Variants of Patterns of Intra- and Extra-prostatic Arterial Distribution of the Prostatic Artery Applied to Prostatic Artery Embolization: Proposal of a Classification
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The development of prostatic artery embolization has led to better understand the complex male pelvic arterial anatomy. To the best of our knowledge, there is still no precise description of the distribution of the branches of the prostatic artery (PA) after its origin. In this study, the patterns of prostatic feeders near to and into the prostate were analyzed, and a classification was proposed.
Materials and Methods
This study is based on angiograms of 101 consecutive male patients, mean age 70, who underwent PAE between December 2013 and June 2016, to treat symptomatic benign prostatic hyperplasia.
The proposed classification is derived from the analysis of 143 solitary PAs from 199 hemipelves (72%). Pattern A was defined as an artery feeding only the prostate, patterns B and C as a PA with a concomitant large supply to the penis (pattern B) or to the rectum (pattern C). A pattern A was found in 89/143 (62%), a pattern B in 16/143 (12%) and pattern C in 38/143 (26%). Protection of a penile/rectal supply was never required in pattern A, while it was performed in 14/16 (87%) of pattern B, and in 7/38 (18%) of pattern C PAs. The PErFecTED technique could be performed in 51%, 50 and 55% of cases in pattern A to C.
This study proposes a new classification of intra-/extra-prostatic arterial distribution of the PA that could be helpful to prevent complications of PAE. Further prospective angiographic investigations are necessary to confirm its clinical value.
KeywordsProstatic Hyperplasia Embolization Therapeutic Endovascular procedure Radiology Interventional Prostate
Benign prostatic hyperplasia
Prostatic artery embolization
Lower urinary tract symptoms
Acute urinary retention
Institutional review board
Digital subtraction angiography
Cone beam computed tomodensitometry
Internal iliac artery
Accessory pudendal artery
Internal pudendal artery
Compliance with Ethical Standards
Conflict of interest
Authors Gregory Amouyal, Olivier Pellerin, Costantino Del Giudice, Carole Dean, Nicolas declare that they have no conflict of interest. Thiounn Marc Sapoval has financial support from Merit Medical (Salt Lake City, USA) for attending/speaking at symposia/congresses and for educational programs.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”
Informed consent was obtained from all individual participants included in the study.
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