Oxford University Hospitals NHS Foundation Trust The Churchill Hospital, Old Rd, Oxford, OX3 7LE, UK.
Eur Radiol. 2021 Mar;31(3):1308-1315. doi: 10.1007/s00330-020-07244-3. Epub 2020 Sep 9.
Predicting patients that will pose procedural technical challenges in prostate artery embolisation (PAE) remains difficult, with prolonged procedural times impacting on both patient dose and resource planning. Understanding the factors that influence these parameters as well as the likelihood of technical success is therefore important in effective patient selection and procedural planning.
Data were collected retrospectively for 75 consecutive patients who underwent PAE. Multiple patient predictor variables available from planning computed tomography angiography (CTA) were identified and measured objectively. The vessel angles navigated during the procedure, prostate volume, prostate artery (PA) diameter, PA origin, aortic atheroma, iliac tortuosity and baseline demographics were correlated with outcome variables (fluoroscopy time, air kerma (AK), dose area product (DAP), the number of cone beam CTs (CBCTs)) performed and whether bilateral embolisation was possible (technical success). Data were analysed using linear regression, ANOVA, t tests and chi-squared tests.
Aortic atheroma severity significantly increased fluoroscopy time (p = 0.004), whilst air kerma (AK) was significantly greater in patients with smaller prostatic arteries (p = 0.009) and smaller pre-procedural prostate volumes (p = 0.038). Increased vascular tortuosity and prostatic artery origin were not shown to significantly affect fluoroscopy time or DAP. Smaller prostate artery size (p = 0.007) also increases the likelihood of either unilateral embolisation or technical failure.
Pre-operative prediction of technical outcome measures in PAE remains challenging. However, vascular calcification, prostatic artery diameter and prostate volume are likely to be important factors when considering the risk/benefits of PAE.
• Increased severity of atheroma and the presence of small prostate arteries increase fluoroscopy time and AK respectively during prostate artery embolisation. • Lower pre-procedural prostate volume increases the AK during procedures. • Smaller prostate artery size increases the likelihood of either unilateral embolisation or technical failure.
预测前列腺动脉栓塞术（PAE）中存在手术技术挑战的患者仍然具有难度，因为手术时间延长会影响患者剂量和资源规划。因此，了解影响这些参数的因素以及技术成功的可能性对于有效的患者选择和手术规划非常重要。
回顾性收集了 75 例连续接受 PAE 治疗的患者数据。从计划计算机断层血管造影（CTA）中确定并客观测量了多个患者预测变量。术中所经过的血管角度、前列腺体积、前列腺动脉（PA）直径、PA 起源、主动脉粥样硬化、髂动脉迂曲和基线人口统计学特征与术中透视时间、空气比释动能（AK）、剂量面积乘积（DAP）、锥形束 CT 数量（CBCT）以及双侧栓塞是否可行（技术成功）的结果变量相关。使用线性回归、方差分析、t 检验和卡方检验对数据进行分析。
主动脉粥样硬化严重程度显著增加了透视时间（p=0.004），而较小的前列腺动脉（p=0.009）和较小的术前前列腺体积（p=0.038）导致的 AK 显著增加。增加的血管迂曲程度和前列腺动脉起源并未显著影响透视时间或 DAP。较小的前列腺动脉尺寸（p=0.007）也增加了单侧栓塞或技术失败的可能性。
PAE 中技术结果测量的术前预测仍然具有挑战性。然而，血管钙化、前列腺动脉直径和前列腺体积在考虑 PAE 的风险/获益时可能是重要因素。
• 粥样硬化严重程度增加和前列腺动脉较小分别增加了前列腺动脉栓塞术中的透视时间和 AK。• 术前前列腺体积较小会增加手术中的 AK。• 前列腺动脉尺寸较小会增加单侧栓塞或技术失败的可能性。
