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Variants of Patterns of Intra- and Extra-prostatic Arterial Distribution of the Prostatic Artery Applied to Prostatic Artery Embolization: Proposal of a Classification

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

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.

Results

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.

Conclusion

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.

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Abbreviations

BPH:

Benign prostatic hyperplasia

PA:

Prostatic artery

PAE:

Prostatic artery embolization

LUTS:

Lower urinary tract symptoms

AUR:

Acute urinary retention

IR:

Interventional radiologist

IRB:

Institutional review board

DSA:

Digital subtraction angiography

AP:

Antero-posterior

CBCT:

Cone beam computed tomodensitometry

IIA:

Internal iliac artery

PT:

PErFecTED technique

APA:

Accessory pudendal artery

IPA:

Internal pudendal artery

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Authors and Affiliations

  1. Faculté de Médecine, Université Paris Descartes - Sorbonne - Paris - Cité, Paris, France

    Gregory Amouyal, Olivier Pellerin, Costantino Del Giudice, Nicolas Thiounn & Marc Sapoval

  2. Interventional Radiology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France

    Gregory Amouyal, Olivier Pellerin, Costantino Del Giudice, Carole Dean & Marc Sapoval

  3. INSERM U970, Paris, France

    Olivier Pellerin, Carole Dean & Marc Sapoval

  4. Urology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France

    Nicolas Thiounn

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  1. Gregory Amouyal
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Correspondence to Gregory Amouyal.

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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.

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.

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Amouyal, G., Pellerin, O., Del Giudice, C. et al. Variants of Patterns of Intra- and Extra-prostatic Arterial Distribution of the Prostatic Artery Applied to Prostatic Artery Embolization: Proposal of a Classification. Cardiovasc Intervent Radiol 41, 1664–1673 (2018). https://doi.org/10.1007/s00270-018-2064-3

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  • DOI: https://doi.org/10.1007/s00270-018-2064-3

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