BackTable Vascular & Interventional Ep. 611 Challenges in Prostate Artery Embolization with Dr. Rajasekhara Ayyagari
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Jan 27, 2026 Dr. Rajasekhara Ayyagari, an interventional radiologist who built multiple prostate artery embolization programs, walks through tough PAE scenarios. He discusses balloon occlusion microcatheters, switching from beads to glue, protecting penile flow with coils, and tactics for tortuous or crossover anatomy. Practical points on Foley timing, postprocedure care, and technique workarounds are also highlighted.
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Career Pivot From Urology To Interventional Radiology
- Rajasekhara Ayyagari described switching from urology to IR after preferring minimally invasive procedures.
- He built a PAE practice by leveraging urology relationships and early adoption of the technique.
Use Balloon Occlusion For Penile Protection
- Use a balloon-occlusion microcatheter like the Sniper to prevent non-target penile embolization when prostatic branches are close to pudendal flow.
- If you don't have a balloon catheter, inject very slowly with a regular microcatheter and stop at any sign of reflux.
Experience Reduces Need For Cone-Beam CT
- Cone-beam CT is useful early in learning but becomes less necessary with experience and angiographic tricks.
- Simple techniques like letting the patient breathe can help distinguish bladder from prostate vessels.