前立腺動脈塞栓術における経橈骨動脈アプローチの安全性と技術的成功：系統的レビューとメタアナリシス

Transradial access (TRA) has become an alternative vascular access site for a range of procedures in interventional radiology. The aim of this systematic review and meta-analysis was to assess the safety and technical success of TRA for prostate artery embolisation (PAE).

A systematic search of the Medline, Embase, and Scopus databases was performed in November 2024. Primary studies describing outcomes in TRA for PAE involving 10 or more adult patients were included. The primary efficacy outcome was technical success, defined as bilateral PAE meaning successful embolisation of both prostate arteries, and primary safety outcome was 30-day mortality. The ROBINS-I tool was used to assess risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation framework was used to assess the strength of evidence.

Six retrospective studies were included in this review (n=1208 patients). A random-effects meta-analysis was performed, demonstrating a 96.5 % technical success rate of TRA for PAE. Four (0.3 %) major complications and 53 (4.4 %) minor complications occurred. Mean fluoroscopy time, procedure time, and air kerma via TRA were all comparable to other access sites. Moderate between-study heterogeneity was present (I² = 41.3 %). The overall risk of bias was moderate; however, no significant publication bias was present. The strength of evidence was moderate.

The findings of this study support TRA as a feasible alternative access route for PAE with similar complication rates, procedure times, and radiation doses compared to transfemoral access (TFA). However, further prospective, controlled studies are required to evaluate TRA head-to-head with TFA to establish whether one approach is superior.