Background: Prostatic artery embolization (PAE) has been established as a safe and effective
treatment option for symptomatic benign prostatic hyperplasia. Thorough knowledge
of detailed prostatic artery (PA) anatomy is essential to guarantee technical success
and to avoid potential complications of non-target embolization. We aim to provide
a pictorial review of PA and prevalence of each anatomical variant, in addition to
important anatomical considerations, extracted from our case series. Method(s): We performed PAE on 168 consecutive patients until 2019. The most commonly used tools
were 5-French cobra-head angiographic catheter and 2.7-French microcatheter. Images
were analyzed by the operators. Result(s): In the 168 patients, 331 PAs were angiographically identified. Double arterial supply
on the same side was noted in 9 patients (5%). In 10 patients (6%), only a unilateral
PA was identified. No PA could be identified in 2 patients (1%). The frequencies of
origins of PAs were found to be as follows: 133 (40%) from superior vesical artery
(SVA), 97 (29%) from internal pudendal artery (IPA), 70 (21%) from obturator artery,
29 (9%) originated directly from anterior division of internal iliac artery and only
2 (<1%) originated from inferior gluteal artery. Contrast filling of contralateral
PA main trunk was identified in 31 patients (18%). Penile anastomosis was identified
with 28 PAs (8%) and rectal anastomosis was observed with 14 PAs (4%). Conclusion(s): PA has variable origins, even for both sides in the same patient. Knowledge of its
detailed anatomy and anastomosis with nearby arteries is essential for safe and timely
performance of PAE.
