Pelvic Arterial Anatomy Relevant to Prostatic Artery Embolisation and Proposal for Angiographic Classification
- 1.9k Downloads
To describe and categorize the angiographic findings regarding prostatic vascularization, propose an anatomic classification, and discuss its implications for the PAE procedure.
Angiographic findings from 143 PAE procedures were reviewed retrospectively, and the origin of the inferior vesical artery (IVA) was classified into five subtypes as follows: type I: IVA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery (SVA); type II: IVA originating from the anterior division of the IIA, inferior to the SVA origin; type III: IVA originating from the obturator artery; type IV: IVA originating from the internal pudendal artery; and type V: less common origins of the IVA. Incidences were calculated by percentage.
Two hundred eighty-six pelvic sides (n = 286) were analyzed, and 267 (93.3 %) were classified into I–IV types. Among them, the most common origin was type IV (n = 89, 31.1 %), followed by type I (n = 82, 28.7 %), type III (n = 54, 18.9 %), and type II (n = 42, 14.7 %). Type V anatomy was seen in 16 cases (5.6 %). Double vascularization, defined as two independent prostatic branches in one pelvic side, was seen in 23 cases (8.0 %).
Despite the large number of possible anatomical variations of male pelvis, four main patterns corresponded to almost 95 % of the cases. Evaluation of anatomy in a systematic fashion, following a standard classification, will make PAE a faster, safer, and more effective procedure.
KeywordsBenign prostatic hyperplasia (BPH) Prostatic artery embolisation (PAE) Pelvic anatomy
Conflict of interest
All authors declare that they have no conflicts of interest.
- 1.Antunes AA, Carnevale FC, da Motta-Leal-Filho JM, Yoshinaga EM, Cerri LM, Baroni RH, et al. Clinical, laboratorial and urodynamic findings of prostatic artery embolization for the treatment of urinary retention related to benign prostatic hyperplasia. A prospective singe-center pilot study. Cardiovasc Intervent Radiol. 2013;36:978–86.PubMedCrossRefGoogle Scholar
- 3.Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, et al. Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol. 2013;23:2561–72.PubMedCrossRefGoogle Scholar
- 4.Assis AM, Rodrigues VCP, Yoshinaga EM, Antunes AA, Harward SH, Srougi M, et al. Prostatic artery embolization (PAE) for treatment of benign prostatic hyperplasia in patients with prostates exceeding 90 g: a prospective single center study. J Vasc Interv Radiol. 2015;26:87–93.PubMedCrossRefGoogle Scholar
- 12.Carnevale FC, Antunes AA, da Motta Leal Filho JM, de Oliveira Cerri LM, Baroni RH, Marcelino AS, et al. Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol. 2010;33:355–61.PubMedCentralPubMedCrossRefGoogle Scholar