Abstract No. 419 - Evaluation of the prostatic artery anatomy and its variants with cone beam CT scan

Abstract

Learning Objectives: Cone beam CT scan (CBCT) pictorial review of the Prostatic artery (PA) anatomic variants.Discussion of optimal CBCT protocols in terms of location of the microcatheter, rate and volume of contrast injection as well as reconstruction algorithm during Prostatic artery embolization (PAE) Background: Thorough knowledge of PA anatomy and its variants is important in performing PAE successfully. Significant variability of the antero-lateral PA (AT) and posterolateral PA (PT) is observed in terms of origin, course and anastomosis with other important arteries. Identification and catheterization of these arteries is important during PAE to prevent nontarget embolization leading to ischemic damage to critical pelvic organs. Optimal quality of CBCT is important in identifying these arteries, their origins and atherosclerotic changes guiding the superselective catheterization of these arteries. Clinical Findings/Procedure Details: AT primarily supplies the central gland and benign prostatic hyperplasia nodules and most important artery to embolize. It frequently arises from the superior vesical artery. PT supplies peripheral portion of the gland and has frequent anastomosis with anal and rectal arteries. AT and PT may arise from the single artery (branch of internal iliac artery IIA) in more than 50% of cases. CBCT can identify these arteries and their anastomosis with other critical arteries in great detail. Size and location of the microcatheter, rate and volume of the contrast injection as well as reconstruction algorithm determines the CBCT quality. We have been successfully doing CBCT with microcatheter nonselectively (arterial phase) and superselective at AT or PT (parenchymal phase) without any periprocedure morbidity. Conclusion and/or Teaching Points: PAE can be performed safely and effectively with thorough knowledge of PA anatomy and its anatomic variants as well as optimizing CBCT protocols.