J. Spies

Society of Interventional Radiology position statement: prostate artery embolization for treatment of benign disease of the prostate.

Prostatic artery embolization (PAE) is a promising new treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). It has therefore garnered much interest in the interventional community. This article will review the scientific background for this therapy, describe the current devices available for treatment, and state the position of the Society of Interventional Radiology (SIR) with regard to the study and potential adoption of this therapy.

The New Interventional Radiology Pathways: Options for Implementation

The new interventional radiology (IR) pathways have generated much discussion with articles and editorials pointing out perceived advantages and disadvantages compared to the current pathways. To briefly review, under the new system, there are three pathways to enter IR: the integrated (INT) IR residency, the independent (IND) IR residency, and the early specialization in interventional radiology (ESIR) program. The pathways have been designed to provide maximum flexibility to programs for implementation and to radiology residents for planning their subspecialty training. As a result, there are many potential permutations for these training programs, and understanding the variety of options can be a challenge at first. We offer three potential solutions, based on the different circumstances or requirements a department might face. The first two solutions involve integrated programs created through newly funded and converted diagnostic radiology slots, respectively. The third involves establishing ESIR and IND programs only. Hopefully, the examples provided will be useful for those currently planning for the future of their IR training programs.

Benign Metastasizing Leiomyomas Following Myomectomy and Uterine Artery Embolization

Benign metastasizing leiomyomas (BMLs) are rare sequelae of common uterine leiomyomas and most frequently found in the lungs. Most cases of BMLs occur with a history of prior gynecologic procedures; however, none have yet been reported in association with uterine artery embolization (UAE). This case report highlights the disease course for a 48-yo female with a history of both myomectomy and UAE for uterine fibroids who presented later with bilateral pulmonary BMLs. Though the pathophysiology of BMLs is poorly understood and this case is confounded by prior myomectomy, it does bring into question whether UAE has a role in BML development. Regardless, UAEs have become a routine procedure and interventionalists should be aware of the possibility of BMLs in post-fibroid treatment patient populations.

Uterine artery embolization: A review of current concepts

Uterine artery embolization (UAE) has gained traction as a safe and effective treatment modality for symptomatic uterine leiomyomata since its introduction nearly two decades ago. This review includes an overview of current concepts with regard to patient selection, technique, and outcomes following UAE. Specific topics also include the impact of this procedure on fertility and pregnancy, the emerging role of UAE in the treatment of adenomyosis, and how UAE compares with surgical intervention for the treatment of symptomatic leiomyomata.

Utility of MR Angiography in the Identification of Prostatic Artery Origin Prior to Prostatic Artery Embolization

In 17 patients who underwent prostate artery embolization for treatment of lower urinary tract symptoms, the accuracy of preprocedural magnetic resonance (MR) angiography was retrospectively compared with intraprocedural digital subtraction angiography (DSA) in the identification of prostatic artery origin. Of 34 vessels, 26 MR angiography identified origins (76.5%) were confirmed by DSA at the time of embolization. Although image postprocessing is required, the ability of MR angiography to accurately identify prostatic artery origins prior to embolization is useful in treatment planning and can obviate the need for separate computed tomographic angiography, thus reducing both radiation dose and time demand on patients.