Anatomical Variation in the Prostate Artery: What a Trainee Needs to Know

This submission has open access
Submission ID :
GEST2021-54
Submission Type
Submission Topic
Sub-topics
Prostate Artery Embolization (PAE)
Purpose :
The focus of this educational exhibit is to present a review of the anatomical arterial and collateral variations of the prostate artery.
Materials & Methods :
We present a review of prostate artery embolization (PAE) and its utility in treating lower urinary tract symptoms (LUTS). To better aid in understanding the technical complexity of PAE, especially when factoring in anatomical arterial and collateral variants, a pictorial review of these variations will be displayed. A review of the relevant literature of PAE will be added, along with procedural suggestions and tips for current interventionalists and to serve as a teaching opportunity for resident trainees.
Results :
Given the increasing use of PAE in the treatment for LUTS caused by benign prostatic hyperplasia (BPH), further emphasis on the anatomical variants is warranted. BPH is a common, chronic enlargement of the prostate whose prevalence increases significantly as men age. PAE was originally developed in 2010 as a treatment for BPH and has been shown to be safe and effective in patients whose BPH is refractory/intolerant to pharmacotherapy. Preliminary data suggests that PAE is highly effective with little to no related sexual dysfunction. This procedure may be technically challenging due to, in part, identifying the prostate arteries and differentiating them from the surrounding arteries. Perhaps even more challenging is the presence of prostate artery origin, collateral arterial supplies, and anastomotic anatomical variants. Patients may be categorized in one of five angiographic anatomical classifications based on prostate artery origins. Not only can the variant anatomy complicate catheterization, but it may also impact other factors such as clinical outcomes, complication rates, procedure time, radiation exposure, and interventionalist confidence. Depending on the origin type (Type I-V), the interventionalist may vary the approach and catheterization to better suit the patient's anatomy, as well as better predict any future complications (usually seen as non-target embolization) of the procedure.
Conclusions :
PAE has been shown to be safe and effective in the treatment of LUTS secondary to BPH. The procedure may be technically difficult given the varying prostate artery origins and accompanied collaterals and anatomic vessels. Correctly identifying the patient's anatomical classification and modifying the approach may result in favorable clinical outcomes and reduced complications, procedure time, and radiation exposure.
Poster Abstract :
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Associated Sessions

SUNY Upstate Medical University
Radiology Resident
,
SUNY Upstate Medical University
SUNY Upstate Medical University
SUNY Upstate Medical University
SUNY Upstate Medical University

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