Prostatic Arterial Supply: Anatomic and Imaging Findings Relevant for Selective Arterial Embolization

Bilhim, Tiago; Pisco, João Martins; Fernandes, Lúcia; Pinheiro, Luís Campos; Furtado, Andrea; Casal, Diogo; Duarte, Margarida; Pereira, José António; Oliveira, António G.; O’Neill, João Goyri

doi:10.1016/j.jvir.2012.07.028

Cited by 184 publications

(127 citation statements)

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“…Cadaveric and imaging studies have described in detail the prostatic artery anatomy relevant for embolization (1,2,7,8). Prostatic arteries have highly variable origins from the branches of the internal iliac artery.…”

Section: Discussionmentioning

confidence: 99%

“…The rare incidence of prostatic arteries arising from AOAs (o 2% from our experience) may explain why it was not reported before. Previous studies on prostatic artery anatomy included o 75 patients (1,2,7,8), which was probably the reason for not reporting this variant.…”

Section: Discussionmentioning

confidence: 99%

“…All patients underwent CT angiography before PAE as previously described (1). PAE was performed under local anesthesia by a contralateral femoral approach; when the prostatic artery originated from the right AOA, the left femoral artery was punctured and vice versa.…”

Section: Methodsmentioning

confidence: 99%

“…Prostatic arterial embolization (PAE) to relieve lower urinary tract symptoms in patients with benign prostatic hyperplasia is a challenging procedure partly because of the highly variable origin and complex anatomy of the prostatic arteries (1). Computed tomography (CT) angiography performed before PAE has been used to help identify the prostatic arteries and to guide the procedure (2).…”

mentioning

confidence: 99%

“…Computed tomography (CT) angiography performed before PAE has been used to help identify the prostatic arteries and to guide the procedure (2). The prostatic arteries may arise from the different branches of the internal iliac artery, including from the obturator artery, in 13% of pelvic sides (1,2). However, the obturator artery may arise from the inferior epigastric artery or directly from the external iliac artery and be named an accessory or aberrant obturator artery (AOA).…”

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confidence: 99%

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The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

Bilhim

Pisco²,

Pinheiro

et al. 2014

Journal of Vascular and Interventional Radiology

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In 9 of 491 patients (1.8%) who underwent prostatic arterial embolization (PAE) for benign prostatic hyperplasia from March 2009-November 2013, prostatic arteries arose from the external iliac artery via an accessory obturator artery (AOA). Computed tomography angiography performed before the procedure identified the variant and allowed planning before the procedure. The nine AOAs were catheterized from a contralateral femoral approach. Bilateral PAE was technically successful in the nine patients. There was a mean decrease in international prostate symptom score of 6.5 points and a mean prostate volume reduction of 15.1% (mean follow-up, 4.8 mo) in the nine patients. ABBREVIATIONSAOA = accessory obturator artery, DSA = digital subtraction angiography, IPSS = International Prostate Symptom Score, PAE = prostatic arterial embolization, PVA = polyvinyl alcohol, QoL = quality of life Prostatic arterial embolization (PAE) to relieve lower urinary tract symptoms in patients with benign prostatic hyperplasia is a challenging procedure partly because of the highly variable origin and complex anatomy of the prostatic arteries (1). Computed tomography (CT) angiography performed before PAE has been used to help identify the prostatic arteries and to guide the procedure (2). The prostatic arteries may arise from the different branches of the internal iliac artery, including from the obturator artery, in 13% of pelvic sides (1,2). However, the obturator artery may arise from the inferior epigastric artery or directly from the external iliac artery and be named an accessory or aberrant obturator artery (AOA). An AOA is a common variation that may be present in 30% of pelvic sides (3). Prostatic arteries arising from AOAs are a possible variant of particular relevance when performing PAE. The purpose of this report is to clarify this anatomic variation and report successful catheterization and embolization in nine patients with lower urinary tract symptoms related to benign prostatic hyperplasia. MATERIALS AND METHODSThe institutional review board waived the need to obtain permission to perform this retrospective analysis. From March 2009-November 2013, PAE was performed in 491 patients to relieve lower urinary tract symptoms secondary to benign prostatic hyperplasia. Nine patients with prostatic arteries arising from AOAs were included. AOAs were classified as (i) obturators arising from the inferior epigastric artery, (ii) obturators arising directly from the external iliac artery, or (iii) codominant obturators originating from both the external and the internal iliac artery systems (3).Among the nine patients evaluated, mean patient age was 62.9 years (range, 51-74 y). Mean International Prostate Symptom Score (IPSS) was 18.9 points (range, 14-21 points), mean quality of life (QoL) score was 4.0 points (range, 3-6 points). Mean peak flow rate was 11.2 mL/s (range, 5.9-13.5 mL/s), mean postvoid residual & SIR, 2014

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

Bilhim

Pisco²,

Pinheiro

et al. 2014

Journal of Vascular and Interventional Radiology

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Endovascular Interventions for the Pelvis

Diamond¹,

Conway²,

Carroccio³

et al. 2022

Interventional Cardiology

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Cadaveric and radiologic study of the anatomical variations of the prostatic arteries: A review of the literature and a new classification proposal with application to prostatectomy

et al. 2016

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Development of prostatic arterial embolization (PAE) to treat benign prostatic hyperplasia (BPH) has raised interest in the variations of the prostatic arteries (PA). The aim of this study is to identify these vascular variations, to compare them with previous data, and to propose a simple classification. Ten adult male pelvis sides from embalmed cadavers were dissected, ages 69 to 92 years, and 10 PA were examined. In a retrospective analysis of 34 DSA pelvic angiographies on 28 patients aged 50 to 90 years, 48 PA were identified. A total of 58 PA were therefore analyzed. Six types are defined. Type I: PA originates from the anterior division (AD) of the internal iliac artery (IIA), 20.7%; Type II: PA emerges from the obturator artery (OA), 5.2%; type III: PA arises from the gluteal-pudendal trunk (GPT), 27.5%; Type IV: PA originates from the internal pudendal artery (IPA), 29.3%; Type V: PA comes from the middle rectal artery (MRA), 15.5%. Other origins, not observed in our sample but described in the literature, were amalgamated under Type VI. The AD/GPT/IPA stem is the main source of the PA. Analysis of the definitions of IIA branches and the associated terminology is necessary for interpreting the results reported by several authors on different samples, but in general the results fit the meta-analysis well. A new, simple, and complete classification for vascular variations of the PA is proposed. Clin. Anat. 30:71-80, 2017. © 2016 Wiley Periodicals, Inc.

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Prostatic Arterial Supply: Anatomic and Imaging Findings Relevant for Selective Arterial Embolization

Cited by 184 publications

References 11 publications

The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

Endovascular Interventions for the Pelvis

Cadaveric and radiologic study of the anatomical variations of the prostatic arteries: A review of the literature and a new classification proposal with application to prostatectomy

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