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

Ryun Gil; Dong Jae Shim; Doyoung Kim; Dong Hwan Lee; Jung Jun Kim; Jung Whee Lee

doi:10.3348/kjr.2021.0934

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

Korean J Radiol. 2022 May;23(5):548-554. doi: 10.3348/kjr.2021.0934.

Authors

Ryun Gil¹, Dong Jae Shim², Doyoung Kim¹, Dong Hwan Lee³, Jung Jun Kim³, Jung Whee Lee¹

Affiliations

¹ Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
² Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. inharad@naver.com.
³ Department of Urology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

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.

Keywords: Lower urinary tract symptoms; Percutaneous transcatheter embolization; Prostate; Prostatic artery embolization.

MeSH terms

Embolization, Therapeutic* / adverse effects
Femoral Artery
Humans
Lower Urinary Tract Symptoms* / etiology
Lower Urinary Tract Symptoms* / therapy
Male
Prostate / diagnostic imaging
Prostatic Hyperplasia* / diagnostic imaging
Prostatic Hyperplasia* / etiology
Prostatic Hyperplasia* / therapy
Radial Artery
Retrospective Studies
Treatment Outcome