REGULAR CONTENT
Final ID
589
Type
Educational Exhibit-Poster Only
Authors
R Riaz1, C Rogers1, M Zanini1, D Pucheril1, N Gupta1, S Schwartz1
Institutions
1Henry Ford Hospital, Detroit, MI
Purpose
Present a case of prostatic artery embolization (PAE) as a means of preoperative risk reduction to mitigate blood loss in a high risk patient. Preoperative, intraprocedural, and postoperative imaging will help illustrate the use of PAE prior to prostatectomy, with histologic specimens demonstrating embolic distribution and ischemic changes.
Materials & Methods
Prostate artery embolization has historically been utilized as a means of controlling hemorrhage after surgery or biopsy. Recently, PAE has been proposed as an alternative treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Although transurethral resection of the prostate (TURP) remains the gold standard, several studies have been performed in recent years demonstrating that PAE is a viable treatment option. However, there is no documented case of PAE used for preoperative risk reduction. We report a novel application of PAE performed in a chronically anticoagulated Jehovah's Witness prior to simple prostatectomy.
Results
The patient is a 61-year old male with a history of BPH and lower urinary tract symptoms, including urinary retention and hematuria, eventually requiring an indwelling Foley catheter. He failed conservative medical management and surgical removal was desired. Due to chronic anticoagulation for atrial fibrillation and religious beliefs preventing intraoperative blood products, he was at high-risk to undergo surgery. After a multidisciplinary conference, preoperative PAE was employed as a means of risk reduction.One day prior to surgery, bilateral PAE was performed using 100-300 and 300-500 µm microspheres until stasis. Intraprocedural cone beam CT was utilized to delineate the vascular anatomy and ensure targeted embolization. The following day, he underwent robotic assisted simple prostatectomy with minimal blood loss. Pathologic specimens demonstrated ischemic changes and the presence of microspheres within the prostatic tissue, confirming a successful PAE.
Conclusions
Preoperative prostate artery embolization can be an invaluable tool to reduce the surgical risk in complex prostate surgeries, as well as offer surgical options to patients whose belief system precludes the use of blood products.
Final ID
589
Type
Educational Exhibit-Poster Only
Authors
R Riaz1, C Rogers1, M Zanini1, D Pucheril1, N Gupta1, S Schwartz1
Institutions
1Henry Ford Hospital, Detroit, MI
Purpose
Present a case of prostatic artery embolization (PAE) as a means of preoperative risk reduction to mitigate blood loss in a high risk patient. Preoperative, intraprocedural, and postoperative imaging will help illustrate the use of PAE prior to prostatectomy, with histologic specimens demonstrating embolic distribution and ischemic changes.
Materials & Methods
Prostate artery embolization has historically been utilized as a means of controlling hemorrhage after surgery or biopsy. Recently, PAE has been proposed as an alternative treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Although transurethral resection of the prostate (TURP) remains the gold standard, several studies have been performed in recent years demonstrating that PAE is a viable treatment option. However, there is no documented case of PAE used for preoperative risk reduction. We report a novel application of PAE performed in a chronically anticoagulated Jehovah's Witness prior to simple prostatectomy.
Results
The patient is a 61-year old male with a history of BPH and lower urinary tract symptoms, including urinary retention and hematuria, eventually requiring an indwelling Foley catheter. He failed conservative medical management and surgical removal was desired. Due to chronic anticoagulation for atrial fibrillation and religious beliefs preventing intraoperative blood products, he was at high-risk to undergo surgery. After a multidisciplinary conference, preoperative PAE was employed as a means of risk reduction.One day prior to surgery, bilateral PAE was performed using 100-300 and 300-500 µm microspheres until stasis. Intraprocedural cone beam CT was utilized to delineate the vascular anatomy and ensure targeted embolization. The following day, he underwent robotic assisted simple prostatectomy with minimal blood loss. Pathologic specimens demonstrated ischemic changes and the presence of microspheres within the prostatic tissue, confirming a successful PAE.
Conclusions
Preoperative prostate artery embolization can be an invaluable tool to reduce the surgical risk in complex prostate surgeries, as well as offer surgical options to patients whose belief system precludes the use of blood products.