了104例因良性前列腺增生继发下尿路症状的连续患者。对160/208（76.9%）侧半骨盆进行了锥形束CT检查，以确定前列腺动脉（PA）的起源。73/104（70.2%）例患者可对盆腔动脉迂曲进行分类。分析了实施86.5%的PAE手术的2名介入医生的学习曲线。
盆腔动脉迂曲在25例（34.2%）中位年龄64岁的患者中被分类为轻度，在40例（54.8%）中位年龄69岁的患者中为中度，在8例（11.0%）中位年龄70岁的患者中为重度（轻度与中度，P = .002；轻度与重度，P = .019）；透视时间中位数分别为24、36和46分钟（P = .008，P = .023）；造影剂用量中位数分别为105、122.5和142 mL（P = .029，P = .064）；双侧PAE发生率分别为84.0%、77.5%和62.5%（P = .437）。起源于膀胱上动脉的PA最为常见（27.5%），与起源于闭孔动脉（最不常见）的PA相比，其剂量面积乘积更高（中位数402.4 vs 218 Gy∙cm，P = .033），透视时间更长（中位数42.5 vs 27分钟，P = .01）。介入医生的经验对手术时间有显著影响（中位数159 vs 130分钟，P = .006）。
老年患者盆腔动脉迂曲更为常见，且预示着PAE的技术效果较差。起源于闭孔动脉的PA与较低的剂量面积乘积和透视时间相关，尤其是与起源于膀胱上动脉的PA相比。介入医生的经验对技术效果有显著影响。
