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. 2022 Jan-Feb;55(1):6-12.
doi: 10.1590/0100-3984.2021.0021.

Protection of nontarget structures in prostatic artery embolization

Bruna Ferreira Pilan  1 , André Moreira de Assis  1 , Airton Mota Moreira  1 , Vanessa Cristina de Paula Rodrigues  1 , Francisco Cesar Carnevale  1
Affiliations

Protection of nontarget structures in prostatic artery embolization

Bruna Ferreira Pilan et al. Radiol Bras. 2022 Jan-Feb.

Abstract
in English, Portuguese

Objective: To describe the efficacy and safety of protective embolization during prostatic artery embolization, as well as to discuss its clinical relevance.

Materials and methods: This was a retrospective, observational, single-center study including 39 patients who underwent prostatic artery embolization to treat lower urinary tract symptoms related to benign prostatic hyperplasia between June 2008 and March 2018. Follow-up evaluations, performed at 3 and 12 months after the procedure, included determination of the International Prostate Symptom Score, a quality of life score, and prostate-specific antigen levels, as well as ultrasound, magnetic resonance imaging, and uroflowmetry.

Results: Protective embolization was performed in 45 arteries: in the middle rectal artery in 19 (42.2%); in the accessory internal pudendal artery in 11 (24.4%); in an internal pudendal artery anastomosis in 10 (22.2%); in the superior vesical artery in four (8.9%); and in the obturator artery in one (2.2%). There was one case of nontarget embolization leading to a penile ulcer, which was attributed to reflux of microspheres to an unprotected artery. There were no complications related to the protected branches. All of the patients showed significant improvement in all of the outcomes studied (p < 0.05), and none reported worsening of sexual function during follow-up.

Conclusion: Protective embolization can reduce nontarget embolization during prostatic artery embolization without affecting the results of the procedure. In addition, no adverse events other than those expected or previously reported were observed. Therefore, protective embolization of pudendal region is safe.

Objetivo: Descrever a eficácia e a segurança da embolização de proteção na embolização de artérias prostáticas e discutir sua relevância clínica.

Materiais e métodos: Estudo retrospectivo, observacional, de um único centro, que inclui 39 pacientes submetidos a embolização de artérias prostáticas para tratamento de sintomas do trato urinário inferior relacionados a hiperplasia benigna da próstata, de junho de 2008 a março de 2018. O acompanhamento foi realizado em 3 meses e 12 meses, incluindo International Prostate Symptom Score, escore de qualidade de vida, antígeno prostático específico, ultrassom, ressonância magnética e urofluxometria.

Resultados: Embolização de proteção foi realizada em 45 artérias: artérias retais médias em 19 (42,2%); artérias pudendas internas acessórias em 11 (24,4%); anastomoses com ramos da artéria pudenda interna em 10 (22,2%); artérias vesicais superiores em quatro (8,9%); e artéria obturatória em uma (2,2%). Houve um caso de embolização não alvo que provocou uma úlcera peniana, atribuída a refluxo de partículas para uma artéria não protegida. Não houve complicações relacionadas com os ramos protegidos. Os pacientes apresentaram melhora significativa em todos os resultados estudados (p < 0,05) e não relataram piora da função sexual durante o acompanhamento.

Conclusão: Embolização de proteção pode ser realizada para diminuir embolização não alvo sem interferir nos resultados da embolização de artérias prostáticas. Além disso, não foi observado nenhum evento adverso diferente dos já esperados ou previamente publicados. A embolização de proteção na região pudenda é segura.

Keywords: Embolization, therapeutic/methods; Erectile dysfunction; Prostate; Prostatic hyperplasia.

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Figures

Figure 1
Figure 1
A: Selective digital subtraction angiography of the left prostatic artery, ipsilateral oblique view. White arrow: anteromedial branch; black arrow: common trunk of the posterolateral branch of the prostatic artery and middle rectal artery; arrowhead: middle rectal artery; star: prostate gland. B: Selective prostatic artery digital subtraction angiography after PE of the posterolateral branch-rectal trunk. Black arrow: prostatic artery; white arrow: anteromedial branch; black arrowhead: posterolateral branch-rectal trunk; star: prostate gland; white arrowhead: microcoil.
Figure 2
Figure 2
A: Selective digital subtraction angiography of the accessory pudendal artery. Black arrow: prostatic branch; white arrow: distal accessory internal pudendal artery; star: prostate gland; white arrowhead: pudendal territory; black arrowhead: protective coil embolization of the contralateral middle rectal artery. B: Digital subtraction angiography after PE of the distal accessory internal pudendal artery. Black arrow: anteromedial prostatic branch; white arrow: posterolateral branch of the prostatic artery; star: prostate gland; white arrowhead: protective coil embolization of an accessory internal pudendal artery; black arrowhead: protective coil embolization of the contralateral middle rectal artery.
Figure 3
Figure 3
A: Selective digital subtraction angiography of the right internal iliac artery, ipsilateral oblique view. The prostatic artery (arrowhead) originates from the internal pudendal artery—representing a type IV variation (arrow)—in a very short trunk. B: Fluoroscopy without digital subtraction angiography or contrast injection, after PAE. The microcatheter is within the prostatic artery (arrow). Note the low flow of the contrast medium in the internal pudendal artery (arrowhead), indicating that there was reflux of the microspheres, which was the cause of the NTE in this patient.
See this image and copyright information in PMC

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