Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography
- 530 Downloads
This work aimed to study the prevalence and radiologic anatomy of the middle rectal artery (MRA) using computed tomographic angiography (CTA) and digital subtraction angiography (DSA). The retrospective study (October 2010–February 2012) focused in 167 male patients with prostate enlargement (mean age 64.7 years, range 47–81 years) who underwent selective pelvic arterial embolization for the relief of lower urinary tract symptoms. All patients underwent CTA previously to DSA to evaluate the vascular anatomy of the pelvis and to plan the treatment. MRAs were identified and classified according to their origin, trajectory, termination and relationship with surrounding arteries. We found MRAs in 60 (35.9 %) patients (23.9 % of pelvic sides, n = 80) and of those, 20 (12 %) had bilateral MRAs; 24 MRAs (30 %) were independent of neighbouring arteries and 56 MRAs (70 %) had common origins with prostatic arteries (prostato-rectal trunk). The most frequent MRA origin was the internal pudendal artery (60 %, n = 48), followed by the inferior gluteal artery (21.3 %, n = 17) and common gluteal-pudendal trunk (16.2 %, n = 13). In 2 patients the MRA originated from the obturator artery (2.5 %). Anastomoses to the superior rectal and inferior mesenteric arteries were found in 87.5 % of cases (n = 70). We concluded that MRAs are anatomical variants present in less than half of male patients; have variable origins and frequently share common origins with prostatic arteries. Their correct identification is likely to contribute to improve interventional radiology procedures and prostatic or rectal surgeries.
KeywordsAnatomy Digital subtraction angiography Computed tomographic angiography Middle rectal artery Rectal arteries
The authors confirm full access to all the data in this study and have final responsibility for the decision to submit for publication. All authors take responsibility for the integrity of the data and the accuracy of the data analysis. The authors declare no Grant supports, NIH funding or potential conflicts of interest regarding this article. There are no conflicts of interest for any of the institutions participating in this study and no financial or personal relationships with other people or organizations that could inappropriately influence (bias) this work. Sandra Carmo for her contribution towards defining the best tube angulations for DSA and PAE. Teresa, Iládia, Cláudia and Maria José for technical support.
- 1.Adachi B (1928) Das arteriensystem der japaner. Band II. Verlag Der Kaiserlich-Japanischen, Universitat zu Kyoto, Kyoto, p 56Google Scholar
- 8.Michels NA (1955) Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. JB Lippincott Company, Philadelphia, p 389Google Scholar
- 9.Moore KL, Dalley AF, Agur AMR (2008) Clinically Oriented Anatomy, 6th edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, p 371Google Scholar
- 15.Rouvière H, Delmas A (1987) Anatomía Humana, vol 2. Tronco, 9th edn. Masson S.A., Paris, 206–7Google Scholar