BackTable Vascular & Interventional Ep. 629 Optimizing Prostate Treatment with Embolization Strategies with Dr. Art Rastinehad and Dr. Don Garbett
Mar 31, 2026
Dr. Don Garbett, high-volume interventional radiologist working with urology in Austin, TX, and Dr. Art Rastinehad, interventional radiologist and urologic oncologist focused on image-guided prostate care, discuss prostate artery embolization strategies. They cover patient selection and workup. They debate access routes, catheter and wire choices, glue versus beads, managing collaterals, procedural timing, and redo strategies.
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Manage Penile And Rectal Collaterals Conservatively
- When you see penile or rectal collaterals, avoid deep non-target embolization: options include moving microcatheter into the collateral and coiling, flow-redirect with vasodilators, or using a balloon catheter.
- Art cautions coiling pudendal-dominant branches because of potential erectile impact.
Beads May Cause Transient Occlusion
- Insight: Particle beads may only occlude microvasculature transiently (≈3 days), increasing revascularization risk compared with techniques aiming to obliterate the arterial trunk.
- Art explains beads can leave the 'road open' while glue or coil-out targets deeper/more permanent shutdown.
Mix Glue Precisely For Deep Penetration
- Mix cyanoacrylate glue thoroughly and choose dilution deliberately; Art uses 1:5 and Fishman 1:10 but warns poor mixing reduces penetration.
- Art stresses careful mixing and technique to achieve deep glue penetration into ~200 µm vessels.