Surgical and Radiologic Anatomy

, Volume 35, Issue 6, pp 517–522 | Cite as

Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography

  • Tiago BilhimEmail author
  • José A. Pereira
  • Hugo Rio Tinto
  • Lúcia Fernandes
  • Marisa Duarte
  • João E. O’Neill
  • João M. Pisco
Anatomic Bases of Medical, Radiological and Surgical Techniques


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.


Anatomy 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.


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Copyright information

© European Union 2013

Authors and Affiliations

  • Tiago Bilhim
    • 1
    • 2
    • 3
    Email author
  • José A. Pereira
    • 2
  • Hugo Rio Tinto
    • 2
    • 3
  • Lúcia Fernandes
    • 2
    • 3
  • Marisa Duarte
    • 2
  • João E. O’Neill
    • 1
  • João M. Pisco
    • 2
    • 3
  1. 1.Anatomy Department, Faculdade de Ciências MédicasUniversidade Nova de LisboaLisbonPortugal
  2. 2.Interventional Radiology DepartmentSaint Louis HospitalLisbonPortugal
  3. 3.Radiology Department, Faculdade de Ciências MédicasUniversidade Nova de LisboaLisbonPortugal

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