Bleeding after prostatectomy: endovascular management

Abstract

Background: To evaluate role of interventional radiology (IR) in post-surgical haemorrhagic complications of prostatectomy.

Methods: A retrospective study was performed. From April 2015 to January 2018, 10 patients referred to IR Department for haemorrhagic complications post radical prostatectomy (RP). All patients (mean age: 68.5 years; range, 58-85 years) were successfully treated with superselective trans-arterial embolization. We evaluated technical and clinical success and post procedural complications.

Results: Technical and clinical success was 100% (10/10) and no major complications were identified. No complications related to the endovascular procedures occurred. No recurrences during follow-up (8-20 months) were observed. Among minor complications, only 20% (2/10) developed mild post embolization syndrome.

Conclusions: The endovascular management of significant haemorrhage after prostatectomy is safe and long-term effective, with no major ischaemic events associated to embolization.

Keywords: Transarterial embolization; angiography; interventional radiology (IR); prostate bleeding; surgical complications.

Figure 1

CT scan. Arterial (A) and venous (B) phases, revealed the presence of a pseudoaneurysm; selective arteriography of the internal iliac artery confirmed the presence of the pseudoaneurysm (C); embolization was performed with microcoils and spongostan (D); final angiogram confirmed complete exclusion of the pseudoaneurysm (E).

Figure 2

Arterial blush at CT (black arrow, A); blush at selective arteriography (white arrow, B) and complete embolization with onyx, microcoils and spongostan (white arrow, C).

Figure 3

Arterial and venous phases of the CT scan revealed pseudoaneurysm (A,B); selective angiogram confirmed pseudoaneurysm and sandwich embolization was planned (C, white arrows) and successfully performed (D).