Radiological Findings of Prostatic Arterial Anatomy for Prostatic Arterial Embolization: Preliminary Study in 55 Chinese Patients with Benign Prostatic Hyperplasia

Abstract

ObjectiveTo describe the prostatic arterial supply using Cone-beam computed tomography (CT) and digital subtraction angiography (DSA) before prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH).MethodsIn a retrospective study from January 2012 to January 2014, 55 male patients (110 hemipelves) with BPH who underwent PAE were evaluated by Cone-beam CT in addition to pelvic DSA during embolization planning. Each hemipelvis was evaluated regarding the number of prostatic arteries (PA) and their origins, diameters, territorial perfusion, and anastomoses with adjacent arteries.ResultsA total of 114 PAs were identified in 110 hemipelves. There was one PA in 96.4% of the hemipelves (n=106), and two independent PAs in the other 3.6% (n=4). The PA was found to originate from the anterior trunk of the internal iliac artery in 39.5% of cases (n=45) , from the superior vesical artery in 32.6% (n=37), and from the internal pudendal artery in 27.9% of cases (n=32). Extra-prostatic anastomoses between PA and adjacent arteries were found in 39.1% of hemipelves (n=43). Intra-prostatic anastomoses between PAs and contra-lateral prostatic branches were found in 61.8% of hemipelves (n=68). In 67.3% of our study population (n=37), the prostate was dominantly supplied via a unilateral PA.ConclusionThe prostatic vascularization is complex with frequent anatomic variations. Knowledge of the vascular anatomy of the prostate may provide indications for planning PAE and avoiding nontarget embolization.

Review of Current Literature for Prostatic Artery Embolization

“…In 2015, Zhang et al evaluated PA anatomy using intraprocedural CBCT and DSA in 55 patients (110 pelvic halves) with BPH who underwent PAE. 23 The results were somewhat different from the previous study by Bilhim et al The incidences of a solitary PA and two independent PAs in this study were 96.4 and 3.6%, respectively. The PAs again were found to originate from various pelvic arteries, including the anterior division of the internal iliac artery (39.5%), the superior vesical artery (32.6%), and the internal pudendal artery (27.9%).…”

Three‐dimensional printing CT‐derived objects with controllable radiopacity

“…3 In addition, the prostate arteries often have very small diameters, on the order of 0.5 to 1.5 mm. 4 While C-arm CT has sufficient spatial resolution to image these arteries, it is performed in the angiography lab during the procedure.…”

Prostate Artery Embolization

“…These may be seen in 10 to 20% of patients. 30,31 However, a distinction must be made between small and large extraprostatic shunts. The former is frequently not visible on DSA unless a high-powered injection is employed.…”