title: Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH.
abstract: BACKGROUND
  During PAE, preembolization angiography of the prostatic artery can show large extra-prostatic shunts, at high risk, if embolized, of rectal or penile necrosis. We report our experience with 11 consecutive patients who underwent protective embolization of large extra-prostatic shunts before successful PAE.
  
  
  METHODS
  We treated 11 consecutive male patients (mean age 67 years), part of a series of 55 consecutive male patients referred for PAE to treat LUTS due to BPH, between December 2013 and January 2015. The procedure involved the exclusion of an extra-prostatic shunt originating from the PA, prior to complete bilateral PAE. We compared the safety and efficacy of the 11 shunt exclusions followed by embolization of the PA to the other 44 basic PAE. Clinical success was defined as a decrease of 25 % or eight points of IPSS, QoL <3 or a one-point decrease, and a Qmax improvement of 25 % or 2.5 mL/s.
  
  
  RESULTS
  We had a 100 % rate of occlusion of the anastomosis. Bilateral embolization of the PA was performed in all patients with no additional time of procedure (p = 0.18), but a significant increase of dose area product (p = 0.03). Distal (PErFecTED) embolization was possible in 64 %. There was no worsening of erectile dysfunction, no rectal or penile necrosis, no immediate or late other clinical complications. Clinical success was 91 % (mean follow-up: 3.5 months), compared to 78 % for the entire PAE group.
  
  
  CONCLUSIONS
  PAE using the protection technique in case of large extra-prostatic shunts is as safe and effective as basic procedures and does not induce any additional time of procedure.
authors.affiliation: Faculté de Médecine, Université Paris Descartes - Sorbonne - Paris - Cité, Paris, France. gregamouyal@hotmail.com.|Interventional Radiology Department, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75015, Paris, France. gregamouyal@hotmail.com.
authors.forename: Gregory
authors.initials: G
authors.lastname: Amouyal
authors.affiliation: Faculté de Médecine, Université Paris Descartes - Sorbonne - Paris - Cité, Paris, France.|Interventional Radiology Department, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75015, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Chague
authors.affiliation: Faculté de Médecine, Université Paris Descartes - Sorbonne - Paris - Cité, Paris, France.|Interventional Radiology Department, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75015, Paris, France.|INSERM U970, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Pellerin
authors.affiliation: Clinical Research Unit, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75015, Paris, France.|INSERM U1418, Paris, France.
authors.forename: Helena
authors.initials: H
authors.lastname: Pereira
authors.affiliation: Faculté de Médecine, Université Paris Descartes - Sorbonne - Paris - Cité, Paris, France.|Interventional Radiology Department, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75015, Paris, France.
authors.forename: Costantino
authors.initials: C
authors.lastname: Del Giudice
authors.affiliation: Interventional Radiology Department, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75015, Paris, France.|INSERM U970, Paris, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Dean
authors.affiliation: Faculté de Médecine, Université Paris Descartes - Sorbonne - Paris - Cité, Paris, France.|Urology Department, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75015, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Thiounn
authors.affiliation: Faculté de Médecine, Université Paris Descartes - Sorbonne - Paris - Cité, Paris, France.|Interventional Radiology Department, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75015, Paris, France.|INSERM U970, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Sapoval
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001165:Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000098:blood supply* / Q000000981:diagnostic imaging; D011470:Prostatic Hyperplasia / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Embolization, therapeutic; Endovascular procedures; Prostate; Prostatic hyperplasia; Radiology, interventional