Pelvic Arterial Anatomy Relevant to Prostatic Artery Embolisation and Proposal for Angiographic Classification

Abstract

Purpose: To describe and categorize the angiographic findings regarding prostatic vascularization, propose an anatomic classification, and discuss its implications for the PAE procedure.

Methods: Angiographic findings from 143 PAE procedures were reviewed retrospectively, and the origin of the inferior vesical artery (IVA) was classified into five subtypes as follows: type I: IVA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery (SVA); type II: IVA originating from the anterior division of the IIA, inferior to the SVA origin; type III: IVA originating from the obturator artery; type IV: IVA originating from the internal pudendal artery; and type V: less common origins of the IVA. Incidences were calculated by percentage.

Results: Two hundred eighty-six pelvic sides (n = 286) were analyzed, and 267 (93.3%) were classified into I-IV types. Among them, the most common origin was type IV (n = 89, 31.1%), followed by type I (n = 82, 28.7%), type III (n = 54, 18.9%), and type II (n = 42, 14.7%). Type V anatomy was seen in 16 cases (5.6%). Double vascularization, defined as two independent prostatic branches in one pelvic side, was seen in 23 cases (8.0%).

Conclusions: Despite the large number of possible anatomical variations of male pelvis, four main patterns corresponded to almost 95% of the cases. Evaluation of anatomy in a systematic fashion, following a standard classification, will make PAE a faster, safer, and more effective procedure.