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Embolization updates pages 10–13
Profile: Alban Denys page 22
New data:
Thrombectomy for PE page 24
September 2022 | Issue 87
“Promising” 10-year data on PAE for benign prostatic hyperplasia presented at ET Tiago Bilhim (Saint Louis Hospital, Lisbon, Portugal) presented during the Scientific Paper session at this year’s European Conference on Embolotherapy (ET; 22–25 June, Nice, France), and won the award of best abstract for his and co-authors’ ‘Long-term outcome of prostatic artery embolization for patients with benign prostatic hyperplasia’. A key takeaway from his presentation was that prostatic artery embolization (PAE) appears a “safe and effective treatment option for patients with benign prostatic hyperplasia [BPH]”.
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ilhim et al conducted this single-centre retrospective study in 1,072 patients with followup over a 10-year period to assess the outcomes of PAE for, as stated in the paper’s title, BPH in patients with lower urinary tract symptoms (LUTS). The authors begin the paper by outlining some of the pre-existing research in the area of PAE for BPH— data have shown that compared to prostatic surgery, PAE can achieve “similar LUTS improvements with a lower adverse event profile.” However, surgery leads to improvement in all BPH objective measurements and data suggest that retreatment rates for patients who underwent prostatic surgery may also be lower. In his presentation, Bilhim reported that the study ran from March 2009–2019, and the 1,072 patients who were studied excluded those who did not have follow-up (11% of the original study population), the 1% in whom PAE was a technical failure and the 3% who were diagnosed with prostate cancer during follow-up. Bilhim went on to detail how each patient was evaluated for International Prostate Symptom Score (IPSS) and quality of life (QoL), prostate volume (PV)—measured with transrectal ultrasound—prostate-specific
antigen (PSA), peak urinary flow rate (Qmax) and postvoid residual (PVR) volume. Follow-up appointments took place yearly and also evaluated use of prostatic medication, reintervention rates and repeat PAE and prostatectomy rates. In terms of embolic agent, Bilhim proceeded to explain that over the 10 years, various embolic agents were used. These were non-spherical polyvinyl alcohol (PVA) particles, measuring 100–300 micrometres and spherical PVA microspheres, measuring 300–500 micrometres. Some patients received treatment with trisacryl gelatin microspheres measuring 100–500 micrometres, or 250-400 micrometres polyzene-coated hydrogel microspheres. Notably, the first group treated within the study remit received PVA particles, so their follow-up was longer. Mean follow-up time was 4.39±2.37 years. Adverse events were determined according to Cardiovascular and Interventional Radiology Society of Europe (CIRSE) criteria, and Bilhim stated that they did not consider frequency, urethral burning sensation or slight pelvic pain lasting for one to three days post-PAE as being in this category, but rather as post-PAE syndrome. Tiago Bilhim
Treating placenta accreta spectrum with multivessel pelvic embolization The findings of a collaborative research project at the University of California San Diego (UCSD), San Diego, USA were presented in an abstract titled ‘Multivessel pelvic embolization during caesarean hysterectomy for placenta accreta spectrum: A single-centre experience and comparison to internal iliac artery balloon occlusion’ at the Society of Interventional Radiology (SIR) 2022 Annual Meeting (11–16 June, Boston, USA). The abstract’s lead author, Christine Boone (UCSD, San Diego, USA) explained to Interventional News her surprise at the extent of blood loss reduction with embolization compared to internal iliac artery balloon occlusion (IIABO), alongside other noteworthy findings. THIS COLLABORATION AMONG interventional radiology, obstetrics and gynaecology, and maternal foetal medicine teams aimed to compare how intraoperative pelvic embolization performed to reduce blood loss during surgical management of placenta accreta spectrum (PAS) versus IIABO. Regarding the study’s results, Boone first outlined her prediction that blood loss would be “similar or better” among the embolization group. “But what surprised me was by how much [embolization improved outcomes],” Boone went on to acknowledge. In the IIABO group, she noted, median blood loss was 2.5 Continued on page 4
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