Angiographic Anatomy of Prostatic Arteries in 168 Patients Undergoing Prostate Artery Embolization for Benign Prostatic Hyperplasia

Background: Prostatic artery embolization (PAE) has been established as a safe and effective treatment option for symptomatic benign prostatic hyperplasia. Thorough knowledge of detailed prostatic artery (PA) anatomy is essential to guarantee technical success and to avoid potential complications of non-target embolization. We aim to provide a pictorial review of PA and prevalence of each anatomical variant, in addition to important anatomical considerations, extracted from our case series. Method(s): We performed PAE on 168 consecutive patients until 2019. The most commonly used tools were 5-French cobra-head angiographic catheter and 2.7-French microcatheter. Images were analyzed by the operators. Result(s): In the 168 patients, 331 PAs were angiographically identified. Double arterial supply on the same side was noted in 9 patients (5%). In 10 patients (6%), only a unilateral PA was identified. No PA could be identified in 2 patients (1%). The frequencies of origins of PAs were found to be as follows: 133 (40%) from superior vesical artery (SVA), 97 (29%) from internal pudendal artery (IPA), 70 (21%) from obturator artery, 29 (9%) originated directly from anterior division of internal iliac artery and only 2 (<1%) originated from inferior gluteal artery. Contrast filling of contralateral PA main trunk was identified in 31 patients (18%). Penile anastomosis was identified with 28 PAs (8%) and rectal anastomosis was observed with 14 PAs (4%). Conclusion(s): PA has variable origins, even for both sides in the same patient. Knowledge of its detailed anatomy and anastomosis with nearby arteries is essential for safe and timely performance of PAE.

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Artikel online veröffentlicht:
11. Mai 2021