Ahmet GÜDELOĞLU, Ali Cansu BOZACI, Fatma Gonca ELDEM, Bora PEYNİRCİOĞLU, Fırat ATAK, Osman ÖCAL

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

Background/aim: 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. Materials and methods: 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. Results: 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. Conclusion: 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.Key words: Prostate artery embolization, prostatic arterial supply, interventional radiology

PDF

___

1. Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA et. al. Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic-controlled analysis. Cardiovascular and Interventional Radiology 2016; 39 (1): 44- 52.doi: 10.1007/s00270-015-1202-4
2. Pisco JM, Bilhim T, Pinheiro LC, Fernandes L, Pereira J et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. Journal of Vascular and Interventional Radiology 2016; 27 (8): 1115-1122.doi: 10.1016/j.jvir.2016.04.001
3. Carnevale FC, Soares GR, de Assis AM, Moreira AM, Harward S et al,. Anatomical variants in prostate artery embolization: a pictorial essay. Cardiovascular and Interventional Radiology 2017; 40 (9): 1321-1337.doi: 10.1007/s00270-017-1687-0
4. Clegg EJ. The arterial supply of the human prostate and seminal vesicles. Journal of Anatomy 1955; 89 (Pt 2): 209-216.
5. Clegg EJ. The vascular arrangements within the human prostate gland. British Journal of Urology 1956; 28 (4): 428-435.
6. Bouissou H, Talazac A. Arterial vascularization of the normal and the pathological prostate. Annales d’ Anatomie Pathologique (Paris) 1959; 4 (1): 63-79.
7. Bilhim T, Casal D, Furtado A, Pais D, O’Neill JE et. al. Branching patterns of the male internal iliac artery: imaging findings. Surgical and Radiologic Anatomy 2011; 33 (2): 151-159.doi: 10.1007/s00276-010-0716-3
8. Carnavale FC, Antunes AA. Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia. How I do it. Cardiovascular and Interventional Radiology 2013; 36 (6): 1452-1463.doi: 10.1007/s00270-013-0680-5
9. Carnevale FC, Moreira AM, Antunes AA. The “PErFecTED technique”: proximal embolization first, then embolize distal for benign prostatic hyperplasia. Cardiovascular and Interventional Radiology 2014; 37 (6): 1602-1605.doi: 10.1007/ s00270-014-0908-z
10. de Assis AM, Moreira AM, de Paula Rodrigues VC, Harward SH, Antunes AA et al. Pelvic Arterial anatomy relevant to prostatic artery embolisation and proposal for angiographic classification. Cardiovascular and Interventional Radiology 2015; 38 (4): 855- 861.doi: 10.1007/s00270-015-1114-3
11. Bilhim T, Pisco JM, Rio Tinto H, Fernandes L, Pinheiro LC et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. Journal of Vascular and Interventional Radiology 2012; 23 (11): 1403-1415.doi: 10.1016/j.jvir.2012.07.028
12. Wang MQ, Duan F, Yuan K, Zhang GD, Yan J et. al. Benign prostatic hyperplasia: cone-beam CT in conjunction with DSA for identifying prostatic arterial anatomy. Radiology 2017; 282 (1): 271-280.doi: 10.1148/radiol.2016152415
13. Garcia-Monaco R, Garategui L, Kizilevsky N, Peralta O, Rodriguez P et. al. Human cadaveric specimen study of the prostatic arterial anatomy: implications for arterial embolization. Journal of Vascular and Interventional Radiology 2014; 25 (2): 315-322.doi: 10.1016/j.jvir.2013.10.026
14. Bilhim T, Pisco JM, Furtado A, Casal D, Pais D et al. Prostatic arterial supply: demonstration by multirow detector angio CT and catheter angiography. European Radiology 2011; 21 (5): 1119-1126.doi: 10.1007/s00330-010-2015-0
15. du Pisanie J, Abumoussa A, Donovan K, Stewart J, BaglaS et. al. Predictors of prostatic artery embolization technical outcomes: patient and procedural factors. Journal of Vascular and Interventional Radiology 2019; 30 (2): 233-240.doi: 10.1016/j. jvir.2018.09.014
16. Enderlein GF, Lehmann T, von Rundstedt FC, Aschenbach R, Grimm MO et al. Prostatic artery embolization-anatomic predictors of technical outcomes. Journal of Vascular and Interventional Radiology 2020; 31 (3): 378-387. doi: 10.1016/j.jvir.2019.09.005
17. Han HC. Twisted blood vessels: symptoms, etiology and biomechanical mechanisms. Journal of Vascular Research 2012; 49 (3): 185-197.doi: 10.1159/000335123