Abstract No. 103 The Impact of Prostate Artery Origin on Procedure Time for Prostate Artery Embolization with n-Butyl cyanoacrylate

Prostatic artery embolization (PAE) is considered a technically challenging procedure given the anatomic variations of the prostatic artery (PA) origin. As a result, a standardized angiographic classification system was established to facilitate recognition and catheterization of target branches. The impact of anatomical patterns on the outcomes of PAE with microparticles has been studied extensively. This project aims to investigate the impact of PA anatomy on procedure time for PAE with NBCA. Retrospective review was conducted for patients who underwent successful PAE with NBCA as the primary embolic from June 2022 to July 2023. All cases were performed at a single institution with a single operator with 10 years of experience. Angiographic findings from 124 PAEs with NBCA were analyzed to categorize the origin of the left and right PA according to a previously established anatomical classification system: from the anterior division of the internal iliac artery (IIA) in a common trunk with the superior vesical artery (SVA) (type I); from the anterior division of the IIA inferior to the SVA origin (type II); from the obturator artery (type III); from the internal pudendal artery (type IV); from less common origins (type V). Procedure times were independently measured by laterality as the time between the first angiogram in the IIA and the last angiogram demonstrating stasis after embolization. Patients with previous embolizations and rare anatomic variants such as corona mortis were excluded. 151 prostatic arteries met the criteria for inclusion and could be accurately assessed on imaging. Type I was the most common prostatic artery origin (n=54, 35.8%), followed by type IV (n=42, 27.8%), type III (n=35, 23.2%), type II (n=16, 10.6%), and type V (n=4, 2.6%). Rare type V origins led to the longest procedure times (median 27.7 minutes, IQR 16.6-41.7 minutes), followed by type I (median 20.0 minutes, IQR 11.1-24.3 minutes), type II (median 16.6 minutes, IQR 14.4-20.6 minutes), type III (median 15.8 minutes, IQR 12.4-22.9 minutes), and type IV (median 13.8 minutes, IQR 10.1-20.2 minutes). Type V and type I origins led to longer procedure times in PAE with NBCA. Thorough understanding of pelvic vascular anatomy and the different possible origins of the PA are essential for the safe and prompt completion of PAE.