Prostatic Artery Embolization: Comparing Outcomes in Patients with Standard and Non-Standard Anatomy

Tuesday, April 1, 2025

4:12 PM – 4:21 PM CT

Location: Music City Center, 204

Presenting Author(s)

Delmarie M. Rivera-Rodriguez, MD (she/her/hers)

Medical Student
Northwestern Memorial Hospital, Universidad Central del Caribe School of Medicine, United States

Author/Co-author(s)

Ajay Varadhan, BS

Northwestern Interventional Radiology Research Fellow and Medical Student
Northwestern University Feinberg School of Medicine, Chicago, IL, United States
KJ

Kimberly Jenkins, n/a

Patient Care Coordinator
Northwestern Memorial Hospital, United States
EH

Elias Hohlastos, MD

Northwestern Vascular and Interventional Radiology Faculty
Northwestern University Feinberg School of Medicine, Chicago, IL, United States
Riad Salem, MD

Chief of Vascular and Interventional Radiology in the Department of Radiology
Northwestern Memorial Hospital, United States
SM

Samdeep Mouli, MD, FSIR

Associate Professor
Northwestern University Feinberg School of Medicine, United States

Purpose: Prostatic artery embolization (PAE) is an established treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). While certain prostatic artery anatomical factors have been associated with increased procedural difficulties, their influence on clinical outcomes remains unclear {1,2}. This study compares outcomes between patients with non-standard anatomy (NSA) and standard anatomy (SA).

Materials and Methods:

This single-center retrospective study included 145 males with BPH-induced LUTS treated via PAE from 2020-2023. SA (Carnevale Types 1-4) and NSA (Type 5 or significant variations) groups were compared {3}. PAE was performed using 300-500 μm particles under angio-CT guidance (Nexaris, Siemens Healthineers, Germany) via femoral artery approach, with pelvic angiography and cone-beam CT confirming catheterization and embolization {4,5}. Technical success was defined as successful catheterization and embolization of bilateral prostatic arteries without additional interventions. Data collected included mean dose-area product (DPL), fluoroscopy and procedure time, mean number of coils used, baseline and follow-up IPSS, and adverse event rates. Statistical analysis of quantitative data was conducted using Student’s t-test with significance set at p< 0.05.

Results:

The mean age was 68.56 ± 7.71 years for the SA group (n=114) and 65.40 ± 8.02 years for the NSA group (n=30). Technical success was 96% (NSA: 93%; SA: 97%). Mean DPL was 445.06 ± 219.30 Gy·cm² for NSA and 498.30 ± 272.89 Gy·cm² for SA (p=0.40). Fluoroscopy times were similar (NSA: 64.01 ± 8.03 min; SA: 64.36 ± 25.10 min, p=0.94), as were mean procedure times (NSA: 195.77 ± 45.75 min; SA: 191.75 ± 49.06 min, p=0.69). The mean number of coils used was 4.13 ± 3.54 for NSA and 4.04 ± 3.67 for SA (p=0.90). Baseline IPSS scores were similar (NSA: 23.17 ± 5.40; SA: 23.46 ± 6.12, p=0.81). Last follow-up IPSS scores were 11.07 ± 7.54 for NSA and 10.73 ± 7.63 for SA (p=0.83). Both groups showed significant IPSS improvements from baseline to follow-up (p >0.0001). Adverse events were reported at 6.65% for NSA and 5.22% for SA.

Conclusion:

PAE is a feasible and effective treatment for LUTS due to BPH, achieving 96% technical success and comparable outcomes in both SA and NSA patients, highlighting its safety across different anatomical variations.