Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization

Area of Science:

• Vascular Anatomy
• Interventional Radiology
• Urology

Background:

• Benign prostatic hyperplasia (BPH) is a common condition requiring effective treatment.
• Prostatic artery (PA) embolization is an emerging minimally invasive treatment for symptomatic BPH.
• Detailed knowledge of PA anatomy is crucial for successful embolization procedures.

Purpose of the Study:

• To delineate the anatomical variations and imaging characteristics of prostatic arteries (PAs).
• To evaluate PA anatomy using multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA).
• To provide anatomical insights for PA embolization in patients with benign prostatic hyperplasia (BPH).

Main Methods:

• Retrospective analysis of 75 men (150 pelvic sides) undergoing pelvic CT angiography and DSA prior to PA embolization for BPH.
• Evaluation of each pelvic side for the number, origin, trajectory, termination, and anastomoses of PAs.
• Assessment of accessory pudendal arteries in relation to PAs.

Main Results:

• 57% of pelvic sides had one PA, 43% had two independent PAs (mean diameter 1.6 mm).
• Common PA origins included internal pudendal artery (34.1%), superior vesical artery trunk (20.1%), and obturator artery (12.6%).
• Anastomoses to adjacent arteries were noted in 57% of sides; accessory pudendal arteries were present in 20%.

Conclusions:

• Prostatic artery origins exhibit significant variability between sides and individuals.
• The internal pudendal artery is the most frequent origin for prostatic arteries.
• These anatomical findings are essential for guiding prostatic artery embolization in BPH treatment.