Human Cadaveric Specimen Study of the Prostatic Arterial Anatomy: Implications for Arterial Embolization Ricardo Garcia-Monaco, MD, PhD, Lucas Garategui,

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Human Cadaveric Specimen Study of the Prostatic Arterial Anatomy: Implications for Arterial Embolization Ricardo Garcia-Monaco, MD, PhD, Lucas Garategui, MD, Nestor Kizilevsky, MD, Oscar Peralta, MD, Pablo Rodriguez, MD, Jose Palacios-Jaraquemada, MD Journal of Vascular and Interventional Radiology Volume 25, Issue 2, Pages 315-322 (February 2014) DOI: 10.1016/j.jvir.2013.10.026 Copyright © 2014 SIR Terms and Conditions

Figure 1 Schematic drawing of the prostatic arterial anatomy. References are listed in Table 1. Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions

Figure 2 Anatomic specimen. Anterolateral view (a); specimen magnification after partial prostatic dissection (b). References are listed in Table 1. The superior prostatic pedicle (1) divides into a medial (2) and a lateral branch (3). Notice (b) several arterial branches enter into the medial lobe and the anastomosis of the lateral branch with an inferior prostatic artery (arrow) branching from the IPA (12). Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions

Figure 3 Anatomic specimen with enlarged prostate. Posterior view. References are listed in Table 1. The medial and lateral prostatic branches emerge from two separate superior prostatic pedicles. Notice the enlarged medial branch (2) from the genito-vesical artery (7) and the lateral branch (3) from the prostatic-vesical artery (5). Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions

Figure 4 Anatomic specimen with enlarged prostate. Posterior lateral view. References are listed in Table 1. The rectum and the left seminal vesicle are retracted in the posterior-inferior direction. The inferior prostatic arteries (14) enter the prostate in its lateral border. Notice the anastomoses with the lateral branch of the superior prostatic pedicle (arrow) and the plexual configuration of the inferior prostatic pedicle. Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions

Figure 5 Anatomic specimen with enlarged prostate. References are listed in Table 1. Posterior view. The rectum is retracted in the posterior-inferior direction. The left superior prostatic pedicle (1) branches from a prostatic-vesical artery (5) originating in the IPA (12). On the right, the superior prostatic pedicle originates directly from the anterior trunk of the internal iliac artery (8) as a prostatic-vesical artery (5). Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions

Figure 6 Anatomic specimen. Left hemipelvis, posterior view. References are listed in Table 1. The rectum and the seminal vesicles are retracted in the posterior-inferior direction. There are three separate superior arterial feeders to the prostate: two separate medial branches arising from the genito-vesical artery (7) and middle rectal artery (13), respectively, and a lateral branch (3) arising from the prostatic-vesical artery (5). Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions

Figure 7 Anatomic specimen. Posterior view. References are listed in Table 1. The inferior prostatic pedicle forms a plexus (14) at the prostatic apex. Its afferents are vessels originating from the IPA (12), the inferior rectal artery (19), and the superior rectal artery (not colored) (19). Notice the longitudinal anastomoses of the superior and inferior prostatic pedicles (arrows) and a transverse anastomosis between the right and left medial branches (double arrows). Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions

Figure 8 Angiogram in a patient with BPH. References are listed in Table 1. (a) Angiogram after selective catheterization of the right prostatic-vesical artery. Oblique view. (b) Angiogram after bilateral selective catheterization of the prostatic-vesical arteries. Anteroposterior view (right and left image fusion). Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions

Figure 9 Anatomic specimen. Lateral view. References are listed in Table 1. The superior prostatic pedicle (1) originates directly in the anterior division of the hypogastric artery as a prostatic-vesical artery (5). Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions

Figure 10 Anatomic specimen of the left hemipelvis. Posterior superior view. References are listed in Table 1. The rectum is retracted in the posterior-inferior direction. The superior prostatic pedicle (1) originates in the middle rectal artery (13). Journal of Vascular and Interventional Radiology 2014 25, 315-322DOI: (10.1016/j.jvir.2013.10.026) Copyright © 2014 SIR Terms and Conditions