Abstract No. 384 Effect of pelvic vascular anatomy on fluoroscopy time during prostate artery embolization

Abstract

Prostate artery embolization (PAE) for lower urinary tract symptoms secondary to benign prostate hyperplasia is a minimally invasive treatment for patients when medical therapy fails, who are poor surgical candidates, or decline invasive therapy (1). The correlation between subtypes of pelvic vascular anatomy and procedure length remains unclear. Identification of difficult anatomy will help guide procedural planning and patient informed consent. A retrospective review was performed on patients who underwent PAE between August 2017 and August 2019 at three hospital sites. Data on pelvic vascular anatomy and PAE procedural times were collected and analyzed. A total of 42 patients received preprocedural cross-sectional pelvic imaging. Eighty-two prostate arteries were embolized. Mean age was 72 years (range, 55-91 years) and was not shown to be correlated with fluoroscopy time (FT) per embolization (R2 = 0.003). Tortuosity of the pelvic vasculature on preprocedural imaging was associated with significantly increased FT per embolization (38.0 vs. 24.8 min, P <0.05). A prostate artery originating from the obturator artery was also associated with increased FT per embolization compared to those originating from other major branches of the internal iliac artery (41.3 vs. 26.6 min, P < 0.05). Our study demonstrated a significant increase in FT when the prostate artery originates from the obturator artery. We also confirmed a prior study which described an increase in FT when a patient has tortuous pelvic vasculature. Practitioners performing PAE should be aware of certain anatomic features on preprocedural imaging to better guide procedural time allocation, suite utilization, and informed consent.