Prostatic artery from an extrapelvic obturator artery: a rare common femoral artery variant with clinical implications.

Background: Prostate artery embolization (PAE) is an established treatment option for benign prostatic hyperplasia (BPH). Variations in prostatic artery (PA) origins can present significant technical challenges.

Case presentation: An 86-year-old male with recurrent bladder cancer and persistent gross hematuria post-TURBT presented for PAE. Intra-procedural angiography revealed a prostatic artery branching from an aberrant obturator artery that originated from a trifurcation of the common femoral artery. PAE was successfully performed with contralateral access and particle embolization. The patient's hematuria resolved within 3 days, and his IPSS decreased by 10 points at follow-up.

Conclusion: This case highlights a markedly rare variant of the prostatic artery arising from the common femoral artery, emphasizing the need for careful pre-procedural planning and vigilance during PAE to avoid complications.