Moschouris Hippocrates, Dimakis Andreas, Papadaki Marina G, Liarakos Athanasios, Stamatiou Konstantinos, Isaakidou Ioulita, Tsetsou Ilianna, Mylonakou Vasiliki, Malagari Katerina
Radiology Department, General Hospital "Tzanio", Zanni & Afentouli 1 Str., 18536, Piraeus, Greece.
Department of Surgery, General Hospital "Tzanio", Zanni & Afentouli 1 Str., 18536, Piraeus, Greece.
CVIR Endovasc. 2021 Feb 9;4(1):21. doi: 10.1186/s42155-021-00209-7.
To present and evaluate an approach for reduction of utilization of steep oblique angiographic projections during prostatic artery embolization (PAE).
Single-center, retrospective study of patients who underwent bilateral PAE (from October 2018 to November 2019) and in whom it was possible to embolize PA of at least one pelvic side utilizing anteroposterior projections only (AP-PAE group), with the following techniques: Identification of the origin of PA on anteroposterior angiographic views. Utilization of anatomic landmarks from the planning computed tomographic angiography. Distal advancement of the angiographic catheter or microcatheter in the anterior division of internal iliac artery. Gentle probing with microguidewire at the expected site of origin of the PA. The AP-PAE approach was initially applied to all PAE patients during the study period and when this approach failed, additional steep oblique projections were acquired; patients who underwent bilateral PAE, with both anteroposterior and oblique projections for both pelvic sides, formed the standard PAE (S-PAE) group. The AP-PAE group was compared with S-PAE group in terms of baseline clinical and anatomic features, technical/procedural aspects and outcomes.
Forty-six patients (92 pelvic sides) were studied. AP-PAE was feasible in 12/46 patients (26.0%): unilateral AP-PAE in 9/46 patients (19.5%); bilateral AP-PAE in 3/46 patients (6.5%). AP-PAE group had larger prostates (p = 0.047) and larger PAs (p < 0.001). Body mass index (BMI) and other baseline features were comparable between the two groups (mean BMI, AP-PAE group: 27.9 ± 3.6, S-PAE group: 27.0 ± 3.5, p = 0.451). Mean fluoroscopy time and dose area product were lower in AP-PAE group (46.3 vs 57.9 min, p = 0.084 and 22,924.9 vs 35,800.4 μGym, p = 0.018, respectively). Three months post PAE, comparable clinical success rates (11/12 vs 31/34, p = 0.959) and mean International Prostate Symptom Score reduction (60.2% vs 58.1%, p = 0.740) were observed for AP-PAE and for S-PAE group, respectively. No major complications were encountered.
AP-PAE is associated with significant reduction in radiation exposure and appears to be feasible, safe and effective, but it can be applied in a relatively small percentage of patients.
介绍并评估一种在前列腺动脉栓塞术（PAE）期间减少陡峭斜位血管造影投影使用的方法。
对2018年10月至2019年11月期间接受双侧PAE且至少一侧盆腔的前列腺动脉仅利用前后位投影进行栓塞的患者进行单中心回顾性研究（前后位PAE组），采用以下技术：在前后位血管造影视图上识别前列腺动脉的起源。利用规划计算机断层血管造影的解剖标志。将血管造影导管或微导管向髂内动脉前支远端推进。在前列腺动脉预期起源部位用微导丝轻柔探查。在研究期间，前后位PAE方法最初应用于所有PAE患者，当该方法失败时，获取额外陡峭斜位投影；双侧PAE且两侧盆腔均有前后位和斜位投影的患者组成标准PAE（S-PAE）组。比较前后位PAE组与S-PAE组的基线临床和解剖特征、技术/操作方面及结果。
研究了46例患者（92侧盆腔）。12/46例患者（26.0%）可行前后位PAE：9/46例患者（19.5%）为单侧前后位PAE；3/46例患者（6.5%）为双侧前后位PAE。前后位PAE组前列腺更大（p = 0.047），前列腺动脉更大（p < 0.001）。两组间体重指数（BMI）和其他基线特征相当（平均BMI，前后位PAE组：27.9±3.6，S-PAE组：27.0±3.5，p = 0.451）。前后位PAE组平均透视时间和剂量面积乘积更低（分别为46.3 vs 57.9分钟，p = 0.084；22924.9 vs 35800.4 μGym，p = 0.018）。PAE术后三个月，前后位PAE组和S-PAE组的临床成功率相当（11/12 vs 31/34，p = 0.959），平均国际前列腺症状评分降低程度相当（60.2% vs 58.1%，p = 0.740）。未发生重大并发症。
前后位PAE可显著减少辐射暴露，似乎可行、安全且有效，但仅适用于相对较少比例的患者。
