Prostatic artery embolization using three-dimensional cone-beam computed tomography

•Prostatic artery embolization can be challenging because of anatomical difficulties and individual variations in prostatic arteries.•Three-dimensional cone-beam computed tomography can be used to securely target prostatic arteries during prostatic artery embolization.•Three-dimensional cone-beam computed tomography helps catheterize target vessels in prostatic artery embolization. The purpose of this study was to report the use of three-dimensional (3D) cone-beam computed tomography (CBCT) for prostatic artery embolization (PAE) in patients with benign prostatic hypertrophy (BPH). Twenty-three consecutive men who underwent PAE using 3D CBCT from June 2016 to September 2018, were retrospectively included in this observational single-center study. There were 23 men with a mean age of 73±12 (SD) years (range: 52–94years) with moderate to severe lower urinary tract symptoms (mean international prostate symptom score, 21±5.7 [SD]; range: 9–30) due to BPH (mean prostate weight, 100g±63 [SD]; range: 30–250g). PAEs were analyzed with respect to procedure time, fluoroscopy time, technical success, complications and dosimetric indices. The mean catheterization time of the prostatic artery from the internal iliac artery was 17.3±12.5 (SD) min (range: 8–57min) on the right side and 23.6±14.9 (SD) min (range: 6–54min) on the left side. A technical success was achieved in 21 patients (21/23; 91%). PAE was bilateral in 14 patients (14/21; 66%) and unilateral in 7 patients (7/21; 33%). No occurrence of non-target embolization was reported. The mean dose area product was 146.7±47.9 (SD) Gy.cm2 (range: 54–254Gy.cm2) and mean cumulative air kerma was 771.4±333.3 (SD) mGy; range: 280–1560 mGy. The mean fluoroscopy time was 42.3±23.1 (SD) min (range: 19.4–118.2min). 3D CBCT is a useful tool to identify the prostatic arteries and facilitates catheterization of prostatic arteries with an acceptable level of radiation exposure.