Predictors of Prostatic Artery Embolization Technical Outcomes: Patient and Procedural Factors.

Purpose: To identify technical factors that significantly change prostatic artery embolization (PAE) technical outcomes and to derive and test technical outcome predictive models.

Materials And Methods: Retrospective analysis of PAEs performed by 2 operators (OPs) was performed: OP1, between April 2014 and May 2017 (n = 150); OP2, between February 2017 and December 2017 (n = 67). Multivariate analysis with mixed-effects modeling was used to test significance and derive predictive models. Mean difference was used to analyze prediction accuracy.

Results: Moderate versus none subjective iliac tortuosity grade (SITG) and the presence of internal iliac atherosclerosis (PIIAA) versus none were associated with the following respective technical outcome increases: procedure time (PT): 43% (P < .01), 16% (P < .01); fluoroscopy time (FT): 47% (P < .01), 25% (P < .01); contrast volume (CV): 25.6 mL (P < .001), 13.7 mL (P = .01); and dose area product (DAP) 52% (P < .01), 20% (P = 0.03). Prostatic artery origin left obturator versus left superior vesical was associated with a 24% (P = .01) DAP decrease. For every 1 cc that prostate volume increased, CV decreased on average by 0.1 mL (P = .05). For every 1-cm decrease in patient height and 1-kg increase in weight, DAP increased on average by 0.02% (P < .01) for each. Unilateral versus bilateral versus 3-vessel embolization resulted in a 16.3-mL CV decrease on average for each additional vessel embolized (P = .03). The mean absolute differences between predicted and measured technical outcome values were: PT: 16 minutes, FT: 7 minutes, CV: 25 mL, and DAP: 44 Gy·cm.

Conclusions: In this study, higher SITGs and PIIAA most likely contributed to higher technical outcomes when controlling for the 2 OPs.