Arterial Interventions and Peripheral Arterial Disease (PAD)
Anthony R. Zamary, MS
Kaiser Permanente School of Medicine
Disclosure(s): No financial relationships to disclose
Alexander Andrew Argame, BSN, RN (he/him/his)
Kaiser Permanente Bernard J. Tyson School of Medicine
Geogy Vatakencherry, MD, FSVM,FSIR
Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente physician
Alok Bhatt, MD
Assistant Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente Los Angeles
Learning Objectives: To present a pictorial atlas of prostatic artery anatomy relevant to prostatic artery embolization. This includes a review of common classification systems, such as Yamaki Branching Classification and Carnevale Classification, as well as dangerous anastomoses, collateral identification, and clinically important vascular variants.
Background: Benign prostatic hyperplasia (BPH) affects 80% of men by age 80. The often-associated lower urinary tract symptoms (LUTS) can greatly decrease quality of life. Prostatic artery embolization (PAE), among other minimally invasive surgical techniques (MISTs), is an effective treatment performed by interventional radiologists that has been shown to improve LUTS and reduce prostatic volume. Although understanding prostatic artery anatomy is key for intervention, arterial anatomy is highly varied among individuals. Multiple systems of classifying arterial anatomy by number, origin, anastomoses, incidence of atherosclerosis, branching, and type have been attempted. In this educational exhibit, we seek to provide an atlas of prostatic artery anatomy.
Clinical Findings/Procedure Details:
CLINICAL FINDINGS/PROCEDURE DETAILS:
This exhibit will:
1. Provide a pictorial review of prostatic artery anatomy and classifications by Carnevale et al. and Yamaki et al.
2. Describe the frequency of the previously classified variants based on current literature.
3. Describe the vascular navigation involved in PAE.
4. Identify and describe dangerous anastomoses and collaterals.
5. Identify and describe clinically important vascular variants, including blood supply, size, and vascular compartmentalization.
Conclusion and/or Teaching Points:
CONCLUSION AND/OR TEACHING POINTS: Knowledge of prostatic artery anatomy and its variants is critical to performing successful PAE. PAE is an important therapy for BPH performed by interventional radiologists. Highlighting key imaging findings of PA anatomy variations can help an interventional radiologist determine a procedural approach or alternative therapy option. The atlas of PA anatomy presented here exhibits important PA anatomy variations essential to successful MIST, which can greatly improve a patient’s quality of life.