Comparison of safety and feasibility of prostate artery embolization via transradial access versus transfemoral access: a single center experience

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Andrew Richardson, MD MBA (he/him/his)

Interventional Radiology Resident
Jackson Memorial Hospital

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

KS

Khushi Shah, n/a

Medical Student
University of Miami Miller School of Medicine
AM

Aneesha Maini, n/a

Medical Student
University of Miami Miller School of Medicine
Kenneth Richardson, MS-4

University of Miami Medical Student
University of Miami
MA

Mohammed Aldajani, MD

Interventional Radiology Resident
Jackson Memorial Hospital
JB

Joseph Boateng, MD

Interventional Radiology Resident
Jackson Memorial Hospital
AB

Ansh Bhatia, n/a

Medical Student
KEM Hospital
AS

Akshat Sanan, MS-4

University of Miami Medical Student
UNIVERSITY OF MIAMI
Hamed Jalaeian, MD, MSc, RPVI (he/him/his)

Assistant Professor Clinical Interventional Radiology
University of Miami Health System
Shivank Bhatia, MD

Professor of Interventional Radiology
University of Miami

Disclosure(s):

Andrew Richardson, MD MBA: No financial relationships to disclose

Kenneth Richardson, MS-4: No financial relationships to disclose

Hamed Jalaeian, MD, MSc, RPVI: No financial relationships to disclose

Shivank Bhatia, MD: Embolx: Ownership Interest (Ongoing); Merit Medical: Contracted Research (Ongoing), Research Grant Recipient (Ongoing)

Purpose: To expand upon the safety and feasibility of transradial access (TRA) during prostate artery embolization compared to transfemoral access (TFA).

Materials and Methods: 1000 patients who underwent PAE from April 2014 to August 2022 were assessed for procedural outcomes and adverse events. 823 patients (82.3%) underwent TRA and 177 patients (17.7%) underwent TFA. Mean age was 70.2 ± 9.5 years. PAE was performed for patients with lower urinary symptoms, acute urinary retention with indwelling catheter, or hematuria. Radial artery diameter, Barbeau waveform, procedure time, fluoroscopy time, dose-area product (DAP), air kerma and all complications were reviewed. Technical success was defined as catheterization of the bilateral prostatic arteries and bilateral prostatic artery embolization. Exclusion criteria for TRA was radial artery diameter < 2 mm or Barbeau type D. The TRA group had 16.5%, 82.8%, and 0.7% Barbeau A, B, and C, respectively. Adverse events were recorded using the Clavien-Dindo classification. A two-tailed p< 0.05 was considered statistically significant.

Results: Technical success was achieved in 798 patients (97.2%) in the TRA group and 167 patients (93.3%) in the TFA group (p=0.02). Mean procedure time (74.0 ± 35.6 vs. 107.2 ± 57.4 min, p< 0.001), fluoroscopy time (31.0 ± 15.5 vs. 41.6 ± 22.1 min, p< 0.01), DAP (20705.0 ± 15962.3 vs. 31833.2 ± 22124.3 μGy·m², p< 0.01), and air kerma (1712.6 ± 1716.0 vs. 3028.7 ± 2695.4 mGy, p< 0.01) were lower in the TRA group versus the TFA group. Furthermore, patients undergoing TRA versus TFA had lower access site complications, such as ecchymosis 6 (1%) vs 9 (6.1%) (p< 0.01) and hematomas 5 (0.8%) vs 6 (4%) (p=0.01), respectively. Three TRA patients experienced TIAs and fully recovered without further intervention or disability. One patient experienced a radial artery occlusion without further symptoms.

Conclusion: Transradial PAE is a safe and feasible alternative compared to conventional transfemoral PAE with higher technical success, shorter procedure times, lower radiation exposure, and lower access related complications.