SIR 2024
Embolization
Ajay Varadhan, BS
Northwestern Interventional Radiology Research Fellow and Medical Student
Northwestern University Feinberg School of Medicine, Chicago, IL
Financial relationships: Full list of relationships is listed on the CME information page.
Piyush Goyal, BS
Medical Student
Northwestern University Feinberg School of Medicine, Chicago, IL
Disclosure information not submitted.
Elias Hohlastos, MD
Professor
Northwestern University Feinberg School of Medicine
Disclosure information not submitted.
Kimberly Jenkins, n/a
Patient Care Coordinator
Northwestern Memorial Hospital
Disclosure information not submitted.
Riad Salem, MD, FSIR, MBA
Professor
Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Samdeep Mouli, MD
Associate Professor
Northwestern University Feinberg School of Medicin
Financial relationships: Full list of relationships is listed on the CME information page.
(1) To report comprehensive assessment of pelvic arterial anatomy seen during prostate artery embolization (PAE) using intraprocedural hybrid CT Angiography (CTA). (2) To compare identification of origins and collaterals by intraprocedural hybrid CTA to previously published reports.
Background:
PAE is an effective therapy for lower urinary tract symptoms (LUTS) from benign prostate hyperplasia {1}. Safety and efficacy depend on thorough identification of pelvic arterial anatomy {2}. Limited arterial identification with conventional CT, cone-beam CT (CBCT) and digital subtraction angiography (DSA) has been reported {3,4}. However, intraprocedural integrated hybrid CTA can offer streamlined comprehensive assessment of anatomy with superior soft tissue imaging and contrast resolution {5}. This study reports comprehensive pelvic arterial anatomy seen during PAE using intraprocedural hybrid CTA.
Clinical Findings/Procedure Details:
This exhibit will (1) illustrate pelvic artery anatomy and currently utilized classifications; (2) demonstrate assessment of anatomy by intraprocedural integrated hybrid CTA; (3) identify prostatic artery origins and clinically relevant collaterals; (4) describe pelvic arterial anatomy and frequency of variants by previously published reports; and (5) demonstrate technical considerations and modifications required for successful embolization based on patient anatomy.
Technique: 240 PAE cases performed between July 2020 and August 2023 in a hybrid CTA suite (Siemens Nexaris, Germany). 480 pelvic sides were reviewed. Recorded anatomy included: prostate (PA), PA collaterals, rectal (RA), obturator (OA), superior vesicle (SVA), and internal pudendal (IPA) arteries.
Conclusion and/or Teaching Points:
Efficacy and safety of PAE depends on thorough identification of pelvic arterial anatomy. Intraprocedural hybrid CTA identifies arterial anatomy that is not seen using other modalities and represents a significant technical advancement for PAE. Improved resolution translates into the identification of origins and collaterals with higher frequencies than previous reports. This exhibit illustrates pelvic arterial anatomy and demonstrates efficacy of intraprocedural integrated hybrid CTA during PAE.