CardioVascular and Interventional Radiology

, Volume 41, Issue 11, pp 1664–1673 | Cite as

Variants of Patterns of Intra- and Extra-prostatic Arterial Distribution of the Prostatic Artery Applied to Prostatic Artery Embolization: Proposal of a Classification

  • Gregory AmouyalEmail author
  • Olivier Pellerin
  • Costantino Del Giudice
  • Carole Dean
  • Nicolas Thiounn
  • Marc Sapoval
Clinical Investigation Arterial Interventions
Part of the following topical collections:
  1. Arterial Interventions


The development of prostatic artery embolization has led to better understand the complex male pelvic arterial anatomy. To the best of our knowledge, there is still no precise description of the distribution of the branches of the prostatic artery (PA) after its origin. In this study, the patterns of prostatic feeders near to and into the prostate were analyzed, and a classification was proposed.

Materials and Methods

This study is based on angiograms of 101 consecutive male patients, mean age 70, who underwent PAE between December 2013 and June 2016, to treat symptomatic benign prostatic hyperplasia.


The proposed classification is derived from the analysis of 143 solitary PAs from 199 hemipelves (72%). Pattern A was defined as an artery feeding only the prostate, patterns B and C as a PA with a concomitant large supply to the penis (pattern B) or to the rectum (pattern C). A pattern A was found in 89/143 (62%), a pattern B in 16/143 (12%) and pattern C in 38/143 (26%). Protection of a penile/rectal supply was never required in pattern A, while it was performed in 14/16 (87%) of pattern B, and in 7/38 (18%) of pattern C PAs. The PErFecTED technique could be performed in 51%, 50 and 55% of cases in pattern A to C.


This study proposes a new classification of intra-/extra-prostatic arterial distribution of the PA that could be helpful to prevent complications of PAE. Further prospective angiographic investigations are necessary to confirm its clinical value.


Prostatic Hyperplasia Embolization Therapeutic Endovascular procedure Radiology Interventional Prostate 



Benign prostatic hyperplasia


Prostatic artery


Prostatic artery embolization


Lower urinary tract symptoms


Acute urinary retention


Interventional radiologist


Institutional review board


Digital subtraction angiography




Cone beam computed tomodensitometry


Internal iliac artery


PErFecTED technique


Accessory pudendal artery


Internal pudendal artery


Compliance with Ethical Standards

Conflict of interest

Authors Gregory Amouyal, Olivier Pellerin, Costantino Del Giudice, Carole Dean, Nicolas declare that they have no conflict of interest. Thiounn Marc Sapoval has financial support from Merit Medical (Salt Lake City, USA) for attending/speaking at symposia/congresses and for educational programs.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Carnevale FC, Moreira AM, Harward SH, Bhatia S, de Assis AM, Srougi M, et al. Recurrence of lower urinary tract symptoms following prostate artery embolization for benign hyperplasia: single center experience comparing two techniques. Cardiovasc Interv Radiol. 2017;40(3):366–74.CrossRefGoogle Scholar
  2. 2.
    Pisco JM, Bilhim T, Pinheiro LC, Fernandes L, Pereira J, Costa NV, et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol. 2016;27(8):1115–22.CrossRefGoogle Scholar
  3. 3.
    Clegg EJ. The arterial supply of the human prostate and seminal vesicles. J Anat. 1955;89(2):209–16.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Clegg EJ. The vascular arrangements within the human prostate gland. Br J Urol. 1956;28(4):428–35.CrossRefGoogle Scholar
  5. 5.
    Garcia-Monaco R, Garategui L, Kizilevsky N, Peralta O, Rodriguez P, Palacios-Jaraquemada J. Human cadaveric specimen study of the prostatic arterial anatomy: implications for arterial embolization. J Vasc Interv Radiol. 2014;25(2):315–22.CrossRefGoogle Scholar
  6. 6.
    Bagla S, Rholl KS, Sterling KM, van Breda A, Papadouris D, Cooper JM. Utility of cone-beam CT imaging in prostatic artery embolization. J Vasc Interv Radiol. 2013;24(11):1603–7.CrossRefGoogle Scholar
  7. 7.
    Bilhim T, Pisco JM, Rio Tinto H, Fernandes L, Pinheiro LC, Furtado A, et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol. 2012;23(11):1403–15.CrossRefGoogle Scholar
  8. 8.
    Carnevale FC, Soares GR, de Assis AM, Moreira AM, Harward SH, Cerri GG. Anatomical variants in prostate artery embolization: a pictorial essay. Cardiovasc Intervent Radiol. 2017;40(9):1321–37.CrossRefGoogle Scholar
  9. 9.
    de Assis AM, Moreira AM, de Paula Rodrigues VC, Harward SH, Antunes AA, Srougi M, et al. Pelvic arterial anatomy relevant to prostatic artery embolisation and proposal for angiographic classification. Cardiovasc Interv Radiol. 2015;38(4):855–61.CrossRefGoogle Scholar
  10. 10.
    Zhang G, Wang M, Duan F, Yuan K, Li K, Yan J, et al. Radiological findings of prostatic arterial anatomy for prostatic arterial embolization: preliminary study in 55 Chinese patients with benign prostatic hyperplasia. PLoS ONE. 2015;10(7):e0132678.CrossRefGoogle Scholar
  11. 11.
    Amouyal G, Thiounn N, Pellerin O, Yen-Ting L, Del Giudice C, Dean C, et al. Clinical results after prostatic artery embolization using the PErFecTED technique: a single-center study. Cardiovasc Interv Radiol. 2016;39(3):367–75.CrossRefGoogle Scholar
  12. 12.
    Carnevale FC, Moreira AM, Antunes AA. The “PErFecTED Technique”: proximal embolization first, then embolize distal for benign prostatic hyperplasia. Cardiovasc Interv Radiol. 2014;37(6):1602–5.CrossRefGoogle Scholar
  13. 13.
    Amouyal G, Chague P, Pellerin O, Pereira H, Del Giudice C, Dean C, et al. Safety and efficacy of occlusion of large extra-prostatic anastomoses during prostatic artery embolization for symptomatic BPH. Cardiovasc Interv Radiol. 2016;39(9):1245–55.CrossRefGoogle Scholar
  14. 14.
    Bhatia S, Sinha V, Bordegaray M, Kably I, Harward S, Narayanan G. Role of Coil Embolization during Prostatic Artery Embolization: Incidence, Indications, and Safety Profile. J Vasc Interv Radiol. 2017;28(5):656–64.CrossRefGoogle Scholar
  15. 15.
    Bouissou H, Talazac A. Arterial vascularization of the normal and the pathological prostate. Ann Anat Pathol (Paris). 1959;4(1):63–79.Google Scholar
  16. 16.
    Bilhim T, Pisco J, Pereira JA, Costa NV, Fernandes L, Campos Pinheiro L, et al. Predictors of clinical outcome after prostate artery embolization with spherical and nonspherical polyvinyl alcohol particles in patients with benign prostatic hyperplasia. Radiology. 2016;281(1):289–300.CrossRefGoogle Scholar
  17. 17.
    Kisilevzky N, Laudanna Neto C, Cividanes A. Ischemia of the glans penis following prostatic artery embolization. J Vasc Interv Radiol. 2016;27(11):1745–7.CrossRefGoogle Scholar
  18. 18.
    Abele JT, Moore R, Tymchak W, Owen RJ. Prostate perfusion mapped by technetium-99 m macroaggregated albumin after selective arterial injection. J Vasc Interv Radiol. 2015;26(3):418–25.CrossRefGoogle Scholar
  19. 19.
    Park BJ, Sung DJ, Kim MJ, Cho SB, Kim YH, Chung KB, et al. The incidence and anatomy of accessory pudendal arteries as depicted on multidetector-row CT angiography: clinical implications of preoperative evaluation for laparoscopic and robot-assisted radical prostatectomy. Korean J Radiol. 2009;10(6):587–95.CrossRefGoogle Scholar
  20. 20.
    Bagla S, Smirniotopolous JB, Vadlamudi V. Crossing a prostatic artery chronic total occlusion to perform prostatic arterial embolization. J Vasc Interv Radiol. 2016;27(2):295–7.CrossRefGoogle Scholar
  21. 21.
    Laborda A, De Assis AM, Ioakeim I, Sanchez-Ballestin M, Carnevale FC, De Gregorio MA. Radiodermitis after prostatic artery embolization: case report and review of the literature. Cardiovasc Interv Radiol. 2015;38(3):755–9.CrossRefGoogle Scholar
  22. 22.
    Kably I, Dupaix R. Prostatic artery embolization and the accessory pudendal artery. J Vasc Interv Radiol. 2016;27(8):1266–8.CrossRefGoogle Scholar
  23. 23.
    Bhatia S, Sinha VK, Abdul-Rahim O, Harward S, Narayanan G. Rare prostatic artery origins and the importance of collateral circulation in prostate artery embolization: a pictorial essay. Can Assoc Radiol J. 2018;69(2):220–29.CrossRefGoogle Scholar
  24. 24.
    Box GN, Kaplan AG, Rodriguez E Jr, Skarecky DW, Osann KE, Finley DS, et al. Sacrifice of accessory pudendal arteries in normally potent men during robot-assisted radical prostatectomy does not impact potency. J Sex Med. 2010;7(1 Pt 1):298–303.CrossRefGoogle Scholar
  25. 25.
    Carnevale FC, da Motta-Leal-Filho JM, Antunes AA, Baroni RH, Marcelino AS, Cerri LM, et al. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol. 2013;24(4):535–42.CrossRefGoogle Scholar
  26. 26.
    Pisco J, Campos Pinheiro L, Bilhim T, Duarte M, Rio Tinto H, Fernandes L, et al. Prostatic arterial embolization for benign prostatic hyperplasia: short- and intermediate-term results. Radiology. 2013;266(2):668–77.CrossRefGoogle Scholar
  27. 27.
    Moreira AM, Marques CF, Antunes AA, Nahas CS, Nahas SC, de Gregorio Ariza MA, et al. Transient ischemic rectitis as a potential complication after prostatic artery embolization: case report and review of the literature. Cardiovasc Interv Radiol. 2013;36(6):1690–4.CrossRefGoogle Scholar
  28. 28.
    Isaacson AJ, Bhalakia N, Burke CT. Coil embolization to redirect embolic flow during prostatic artery embolization. J Vasc Interv Radiol. 2015;26(5):768–70.CrossRefGoogle Scholar
  29. 29.
    Kim JI, Desai H, Isaacson AJ. Incidence of “Occult” prostatopudendal arterial anastomoses during prostatic artery embolization. J Vasc Interv Radiol. 2017;28(9):1273–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Faculté de MédecineUniversité Paris Descartes - Sorbonne - Paris - CitéParisFrance
  2. 2.Interventional Radiology Department, Assistance Publique - Hôpitaux de ParisHôpital Européen Georges PompidouParisFrance
  3. 3.INSERM U970ParisFrance
  4. 4.Urology Department, Assistance Publique - Hôpitaux de ParisHôpital Européen Georges PompidouParisFrance

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