Predictors of technical outcome for prostatic artery embolisation using pre-procedural CT angiography

Area of Science:

• Interventional Radiology
• Vascular Imaging
• Urology

Background:

• Prostate artery embolisation (PAE) is a treatment for benign prostatic hyperplasia.
• Predicting procedural technical challenges and outcomes in PAE is currently difficult.
• Prolonged procedural times in PAE can increase patient radiation dose and impact resource planning.

Purpose of the Study:

• To identify patient-specific factors from planning computed tomography angiography (CTA) that predict technical challenges and outcomes in PAE.
• To correlate pre-procedural variables with procedural parameters like fluoroscopy time, radiation dose, and technical success.

Main Methods:

• Retrospective analysis of 75 consecutive PAE patients.
• Objective measurement of pre-procedural CTA variables including prostate volume, prostate artery diameter, aortic atheroma, and iliac tortuosity.
• Correlation of these variables with procedural outcomes (fluoroscopy time, air kerma, dose area product, cone beam CTs, technical success).
• Statistical analysis using linear regression, ANOVA, t tests, and chi-squared tests.

Main Results:

• Aortic atheroma severity significantly increased fluoroscopy time.
• Smaller prostate arteries and lower prostate volumes were associated with significantly greater air kerma (radiation dose).
• Smaller prostate artery size increased the likelihood of unilateral embolisation or technical failure.
• Vascular tortuosity and prostatic artery origin did not significantly affect fluoroscopy time or dose area product.

Conclusions:

• Pre-operative prediction of technical outcomes in PAE remains challenging.
• Vascular calcification (atheroma), prostate artery diameter, and prostate volume are important factors influencing PAE risk/benefit assessment.
• Identifying these factors aids in patient selection and procedural planning for PAE.