To present and evaluate an approach for reduction of utilization of steep oblique angiographic projections during prostatic artery embolization (PAE). Single-center, retrospective study of patients who underwent bilateral PAE (from October 2018 to November 2019) and in whom it was possible to embolize PA of at least one pelvic side utilizing anteroposterior projections only (AP-PAE group), with the following techniques: Identification of the origin of PA on anteroposterior angiographic views. Utilization of anatomic landmarks from the planning computed tomographic angiography. Distal advancement of the angiographic catheter or microcatheter in the anterior division of internal iliac artery. Gentle probing with microguidewire at the expected site of origin of the PA. The AP-PAE approach was initially applied to all PAE patients during the study period and when this approach failed, additional steep oblique projections were acquired; patients who underwent bilateral PAE, with both anteroposterior and oblique projections for both pelvic sides, formed the standard PAE (S-PAE) group. The AP-PAE group was compared with S-PAE group in terms of baseline clinical and anatomic features, technical/procedural aspects and outcomes. Forty-six patients (92 pelvic sides) were studied. AP-PAE was feasible in 12/46 patients (26.0%): unilateral AP-PAE in 9/46 patients (19.5%); bilateral AP-PAE in 3/46 patients (6.5%). AP-PAE group had larger prostates (p = 0.047) and larger PAs (p < 0.001). Body mass index (BMI) and other baseline features were comparable between the two groups (mean BMI, AP-PAE group: 27.9 ± 3.6, S-PAE group: 27.0 ± 3.5, p = 0.451). Mean fluoroscopy time and dose area product were lower in AP-PAE group (46.3 vs 57.9 min, p = 0.084 and 22,924.9 vs 35,800.4 μGy.m2, p = 0.018, respectively). Three months post PAE, comparable clinical success rates (11/12 vs 31/34, p = 0.959) and mean International Prostate Symptom Score reduction (60.2% vs 58.1%, p = 0.740) were observed for AP-PAE and for S-PAE group, respectively. No major complications were encountered. AP-PAE is associated with significant reduction in radiation exposure and appears to be feasible, safe and effective, but it can be applied in a relatively small percentage of patients.

中文翻译：

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前列腺动脉栓塞术在前后投影与斜斜投影中进行：单中心回顾性比较分析

提出并评估一种在前列腺动脉栓塞（PAE）期间减少使用陡峭倾斜血管造影投影的方法。对接受双侧PAE（2018年10月至2019年11月）并且仅通过前后位投射（AP-PAE组）可以栓塞至少一侧骨盆侧PA的患者进行单中心回顾性研究（AP-PAE组） ：在前后血管造影视图上鉴定PA的起源。利用计划计算机断层血管造影术中的解剖标志。内动脉前段血管造影导管或微导管的远侧推进。在PA的预期起源部位使用微导丝进行温和探测。在研究期间，最初将AP-PAE方法应用于所有PAE患者，当该方法失败时，又获得了额外的倾斜斜投影。接受双侧PAE并在骨盆两侧前后突出的患者组成标准PAE（S-PAE）组。将AP-PAE组与S-PAE组在基线临床和解剖特征，技术/程序方面以及结局方面进行了比较。研究了46例患者（92个骨盆侧）。AP / PAE在12/46例患者中可行（26.0％）：单侧AP-PAE在9/46例患者中（19.5％）；3/46例患者中双侧AP-PAE（6.5％）。AP-PAE组具有较大的前列腺（p = 0.047）和较大的PA（p <0.001）。两组之间的体重指数（BMI）和其他基线特征相当（平均BMI，AP-PAE组：27.9±3.6，S-PAE组：27.0±3.5，p = 0.451）。AP-PAE组的平均透视时间和剂量面积积较低（分别为46.3 vs 57.9 min，p = 0.084和22,924.9 vs 35,800.4μGy.m2，p = 0.018）。PAE后三个月，对于AP-PAE和S-PAE，观察到相当的临床成功率（11/12 vs 31/34，p = 0.959）和平均国际前列腺症状评分降低（60.2％vs 58.1％，p = 0.740）。 PAE组。没有遇到重大并发症。AP-PAE可以显着减少辐射暴露，并且似乎是可行，安全和有效的，但可以在相对较小的患者中使用。AP-PAE组和S-PAE组分别观察到可比较的临床成功率（11/12 vs 31/34，p = 0.959）和平均国际前列腺症状评分降低（60.2％vs 58.1％，p = 0.740）。没有遇到重大并发症。AP-PAE可以显着减少辐射暴露，并且似乎是可行，安全和有效的，但可以在相对较小的患者中使用。AP-PAE组和S-PAE组分别观察到可比较的临床成功率（11/12 vs 31/34，p = 0.959）和平均国际前列腺症状评分降低（60.2％vs 58.1％，p = 0.740）。没有遇到重大并发症。AP-PAE可以显着减少辐射暴露，并且似乎是可行，安全和有效的，但可以在相对较小的患者中使用。