Predictors of technical outcome for prostatic artery embolisation using pre-procedural CT angiography
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INTERVENTIONAL
Predictors of technical outcome for prostatic artery embolisation using pre-procedural CT angiography Luke Lintin 1 & Thomas Barge 1 & Phil Boardman 1 & Gabriel Tong 1 & Charles Tapping 1 Received: 1 April 2020 / Revised: 21 July 2020 / Accepted: 28 August 2020 # European Society of Radiology 2020
Abstract Objectives Predicting patients that will pose procedural technical challenges in prostate artery embolisation (PAE) remains difficult, with prolonged procedural times impacting on both patient dose and resource planning. Understanding the factors that influence these parameters as well as the likelihood of technical success is therefore important in effective patient selection and procedural planning. Methods Data were collected retrospectively for 75 consecutive patients who underwent PAE. Multiple patient predictor variables available from planning computed tomography angiography (CTA) were identified and measured objectively. The vessel angles navigated during the procedure, prostate volume, prostate artery (PA) diameter, PA origin, aortic atheroma, iliac tortuosity and baseline demographics were correlated with outcome variables (fluoroscopy time, air kerma (AK), dose area product (DAP), the number of cone beam CTs (CBCTs)) performed and whether bilateral embolisation was possible (technical success). Data were analysed using linear regression, ANOVA, t tests and chi-squared tests. Results Aortic atheroma severity significantly increased fluoroscopy time (p = 0.004), whilst air kerma (AK) was significantly greater in patients with smaller prostatic arteries (p = 0.009) and smaller pre-procedural prostate volumes (p = 0.038). Increased vascular tortuosity and prostatic artery origin were not shown to significantly affect fluoroscopy time or DAP. Smaller prostate artery size (p = 0.007) also increases the likelihood of either unilateral embolisation or technical failure. Conclusions Pre-operative prediction of technical outcome measures in PAE remains challenging. However, vascular calcification, prostatic artery diameter and prostate volume are likely to be important factors when considering the risk/benefits of PAE. Key Points • Increased severity of atheroma and the presence of small prostate arteries increase fluoroscopy time and AK respectively during prostate artery embolisation. • Lower pre-procedural prostate volume increases the AK during procedures. • Smaller prostate artery size increases the likelihood of either unilateral embolisation or technical failure. Keywords Prostate . Embolisation, therapeutic . Prostatic hyperplasia . Computer tomography angiography . Vascular calcification
Abbreviations AK Air kerma ANOVA Analysis of variance CBCT Cone beam computed tomography CFA Common femoral artery CTA Computed tomography angiography DAP Dose area product
DSA IPSS MIP PA PAE PSA TI
* Charles Tapping [email protected]
Introduction
1
Oxford University Hospitals NHS Foundation Trust The Churchill Hospital, Old Rd, Oxford OX3 7LE, UK
Digital subtraction angiography Internati
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