1
|
Moramarco L, Grande AM, Vertemati M, Aseni P. Prostate Artery Embolization in the Treatment of Massive Intractable Bleeding from Prostatic Neoplasms: A Case Report and Systematic Review. J Clin Med 2023; 13:65. [PMID: 38202072 PMCID: PMC10780233 DOI: 10.3390/jcm13010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Lower urinary tract symptoms (LUTS) and hematuria are common symptoms in men with neoplasms, mainly affecting the elderly population. Prostatic arterial embolization (PAE) is a minimally invasive procedure that has shown promising results in managing LUTS and massive intractable prostatic hematuria in patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A few studies, however, have provided valuable insights into the durability and efficacy of PAE focusing on the long-term effectiveness, quality of life, and cancer-specific control of hemostasis and urinary symptoms. As a result of concomitant cardiovascular conditions, these patients often take anticoagulants or antithrombotics, which can worsen their hematuria and clinical status. Transurethral resection of the prostate (TURP) is considered a very high-risk procedure, even without massive bleeding, and requires discontinuation of vitamin K antagonists and antiplatelet therapies. Such patients usually have their surgery postponed, and PAE should be considered a safe alternative treatment. We aimed to report a narrative review from 1976 to June 2023 of the current state of PAE for massive and intractable hematuria, highlighting recent developments in this technique, including prospective cohort studies, and focusing on long-term outcome, safety, and complication management of patients with prostatic neoplasms who develop significant hemorrhagic symptoms. Additionally, we present a case report and a simple algorithm for treating intractable bleeding in a 92-year-old man with PCa and massive hematuria.
Collapse
Affiliation(s)
- Lorenzo Moramarco
- Radiologia—Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Antonino M. Grande
- Divisione Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Paolo Aseni
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
- Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda Hospital, 20162 Milan, Italy
| |
Collapse
|
2
|
Veyg D, Mohanka R, Rumball IP, Liang R, Garcia-Reyes K, Bishay V, Fischman AM. Comparison of 24-Month Clinical Outcomes after Prostatic Artery Embolization in Prostate Glands Larger versus Smaller than 80 mL: A Systematic Review. J Vasc Interv Radiol 2022; 34:578-584.e1. [PMID: 36470516 DOI: 10.1016/j.jvir.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/05/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This review was undertaken to compare the clinical outcomes of prostatic artery embolization (PAE) in patients with >80 versus <80 mL prostatic volume (PV) at the 24-month follow-up to determine whether PV predicted the effectiveness or durability of PAE. MATERIALS AND METHODS The PubMed/MEDLINE database was searched for articles published between 2010 and 2022 using the search term "(prostat∗ artery embolization) AND (long term OR follow-up OR 24-month)." Articles were included if they discussed PAE for benign prostatic hyperplasia (BPH) and reported a minimum follow-up of 24 months. Articles with <10 patients were excluded. A subgroup analysis was performed to evaluate for any difference in clinical outcomes at the 24-month post-PAE follow-up between studies with a mean PV of >80 mL and those with a mean PV of <80 mL. RESULTS A total of 14 studies with 2,260 patients were included, all of which demonstrated significant reduction in symptoms at the 24-month follow-up after PAE. Four studies were included as part of the >80-mL PV subgroup (n = 467), and 10 studies were included as part of the <80-mL PV subgroup (n = 1,793). There was a statistically significant difference between the mean preprocedural PV (128.5 vs 64.0 mL; P = .015). At the 24-month follow-up, there were no significant differences between groups across any of the compared parameters. The collective incidence of major adverse events reported in the studies within this review was <1%. CONCLUSIONS PAE is both safe and durable for patients suffering from BPH and can be effective across a wide range of baseline PVs.
Collapse
Affiliation(s)
- Daniel Veyg
- Long Island Jewish Medical Center, Northwell Health System, Queens, New York.
| | - Rajat Mohanka
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Ian P Rumball
- Zucker School of Medicine at Hofstra University/Northwell Health System, Hempstead, New York
| | - Richard Liang
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | | | - Vivian Bishay
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Aaron M Fischman
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| |
Collapse
|
3
|
Xu ZW, Zhou CG, Tian W, Shi HB, Liu S. Long-Term Efficacy and Recurrence Prediction of Prostatic Artery Embolization for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2022; 45:1801-1809. [PMID: 36131147 DOI: 10.1007/s00270-022-03272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/27/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To explore the efficacy of prostatic artery embolization (PAE) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) during long-term follow-up and analyze predictors related to LUTS recurrence. METHODS This was a single-center retrospective study involving 125 BPH patients with LUTS who underwent PAE from February 2014 to February 2020. The median follow-up was 36 months. Clinical success was defined as reductions in the International Prostate Symptom Score (IPSS) and quality of life (QoL) score and no need for any other treatment for LUTS; otherwise, it was regarded as a clinical failure. Recurrence was defined as a clinical failure that occurred after an initial success. Cumulative clinical success rates, recurrence rates and re-intervention rates were evaluated. Friedman test was performed to compare differences in IPSS, QoL and prostatic volume (PV) among baseline and follow-up times. Predictors for LUTS recurrence were analyzed with the univariate and multivariate Cox regression model. RESULTS Technical success (bilateral PAE) rate was 92.8% (116/125). Significant differences in IPSS, QoL and PV were observed between baseline and follow-up time points (P < 0.001). The cumulative clinical success rates at 2, 3, 4 and 5 years were 82.4%, 65.5%, 52.4% and 37.4%. The cumulative recurrence rates and re-intervention rates at 1, 2 and 5 years were 6.8%, 12.7%, 60.4% and 5.9%, 10.2%, 50.8%, respectively. Unilateral PAE was an significant predictor of recurrence (P < 0.05). CONCLUSIONS PAE is an effective treatment option for LUTS. Unilateral PAE is a significant independent predictor of LUTS recurrence.
Collapse
Affiliation(s)
- Zhong-Wei Xu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Wei Tian
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China.
| |
Collapse
|
4
|
Retrospective observation of the efficacy and safety of prostatic artery embolization combined with transurethral resection of the prostate and simple transurethral resection of the prostate in the treatment of large (> 100 mL) benign prostatic hyperplasia. Abdom Radiol (NY) 2021; 46:5746-5757. [PMID: 34448024 DOI: 10.1007/s00261-021-03258-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To retrospectively compare the efficacy and safety of prostatic artery embolization (PAE) combined with transurethral resection of the prostate (TURP) and simple TURP in treating large (> 100 mL) benign prostatic hyperplasia (BPH). METHODS We retrospectively analyzed the clinical data of 13 and 17 patients with large BPH who underwent TURP and PAE + TURP, respectively, from January 2016 to January 2020. The changes in various indices before and after surgery were compared between the two groups. RESULTS In the PAE + TURP group, the operation time (OT), intraoperative blood loss (BL), postoperative bladder flushing time (PBFT), and postoperative catheter retention time (PCRT) were lower, and the speed of the excised lesion (SEL) was higher than that in the TURP group (P < 0.05). Following-up for 12 months, the prostatic volume (PV), maximum urinary flow rate (Qmax), postvoid residual volume (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL) score, total prostate-specific antigen (T-PSA), and free prostate-specific antigen (F-PSA) in each group improved as compared to before the surgery (P < 0.05), and the above improved indicators, IPSS ratio, and obstructive symptoms in the PAE + TURP group were higher than those in the TURP group (P < 0.05). The incidence of postoperative complications in the PAE + TURP group was lower than that in the TURP group. We obtained the pathological picture of a prostate biopsy after PAE for the first time. CONCLUSION Compared to TURP alone, PAE + TURP should be promoted, because of its greater efficacy and safety in treating large BPH and fewer post-surgical complications.
Collapse
|
5
|
Baboudjian M, Alegorides C, Fourmarier M, Atamian A, Gondran-Tellier B, Andre M, Arroua F, Boissier R, Eghazarian C, Vidal V, Chevrot A, Droupy S, Lechevallier E. Comparison of water vapor thermal therapy and prostate artery embolization for fragile patients with indwelling urinary catheters: Preliminary results from a multi-institutional study. Prog Urol 2021; 32:115-120. [PMID: 34148768 DOI: 10.1016/j.purol.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/05/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To report our preliminary experience with water vapor thermal therapy with the Rezūm™ System and Prostate Artery Embolization (PAE) for treatment of medically refractory, complete urinary retention to achieve successful cessation of catheter dependency in frail-patients. PATIENTS AND METHODS A multi-institutional study was conducted including all patients who underwent Rezūm™ procedure and PAE between October 2017 and June 2020. The included population focused on frail-patients unsuitable for conventional surgery with complete urinary retention. Rezūm™ patients were identified and matched (1:1) with patients who underwent PAE. The matching criteria were age, Charlson score, prostate volume and duration of follow-up. The primary outcome was catheter-free survival, defined as spontaneous voiding and release from catheter dependence. RESULTS Eleven patients from the Rezūm™ group were matched to 11 embolized patients. PAE and Rezūm™ patients were comparable in age (median: 77 vs. 75 years), Charlson score (median: 6 vs. 6) and prostate volume (74 vs. 60 cc). Procedures were significantly longer in the PAE group compared to the Rezūm™ procedures (median: 148 vs. 8min, P<0.001). After a median follow-up of 12 months, spontaneous voiding was conserved in all cases (100%) after the Rezūm™ procedure and in 5 cases (45.4%) after PAE (P=0.01). In catheter-free patients, the rate of benign prostatic hyperplasia medication use after procedure was 40% for PAE and 18.2% for Rezūm™ patients (P=0.54). CONCLUSIONS Our preliminary experience for treatment of complete urinary retention in frail-patients shows the feasibility of PAE and Rezūm™ to restore spontaneous urination without being associated with the occurrence of major complications. Early data suggests that Rezūm™ may provide superior results in terms of cessation of catheter dependence. Future studies are needed to definitively assess which treatment would be best suited for each patient. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- M Baboudjian
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France; Department of Urology, Hospital of Aix en Provence, Aix en Provence, France.
| | - C Alegorides
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - M Fourmarier
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - A Atamian
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - B Gondran-Tellier
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - M Andre
- Department of Radiology and Medical imaging, La Timone Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France; European Center for Medical Imaging Research CERIMED/LIIE, Marseille, France
| | - F Arroua
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - R Boissier
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - C Eghazarian
- Department of Urology, Hospital of Aix en Provence, Aix en Provence, France
| | - V Vidal
- Department of Radiology and Medical imaging, La Timone Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France; European Center for Medical Imaging Research CERIMED/LIIE, Marseille, France
| | - A Chevrot
- Department of Urology, Hospital Universitaire Carémeau de Nimes, Nimes, France
| | - S Droupy
- Department of Urology, Hospital Universitaire Carémeau de Nimes, Nimes, France
| | - E Lechevallier
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, AP-HM, Marseille, France
| |
Collapse
|
6
|
Efficacy and safety of prostatic artery embolization for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. Eur Radiol 2021; 31:4929-4946. [PMID: 33449181 DOI: 10.1007/s00330-020-07663-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of the prostate (TURP) in patients affected by benign prostatic hyperplasia (BPH). We also reviewed mean changes from baseline in PAE at selected follow-up points. METHODS PubMed, Web of Science, and Embase were searched up to May 1, 2020. Randomized controlled trials on PAE were collected according to specific inclusion and exclusion criteria. Meta-analyses were performed using RevMan 5.3, STATA 14, and GraphPad Prism 8. Pooled patient-reported scores and functional outcomes were calculated by using a fixed or random-effect model. RESULTS Eleven articles met our selection criteria and ten independent patient series were included in the final analysis. Pooled estimates suggested no significant difference between TURP and PAE for patient-reported outcomes including International Prostate Symptom Score (2.32 (- 0.44 to 5.09)) and quality of life (0.18 (- 0.41 to 0.77)) at 12 months. PAE was less effective regarding improvements in most functional outcomes such as maximum flow rate, prostate volume, and prostate-specific antigen. Moreover, PAE may be associated with relatively fewer complications, lower cost, and shorter hospitalization. After the PAE procedure, the overall weighted mean differences for all outcomes except sexual health scores were significantly improved from baseline during follow-up to 24 months. CONCLUSION PAE is non-inferior to TURP with regard to improving patient-reported outcomes, though most functional parameters undergo more changes after TURP than after PAE. Moreover, PAE can significantly continue to relieve symptoms for 24 months without causing serious complications. KEY POINTS • PAE is as effective as TURP in improving subjective symptom scores, with fewer complications and shorter hospitalization times. • PAE is inferior to TURP in the improvement of most functional outcomes. • Improvements due to PAE are durable during follow-up to 24 months.
Collapse
|
7
|
Jung EM, Wertheimer T, Putz FJ, Jung F, Kammerer S, Pregler B, Luerken L, Stroszczynski C, Beyer L. Contrast enhanced ultrasound (CEUS) with parametric imaging and time intensity curve analysis (TIC) for evaluation of the success of prostate arterial embolization (PAE) in cases of prostate hyperplasia. Clin Hemorheol Microcirc 2020; 76:143-153. [PMID: 32925006 DOI: 10.3233/ch-209202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM To evaluate the use of dynamic contrast enhanced ultrasound (CEUS) with parametric color-coded imaging and time intensity curve analysis (TIC) for planning and follow-up after prostate arterial embolization (PAE). MATERIAL/METHOD Before and after selective iliacal embolization by PAE with a follow up of 6 months 18 male patients (43-78 years, mean 63±3.5 years) with histopathological proven benign prostate hyperplasia were examined by one experienced examiner. A multifrequency high resolution probe (1-6 MHz) was used for transabdominal ultrasound and CEUS with bolus injections of 2.4 ml sulphur-hexafluoride microbubbles. Independent evaluation of color-coded parametric imaging before and after PAE by in PACS stored DICOM loops from arterial phase (10-15 s) up to 1min were performed. Criteria for successful treatment were reduction of early arterial enhancement by changes of time to peak (TTP) and area under the curve (AUC) by measurements in 8 regions of interest (ROI) of 5 mm in diameter at the margin and in the center and changes from hyperenhancement in parametric imaging (perfusion evaluation of arterial enhancement over 15 s) from red and yellow to blue and green by partial infarctions. Reference imaging method was the contrast high resolution 3 tesla magnetic resonance tomography (MRI) using 3D vibe sequences before and after PAE and for the follow up after 3 and 6 months. RESULTS PAE was technically and clinically successful in all 18 patients with less clinical symptoms and reduction of the gland volume. In all cases color-coded CEUS parametric imaging was able to evaluate partial infarction after embolization with changes from red and yellow to green and blue colors in the embolization areas. Relevant changes could be evaluated for TIC-analysis of CEUS with reduced arterial enhancement in the arterial phase and prolonged enhancement of up to 1 min with significant changes (p = 0.0024). The area under the curve (AUC) decreased from 676±255.04 rU (160 rU-1049 rU) before PAE to 370.43±255.19 rU (45 rU-858 rU) after PAE. Time to peak (TTP) did not change significantly (p = 0.6877); TTP before PAE was 25.82±9.04 s (12.3 s-42.5 s) and after PAE 24.43±9.10 s (12-39 s). Prostate volume decreased significantly (p = 0.0045) from 86.93±34.98 ml (30-139 ml) before PAE to 50.57±26.26 ml (19-117 ml) after PAE. There were no major complications and, in most cases (14/18) a volume reduction of the benign prostate hyperplasia occurred. CONCLUSION Performed by an experienced examiner CEUS with parametric imaging and TIC-analysis is highly useful to further establish prostatic artery embolization (PAE) as a successful minimal invasive treatment of benign prostatic hyperplasia.
Collapse
Affiliation(s)
- E M Jung
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - T Wertheimer
- Department for Internal Medicine III, Hematology and Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - F J Putz
- Department of Nephrology, University Medical Center Regensburg, Regensburg, Germany
| | - F Jung
- Brandenburgische Technische Universität Cottbus-Senftenberg, Institute of Biotechnology, Cottbus, Germany
| | - S Kammerer
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - B Pregler
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - L Luerken
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - L Beyer
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| |
Collapse
|
8
|
Patel NR, Elterman DS, Thulasidasan N, Altman R, Tai E, Zener R, Stella SF, Annamalai G, Mafeld S, Simons ME. Initial Canadian Experience of Prostate Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: Midterm Outcomes. Can Assoc Radiol J 2020; 72:876-882. [PMID: 32673069 DOI: 10.1177/0846537120939930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study aimed to assess the midterm outcomes and safety of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH). METHODS A single-center, retrospective review of PAE performed for BPH was performed. Validated International Prostate Symptom Score (IPSS), quality of life (QoL) index, and International Index for Erectile Function (IIEF-5) questionnaires were completed at baseline and at least 12 months post-procedure. Prostate imaging was performed preprocedure as well as 3 months and 12 months post-procedure to assess prostate volume (PV). Uroflowmetry was also performed at baseline and 12 months post-procedure to assess urine flow rate (Qmax) and post-void residual (PVR) volume. Adverse events were graded according to Society of Interventional Radiology (SIR) guidelines. RESULTS Eighty male patients underwent the PAE procedure (mean age 69 years). Prostate volume decreased significantly from a mean volume 156 to 107 mL after 12 months post-procedure, commensurate with a mean reduction of 27.5% (P < .05). Significant improvements were seen in IPSS (21.8 vs 10.5) and QoL (4.5 vs 2.0) from baseline to 12 months post-procedure (P < .05). There was no significant change in IIEF-5 score. There was a significant reduction in PVR (202 vs 105 mL) and improvement in Qmax (5.9 vs 10.0 mL/s) between baseline and 12 months post-procedure (P < .05). No major complications occurred; 4 minor complications occurred (SIR grade A or B). CONCLUSION Prostate artery embolization achieved a clinically and statistically significant prostate volume reduction, symptom and QoL improvement, and enhanced uroflowmetry parameters in patients with BPH.
Collapse
Affiliation(s)
- Neeral R Patel
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Dean S Elterman
- Department of Urology, 7989University Health Network, Toronto, Ontario, Canada
| | - Narayanan Thulasidasan
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Rachel Altman
- Department of Urology, 7989University Health Network, Toronto, Ontario, Canada
| | - Elizabeth Tai
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Rebecca Zener
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Steffan F Stella
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Ganesan Annamalai
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Sebastian Mafeld
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Martin E Simons
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| |
Collapse
|