Angiographic prostatic arterial anatomy in a Turkish population with benign prostatic hyperplasia

Prostatic artery embolization (PAE) is a minimally invasive effective method in the treatment of benign prostatic hyperplasia (BPH). The procedure is technically challenging, as pelvic vascular anatomy is highly prone to variations and the identification of the prostatic artery (PA) is the most time-consuming step, which can lead to increased procedure times. The aim of this study was to categorize the anatomic variations in the prostatic supply in patients with BPH treated with PAE.

The digital subtraction angiography findings of 68 PAE procedures were reviewed retrospectively and the age, PA origin, number, and procedure of the patients were recorded. The origin of the PA was classified into 5 subtypes using the de Assis/ Carnavale classification. The incidence of each anatomic type was calculated.

In the 68 PAE procedures, 119 pelvic sides were analyzed and a total of 119 PAs were classified. The most common origin was type 1 (n = 43, 36.1%), with the PA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery. This was followed by type 4 (n = 34, 28.6%), with the PA originating from the internal pudendal artery; type 3 (n = 22, 18.5%), with the PA originating from the obturator artery; and type 2 (n = 13, 10.9%), with the PA originating from the anterior division of the IIA.

Anatomic variations are common in the IIA and PA, showing racial and individual differences. Following a standard classification system to identify the origin of the PA is crucial and being aware of the most common types in each population will make PAE a faster and safer procedure.