Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.

Advances in Biomaterials and Technologies for Vascular Embolization

Prostate artery embolisation (PAE) is a new minimally invasive treatment for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). The purpose of this study was to review the efficacy and safety of PAE in the treatment of BPH with LUTS. A systematic review performed according to the PRISMA guidelines with a pre-specified search strategy for PubMed, Web of Science, Cochrane Library and Embase databases protocol (PROSPERO ID: CRD42017059196). Trials studying the efficacy of prostate artery embolisation to treat LUTS with more than ten participants and follow-up longer than 6 months were included by two independent authors. Outcomes investigated were International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate-specific antigen (PSA), peak void flow (Qmax), post-void residual (PVR) and complications. To summarise mean change from baseline, a meta-analysis was done using the random-effects model. The search returned 210 references, of which 13 studies met the inclusion criteria, representing 1,254 patients. Patients in the included studies with data available for meta-analysis had moderate to severe LUTS and a mean IPSS of 23.5. Statistically significant (p value < 0.05) improvements of all investigated outcomes were seen at 12-month follow-up. Major complications were reported in 0.3% of the cases. Our findings suggest that PAE can reduce moderate to severe LUTS in men with BPH with a low risk of complications. • Prostate artery embolisation (PAE) improved International Prostate Symptom Score (IPSS) by 67%. • Major complications after PAE are very rare. • Use of cone-beam CT may reduce risk of non-target embolisation.

Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis.

Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology

https://repositorio.chlc.min-saude.pt/bitstream/10400.17/3575/1/Eur%20Urol%202020%20354.pdf

Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic Hyperplasia

Randomized Comparison of Prostatic Artery Embolization versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia

Medium- and Long-Term Outcome of Prostate Artery Embolization for Patients with Benign Prostatic Hyperplasia: Results in 630 Patients.

Poster: "ECR 2013 / C-1638 / CT Angiography and Digital Subtraction Angiography in the evaluation of atherosclerotic peripheral arterial disease – pictorial essay." by: "J. A. Sousa Pereira, H. A. M. R. Tinto, L. Fernandes, T. Bilhim, Z. Seabra; Lisbon/PT"

CT Angiography and Digital Subtraction Angiography in the evaluation of atherosclerotic peripheral arterial disease – pictorial essay.

Poster: "ECR 2012 / C-2533 / MRI grading of postero-lateral corner and anterior cruciate ligament injuries" by: "J. Lopes Dias1, J. A. Sousa Pereira1, L. Fernandes2, H. A. M. R. Tinto2, R. D. T. Mesquita3, P. Alves1; 1Lisboa/PT, 2Lisbon/PT, 3Porto/PT"

MRI grading of postero-lateral corner and anterior cruciate ligament injuries

Background: Computed tomography angiography (CTA) is an accepted technique for selecting patients with peripheral arterial disease for surgical and endovascular treatment. There is limited data regarding its accuracy for infrapopliteal vessels in patients with diabetic foot. Purpose: Evaluate the diagnostic accuracy of CTA for below the knee arteries in patients with diabetic foot. Methods: Single-center retrospective analysis of CTA and Digital Subtraction Angiography imaging findings in 14 patients that underwent peripheral arterial revascularization due to diabetic foot ulcers. The sensitivity and specificity of CTA was assessed according to each arterial segment based on an adapted Rutherford Score of disease impairment. Results: CTA overall sensitivity and specificity for the detection of significant arterial lesions was 1 (95% C.I. 0.89-1) and 0.7 (95% C.I. 0.35-0.93), respectively. By arterial segment, the sensitivity and specificity for the anterior tibial artery were 0.96 (95% C.I. 0.88-0.99) and 0.86 (95% C.I. 0.57-0.98), for the posterior tibial artery were 0.98 (95% C.I. 0.90-0.99) and 0.93 (95% C.I. 0.66-0.99) and for the peroneal artery were 0.93 (95% C.I. 0.83-0.98) and 0.72 (95% C.I. 0.42-0.92), respectively. Conclusion: CTA has excellent diagnostic accuracy and allows screening of diabetic patients with infrapopliteal peripheral arterial disease.

/pdf/diagnostic-accuracy-of-ct-angiography-for-infrapopliteal-2ey8xw4jd8.pdf

José António Sousa Pereira

Papers

Medium- and Long-Term Outcome of Prostate Artery Embolization for Patients with Benign Prostatic Hyperplasia: Results in 630 Patients.

CT Angiography and Digital Subtraction Angiography in the evaluation of atherosclerotic peripheral arterial disease – pictorial essay.

MRI grading of postero-lateral corner and anterior cruciate ligament injuries

Diagnostic accuracy of CT angiography for infrapopliteal lesions in patients with diabetic foot ulcers undergoing endovascular revascularization

Acute pulmonary embolism in a young female with inherited thrombophilic disorder and large thrombus through a patent foramen ovale