Prostatic artery embolization (PAE) is a safe and effective treatment modality for management of lower urinary tract symptoms in men with benign prostatic hyperplasia. Despite its clinical efficacy, PAE remains technically demanding, necessitating standardized procedural steps to optimize outcomes. Numerous studies have previously described specific methods to optimize PAE. However, complete standardization is limited by patient-specific anatomical variations and operator-dependent factors. To address this, a panel of 14 international experts conducted a consensus panel study to establish evidence-based technical recommendations for PAE. The panel focused on six key procedural domains: pre-procedural imaging requirements, antibiotic prophylaxis before and after PAE, arterial access, techniques for identification and cannulation of prostatic artery, embolization techniques and materials, and strategies to prevent non-target embolization. This manuscript synthesizes expert opinion and current literature to provide a structured framework for performing PAE. Pre-procedural imaging requirements are assessed and their value is explained. Peri-procedural antibiotic prophylaxis is described in different practices. The pros and cons of different arterial access sites are presented. Details on recommended supplies and angiographic techniques are outlined. The available embolic agents and technical details to achieve complete embolization are discussed. Furthermore, the established techniques to avoid non-target embolization are discussed in stepwise fashion and their safety profile is presented. Finally, emerging concepts such as the use of liquid embolic agents and "coil-out" technique for adjunctive coil occlusion of prostatic artery are discussed. While acknowledging procedural heterogeneity, the panel presents the most effective technical methods. Further large-scale studies are warranted to validate these recommendations.
Journal of vascular and interventional radiology : JVIR. 2025 Oct 29 [Epub ahead of print]
Nassir Rostambeigi, Marc Sapoval, Tiago Bilhim, Timothy McClure, Justin P McWilliams, Francisco C Carnevale, Attila Kovács, Mark W Little, Shivank Bhatia, Nainesh S Parikh, Shamar J Young, Raj Ayyagari, Samdeep K Mouli, Jafar Golzarian
Mallinckrodt Institute of Radiology, Washington University, Vascular and Intrventional Radiology, St. Louis, MO, USA. Electronic address: ., Hopital European Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, Paris, France., Interventional Radiology Unit, Curry Cabral Hospital, Unidade Local de Saúde São José; Centro Clínico Académico de Lisboa, Lisboa, Portugal and SAMS Hospital, Lisbon, Portugal., New York Presbyterian hospital, Vascular interventioanl radiology, Weill Cornell Medicine, New York, NY, USA., Vascular Interventional Radiology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA., Vascular and Interventional Radiology, University of São Paulo, Sao Paulo, Brazil., Clinic for Diagnostic and Interventional Radiology and Neuroradiology, WEGE Klinik, Bonn, Germany., University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK., Florida prostate centers, Miami, FL, USA., Moffitt cancer center, diagnotic imaging and interventional radiology, FL, USA., Vascular and Interventional Radiology, Department of Medical Imaging, University of Arizona, Tucson, AZ, USA., Burlington medical group. Burlingon, MA, USA., Vascular Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, US., North Star Vascular & Interventional, Vascular Interventional Radiology, University of Minnesota, Minneapolis, MN, USA.