Fluid mechanics of prostatic artery embolization

Benign prostatic hyperplasia (BPH) is a prevalent disease associated with lower urinary tract symptoms and the most frequent benign tumor in men. To reduce BPH therapy complications, prostatic artery embolization (PAE) was developed over the past decade to replace the surgical options. PAE is a minimally invasive technique in which emboli are injected into the prostate arteries (PA), obstructing the blood flow in the hypervascular nodules. The major challenges in PAE are the catheter skill needed to navigate the tortuous small arteries and deliver emboli to the PA. In this work, we used patient-specific computational fluid dynamics modeling in SimVascular to study the hemodynamics in the iliac arterial tree considering a large network of bifurcations. Subsequently, the transport of embolic particulates in the PAE was simulated. The emboli were released at various locations across the iliac arterial tree. The emboli entering the PA were mapped back to their initial location to create particle destination maps. The results were compared to the finite-time Lyapunov exponent (FTLE) field, revealing the complex transport patterns. Our patient-specific model can be used to find the best spatial location for emboli injection and perform the embolization with minimal non-target delivery.