Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, São Paulo, SP, Brazil.
Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, São Paulo, SP, Brazil.
Tech Vasc Interv Radiol. 2020 Sep;23(3):100691. doi: 10.1016/j.tvir.2020.100691. Epub 2020 Oct 6.
In the last decade, prostatic artery embolization (PAE) established itself as a safe and effective treatment option for lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH), with reproducible results across multiple centers and endorsement by important international societies. However, PAE is also known to be a technically demanding procedure. Accompanying the prevalence of benign prostate hyperplasia, the procedure is usually performed in older patients, in whom atherosclerosis and comorbidities are common features. Also, prostatic vascular anatomy is described to be complex and variable, and pelvic structures are deeply interconnected by anastomosis. Thus, PAE demands a deep familiarization with materials and devices, intraprocedure imaging techniques, microcatetherization skills and with the pelvic vascular anatomy. Especially in the beginning of the learning curve, the procedure can be time-consuming and related to high radiation exposure for both medical team and the patient. In this article, the main points of technical concern during PAE are described and discussed, such as the equipment needed, the effect of different embolic materials, patient's preparation for the procedure, arterial access sites, identifying and catheterizing the prostatic arteries, the embolization techniques, among others. Finally, the most frequent technical challenges are presented, and the possible strategies to overcome them are exemplified and discussed.
在过去的十年中，前列腺动脉栓塞术 (PAE) 已被确立为治疗良性前列腺增生 (BPH) 引起的下尿路症状 (LUTS) 的安全有效的治疗选择，其结果在多个中心具有可重复性，并得到了重要国际协会的认可。然而，PAE 也被认为是一项技术要求很高的手术。伴随良性前列腺增生的流行，该手术通常在老年患者中进行，而这些患者通常存在动脉粥样硬化和合并症等常见特征。此外，前列腺血管解剖结构被描述为复杂且多变，盆腔结构通过吻合术紧密相连。因此，PAE 需要对材料和设备、术中成像技术、微导管插入技术以及盆腔血管解剖结构有深入的了解。特别是在学习曲线的早期，该手术可能会非常耗时，并且会对医疗团队和患者产生较高的辐射暴露。本文将描述和讨论 PAE 过程中的主要技术要点，如所需设备、不同栓塞材料的效果、患者的术前准备、动脉入路、前列腺动脉的识别和导管插入、栓塞技术等。最后，本文将介绍最常见的技术挑战，并举例说明和讨论可能的解决方案。
