BackTable / VI / Podcast / Episode #148
Radial vs. Femoral for Prostate Artery Embolization
with Dr. Blake Parsons
We talk with Dr. Blake Parsons about his approach to Radial vs. Femoral access for Prostate Artery Embolization for BPH, including patient selection, device considerations, and practice pearls.
BackTable, LLC (Producer). (2021, August 16). Ep. 148 – Radial vs. Femoral for Prostate Artery Embolization [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Blake Parsons
Dr. Blake Parsons is a practicing Interventional Radiologist in Oklahoma City.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
In this episode, Dr. Blake Parsons and our host Dr. Chris Beck discuss access sites for prostate artery embolization, along with advice for visualizing pelvic anatomy, procedural tips, and post-operative care.
We start by comparing radial and femoral access. Dr. Parsons prefers femoral access because it is faster, although both approaches share the same amount of bleeding risk. Radial access may offer more pushability and may be more appropriate for patients with tortuous iliac arteries. Additionally, we discuss the closure methods for each approach-- TR Band for radial access, and Angio-Seal for femoral access.
Since pelvic anatomy varies from patient to patient, it can be challenging and time-consuming to identify the prostate artery. Dr. Parsons recommends using the obturator and pudendal arteries as landmarks. He also emphasizes that resources like lectures, meetings, papers, and courses can help IRs gain exposure and confidence in the pelvic anatomy.
Finally, we talk about managing patient expectations about post-operative pain and dysuria relief. Dr. Parsons prescribes antibiotics, Medrol Dosepak, and Pyridium. The timeline for improvement in benign prostatic hyperplasia is different in each patient, but improvement can be tracked with the IPSS score at follow up appointments.
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[Dr. Christopher Beck]:
All right. So before we get too much into a radial versus femoral, can you talk a little bit more about your radial technique? We can start out just talking about who is a suitable candidate for radial artery access.
[Dr. Blake Parsons]:
Yeah. Obviously, I do a Barbeau on everybody that I'm going to do a radial stick on. From an ultrasound standpoint, I pretty much go from the standard. It needs to probably be at least two millimeters. I'm going to use a four or five slender sheath is what I use for access, everything, obviously ultrasound-guided. So four or five French standard cocktail heparin, nitro, verapamil. So 3000 of heparin, 2.5 of verapamil and then 200 to 300 of nitro just depending on their pressures. And then I typically use a glide wire or even use a Baby-J glide to make your way down. I typically use a glide cat, just a standard 45 angle to be able to get down into the pelvis. But that's my typical initial setup to get there.
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