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Prostatic Artery Embolization for Lower Urinary Tract Symptoms via Transradial Versus Transfemoral Artery Access: Single-Center Technical Outcomes

  • Ryun Gil (Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Dong Jae Shim (Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Doyoung Kim (Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Dong Hwan Lee (Department of Urology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jung Jun Kim (Department of Urology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jung Whee Lee (Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2021.12.12
  • 심사 : 2022.03.03
  • 발행 : 2022.05.01

초록

Objective: To evaluate the safety and feasibility of prostatic artery embolization (PAE) via transradial access (TRA) compared with transfemoral access (TFA). Materials and Methods: This retrospective study included 53 consecutive men with lower urinary tract symptoms (LUTS) who underwent PAE between September 2018 and September 2021. Thirty-one patients (mean age ± standard deviation: 70.6 ± 8.4 years) were treated with TFA, including 14 patients treated before adopting TRA. Since December 2019, TRA has also been attempted with the procedure's selection criteria of patent carpal circulation and a height ≤ 172 cm, with 22 patients treated via TRA (69.1 ± 9.6 years). Parameters of technical success (defined as successful bilateral embolization), clinical success (defined as LUTS improvement), procedural time, radiation dose, and adverse events were compared between the two groups using the Fisher's exact test, independent sample t test, Wilcoxon signed-rank test, or Mann-Whitney test. Results: All patients received at least one-side PAE. Technical success of PAE was achieved in most patients (TRA, 21/22; TFA, 30/31; p > 0.999). No technical problem-related conversion from TRA to TFA occurred. The clinical success rate was 85% (11/13) in patients with TRA, and 89% (16/18) in patients with TFA for follow-up > 2 weeks post-PAE (median, 3 months) (p > 0.999). The median procedure time was similar in both groups (TRA, 81 minutes vs. TFA, 94 minutes; p = 0.570). No significant dose differences were found between the TRA and TFA groups in the dose-area product (median Gycm2, 95 [range, 44-255] for TRA and 84 [34-255] for TFA; p = 0.678) or cumulative air kerma (median mGy, 609 [236-1584] for TRA and 634 [217-1594] for TFA; p = 0.551). No major adverse events occurred in either of the groups. Conclusion: PAE via TRA is a safe and feasible method comparable to conventional TFA. It can be safely implemented by selecting patients with patent carpal circulation and adequate height.

키워드

과제정보

The authors thank Ga Young Yea (Bio Medical Art, Incheon Catholic University) for the informative illustration.

참고문헌

  1. Gao YA, Huang Y, Zhang R, Yang YD, Zhang Q, Hou M, et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial. Radiology 2014;270:920-928 
  2. Abt D, Hechelhammer L, Mullhaupt G, Markart S, Gusewell S, Kessler TM, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ 2018;361:k2338 
  3. Knight GM, Talwar A, Salem R, Mouli S. Systematic review and meta-analysis comparing prostatic artery embolization to gold-standard transurethral resection of the prostate for benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2021;44:183-193 
  4. Fischman AM, Swinburne NC, Patel RS. A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol 2015;18:58-65 
  5. Ziakas AG, Koskinas KC, Gavrilidis S, Giannoglou GD, Hadjimiltiades S, Gourassas I, et al. Radial versus femoral access for orally anticoagulated patients. Catheter Cardiovasc Interv 2010;76:493-499 
  6. Chu HH, Kim JW, Shin JH, Cho SB. Update on transradial access for percutaneous transcatheter visceral artery embolization. Korean J Radiol 2021;22:72-85 
  7. Isaacson AJ, Fischman AM, Burke CT. Technical feasibility of prostatic artery embolization from a transradial approach. AJR Am J Roentgenol 2016;206:442-444 
  8. Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M. Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic-controlled analysis. Cardiovasc Intervent Radiol 2016;39:44-52 
  9. Bhatia S, Sinha V, Bordegaray M, Kably I, Harward S, Narayanan G. Role of coil embolization during prostatic artery embolization: incidence, indications, and safety profile*. J Vasc Interv Radiol 2017;28:656-664.e3 
  10. Uflacker AB, Haskal ZJ, Baerlocher MO, Bhatia SS, Carnevale FC, Dariushnia SR, et al. Society of interventional radiology research reporting standards for prostatic artery embolization. J Vasc Interv Radiol 2020;31:891-898.e1 
  11. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196 
  12. Cornelis FH, Bilhim T, Hacking N, Sapoval M, Tapping CR, Carnevale FC. CIRSE standards of practice on prostatic artery embolisation. Cardiovasc Intervent Radiol 2020;43:176-185 
  13. Shiozawa S, Tsuchiya A, Endo S, Kato H, Katsube T, Kumazawa K, et al. Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: comparison with conventional transfemoral approach. J Clin Gastroenterol 2003;37:412-417 
  14. Resnick NJ, Kim E, Patel RS, Lookstein RA, Nowakowski FS, Fischman AM. Uterine artery embolization using a transradial approach: initial experience and technique. J Vasc Interv Radiol 2014;25:443-447 
  15. Iezzi R, Posa A, Bilhim T, Guimaraes M. Most common misconceptions about transradial approach in interventional radiology: results from an international survey. Diagn Interv Radiol 2021;27:649-653 
  16. Bhatia S, Harward SH, Sinha VK, Narayanan G. Prostate artery embolization via transradial or transulnar versus transfemoral arterial access: technical results. J Vasc Interv Radiol 2017;28:898-905