Tiago Bilhim MD, Presenter: Nothing to Disclose

Joao Martins Pisco MD, Abstract Co-Author: Nothing to Disclose

Luis Campos Pinheiro MD, Abstract Co-Author: Nothing to Disclose

Hugo Alexandre Meireles Rio Tinto MD, Abstract Co-Author: Nothing to Disclose

Sandra Marisa Duarte MD, Abstract Co-Author: Nothing to Disclose

Joao O'Neill MD, Abstract Co-Author: Nothing to Disclose

To describe the anatomy and imaging findings of the prostatic arteries (PAs). To identify the main anatomical patterns and variations of the PAs.

From March 2009 - March 2011, 75 male patients (150 pelvic sides) underwent pelvic angio CT and selective pelvic arterial angiography before prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH). PAs were classified on each pelvic side based on the number of vascular pedicles, their origin, trajectory, termination and anastomoses with adjacent arteries.

In 57.3% (n=86) there was only one PA, while in 42.7% (n=64) two independent PAs were identified on each pelvic side, with a total of 214 PAs. In 34.1% (n=73) the PAs originated from the internal pudendal artery; in 20.1% (n=43) from a common trunk with the superior vesical artery; in 17.8% (n=38) from the anterior common gluteal-pudendal trunk; in 12.6% (n=27) from the obturator artery and in 8.4% (n=18) from a common trunk with rectal branches. Rare origins: inferior gluteal artery (3.7%; n=8); accessory pudendal artery (1.9%; n=4) and superior gluteal artery (1.4%; n=3). In 42.7% (n=64) of cases no significant anastomoses were identified, while in 57.3% (n=86) anastomoses to adjacent arteries were documented: internal pudendal arteries (43.3%); contra-lateral (17.6%) and ipsilateral (13.4%) prostatic branches; rectal arteries (14.4%) and vesical arteries (11.3%). There were 30 cases (20%) of accessory pudendal arteries representing anastomoses between the PAs and the internal pudendal arteries and 5 cases (3.3%) of accessory pudendal arteries solely responsible for the arterial blood supply to the corpora cavernosa in close relationship with the PAs.

PAs almost always arise directly from the internal pudendal artery, anterior common gluteal-pudendal trunk, obturator artery or from a common trunk with the superior vesical or rectal arteries. Up to 25% of cases, accessory pudendal arteries may be found in close relationship with the PAs. The number of vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning PAE.  

This is the largest and most comprehensive study to date focusing on prostatic arterial supply, describing the main anatomical and imaging features essential to perform selective embolization.

Bilhim, T, Pisco, J, Pinheiro, L, Rio Tinto, H, Duarte, S, O'Neill, J, Prostatic Arterial Supply: Anatomical and Imaging Findings Based on the Evaluation of 150 Male Pelvic Sides.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004465.html