Prostatic Artery Embolization: Equipment, Procedure Steps, and Overcoming Technical Challenges

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art_CARNEVALE_Prostatic_Artery_Embolization_Equipment_Procedure_Steps_and_Overcoming_2020.PDF (1.07 MB)
Citações na Scopus
6
Tipo de produção
article
Data de publicação
2020
DOI
Scopus
Web of Science
PubMed
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Título do Volume
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Citação
TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY, v.23, n.3, article ID 100691, 6p, 2020
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Unidades Organizacionais
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Resumo
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.
Palavras-chave
Prostatic artery embolization, Benign prostatic hyperplasia, Lower urinary tract symptoms, Cone-beam computed tomography, Proximal Embolization First, Then Embolize, Distal (PErFecTED) technique
URI
https://observatorio.fm.usp.br/handle/OPI/39569
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Coleções
Artigos e Materiais de Revistas Científicas - HC/InRad
Artigos e Materiais de Revistas Científicas - HC/ICESP