03:36 PM Abstract No. 126 Angiographic features to aid identification of the prostatic artery during prostatic arterial embolization

Abstract

To determine a reliable method of identifying the prostatic artery on 45 degree ipsilateral oblique angiograms of the internal iliac artery. In this single-center, retrospective study, 63 patients underwent prostatic artery embolization (PAE) for benign prostatic hyperplasia from Apr 2012 to Sep 2018, performed by a single interventional radiologist. The 45 degree ipsilateral oblique angiograms (n=126) of the internal iliac artery were analyzed to identify two features of the prostate artery: the presence of a hairpin turn (120-180 degrees), and whether the prostate artery crossed or touched the main trunk of the obturator artery. Rectal arteries were evaluated for the same features. The origins of the prostate arteries were documented. ANOVA, Chi-squared, and Fisher’s exact tests were used to assess continuous and categorical data. A main prostatic artery was present in all 126 angiograms, and an obturator artery arose from the hypogastric artery in 95 of 126 angiograms (76.2%). 92 of 95 angiograms containing an obturator artery demonstrated the main prostatic artery crossing or touching the main trunk of the obturator artery, while only 3 did not (96.8% vs 3.2%, p<0.0001). 87 out of 126 main prostatic arteries demonstrated at least one hairpin turn, while 38 prostatic arteries did not (69.0% vs 31.0%, p=<0.0001). Origins of the prostatic arteries were as follows: internal pudendal artery (30.5%), gluteal-pudendal trunk (20.8%), vesicular artery (28.4%), obturator artery (9.7%), accessory internal pudendal artery (8.3%), and iliolumbar artery (0.7%). A total of 43 rectal arteries were identified in the 126 internal iliac angiograms (34.1%). Rectal arteries rarely crossed the obturator artery when present (cross vs no cross: 18.6% vs 81.4%, p=0.0002). The main prostatic artery almost always (96.8%) crosses the main trunk of the obturator artery on the 45 degree ipsilateral oblique angiogram of the hypogastric artery. The prostatic artery also typically features at least one hairpin turn along its course, though this feature is less reliable. These features can aid identification of the prostatic artery for PAE.