Aliaksei Salei;
University of Alabama at Birmingham Hospital
Kory Dees;
University of Alabama at Birmingham Hospital
Rakesh Varma;
University of Alabama at Birmingham Hospital
Theresa Caridi;
University of Alabama at Birmingham Hospital
Background
Benign prostatic hyperplasia (BPH) is a major cause of lower urinary tract symptoms in men after the age of 40 years. The prevalence of BPH is on the rise due to aging of the population. For patients with BPH that are poor surgical candidates or prefer a minimally invasive treatment option, prostatic artery embolization (PAE) is a promising alternative. In depth understanding of prostate artery (PA) anatomy is a key to a successful PAE procedure. This exhibit provides a pictorial review of pertinent concepts of the PA anatomy, including origin variations, duplicated arterial supply, as well as extraprostatic anastomoses.
Educational Goals / Teaching Points
Illustrate variability of PA origin and approaches for its accurate identification. Review possibility of duplicated arterial supply to the prostate and its relevance for PAE. Review extraprostatic arterial anastomoses and techniques to avoid nontarget embolization.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
History of PAE, current evidence, and major guidelines recommendations, common origins of prostate artery, De Assis/Carnevale classification, role of preprocedural imaging and cone beam CT, duplicated PA, concept of central gland and peripheral zone arterial supply, DeMeritt classification of arterial supply to central gland, extraprostatic anastomoses, proposed classification, clinical relevance, and approaches to avoid related complications.
Conclusion
PAE is gaining popularity due to its effectiveness and minimal invasiveness. Procedural success and safety highly depend on correct identification of arterial supply to the prostate and extraprostatic anastomoses. Therefore, it is imperative that interventional radiologists are intimately familiar with clinically relevant aspects of PA anatomy.
