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.