Digital Subtraction Angiography of the Prostatic Artery in Vietnamese Men: Anatomical Variants and Collateral Pathways. A Prospective Observational Study.

OBJECTIVE: To describe the origin, morphology, and branching patterns of the prostatic artery in Vietnamese men with symptomatic benign prostatic hyperplasia and to identify anatomical features relevant to planning and safety of prostatic artery embolization (PAE). METHODS: This prospective study enrolled 120 patients who underwent pelvic digital subtraction angiography before planned PAE at Bach Mai Hospital, Hanoi, Vietnam between September 2022 and December 2024. For each hemipelvis, the number and origin of prostatic arteries were classified using the Yamaki and Moreira de Assis systems. Arterial diameter, length, tortuosity, atherosclerotic changes, and anastomotic connections with adjacent pelvic vessels were documented. Side-to-side differences were analyzed using paired tests, and correlations between arterial measurements and clinical variables were assessed. RESULTS: A total of 240 hemipelves were evaluated. Yamaki type A was the predominant internal iliac artery branching pattern (77.9%). The most common prostatic artery origin was Moreira de Assis type I (46.7%), followed by types IV and III. A single prostatic artery was identified in 91.3% of hemipelves. Mean arterial diameter and length were 1.90 ± 0.43 mm and 180.53 ± 68.60 mm. Tortuosity was present in 70.4% of arteries, atherosclerosis in 38.3%, and anastomoses in 49.2%. No significant side-to-side differences were found in arterial diameter or tortuosity, whereas atherosclerosis differed (p = 0.040). Prostate volume showed a weak positive correlation with arterial diameter (r = 0.27; p < 0.05). CONCLUSIONS: Variability in prostatic artery anatomy highlights the importance of detailed vascular assessment for safe PAE.