Anatomical Variants in Prostate Artery Embolization: A Pictorial Essay

Abstract

Prostate artery embolization (PAE) has emerged as a new treatment option for patients with symptomatic benign prostatic hyperplasia. The main challenges related to this procedure are navigating arteries with atherosclerosis and anatomical variations, and the potential risk of non-target embolization to pelvic structures due to the presence of collateral shunts and reflux of microparticles. Knowledge of classical vascular anatomy and the most common variations is essential for safe embolization, good clinical practice, and optimal outcomes. The aim of this pictorial essay is to illustrate the pelvic vascular anatomy relevant to PAE in order to provide a practical guide that includes the most common anatomical variants as well as to discuss the technical details related to each.

Prostatic Artery Originating from Inferior Mesenteric Artery: A Very Rare Variation Observed in Computed Tomography Angiography

“…10 Various variations and presence of collateral shunts causing complications in PAE procedure were also reported in the literature. 8,12 Some of the reported complications associated with these variations are bladder ischemia, transient ischemic proctitis, pubic avascular necrosis and penile ischemia. 4 Collateral connections that cannot be demonstrated by imaging methods and retrograde reflux were reported to lead these complications.…”

“…4 Collateral connections that cannot be demonstrated by imaging methods and retrograde reflux were reported to lead these complications. 12 Besides, it must be kept in mind that insufficient selective catheterization of accessory prostatic artery during angiography procedure may also lead complications.…”

“…7 In the literature, PA arising from various branches of the internal iliac artery has been reported. [7][8][9][10][11][12] However; to our knowledge, the PA originating from the branches of abdominal arteries has not been described. Arterial variations of the region may be well defined due to the increasing popularity of minimally invasive nonsurgical treatments and widespread use of CTA as a diagnostic method.…”

“…4 In the literature, prostatic artery arises from; internal pudendal, inferior vesical or obturator, umbilical, inferior gluteal or internal iliac arteries. [6][7][8][9][10][11][12] In some cases, the prostatic artery arises from a common trunk such as anterior gluteal-pudendal or prostate-vesical trunk. 7 Considerable anastomoses were found between the prostatic branches and surrounding arteries such as the internal pudendal artery, con-Prostatic Artery Originating from Inferior Mesenteric Artery: A Very Rare Variation Observed in Computed Tomography Angiography A AB BS S T TR RA AC CT T The knowledge of detailed anatomy of the pelvic arterial system is essential to prevent the postoperative morbidity of prostate surgery.…”

State of the art of prostatic arterial embolization for benign prostatic hyperplasia

“…Superior gluteal, iliolumbar and lateral sacral arteries generally arise from the posterior branch; superior (SVA) and inferior vesical arteries (IVA), obturator, middle rectal, inferior gluteal, and internal pudendal arteries (IPA) from the anterior. Carnevale et al (27) created an acronym, PROVISO (Pudendal, Rectal, Obturator, Vesical Inferior and Superior) which can help to memorize the arteries related to prostate vascularization under the ipsilateral Oblique view (last letter of PROVISO) listed in a caudo-cranial sense.…”