Prostate artery embolization (PAE): the tricks to success

Understanding of standard pelvic arterial anatomy and common normal variants encountered during prostate artery embolization (PAE). Role of cross sectional imaging in pre-procedural planning and post procedural follow-up. Techniques employed to avoid non-targeted embolization and achieve a successful procedural outcome. PAE has historically been used to manage intractable haematuria and has only recently been used to manage lower urinary tract symptoms (LUTS) related to BPH. Many men over 50 experience debilitating LUTS caused by obstruction of the bladder outlet by an enlarged prostate. PAE offers these patients a minimally invasive treatment option, however a sound understanding of arterial anatomy is essential in order to achieve a successful result and avoid non-targeted emboliztaion. We describe our technique of PAE and tips employed to achieve a successful procedural outcome. Meticulous pre-procedural planning is essential and a drawing of the arterial configuration of each internal iliac artery, based on CT images, can be used as an aid to interpret angiographic images. The prostatic arteries are cannulated using a combination of Progreat microcatheter and Fathom guidewire, prior to which gyceryl-trinitrate is administered, to avoid spasm. Due to stasis in the vessel, road map can be used to identify the end point of embolization and prevent non-targeted embolization. PAE is a safe and minimally invasive treatment option for patients with BPH, avoiding the complications associated with surgery. The procedure is challenging, however we present techniques, which in our experience have resulted in a successful procedural outcome, minimizing the risk of non-targeted embolization.