Prostatic Artery Embolization in a Patient With Bilateral Internal Iliac Artery Occlusions

Background: Prostatic artery embolization (PAE) is an established treatment for lower urinary tract symptoms due to benign prostatic hyperplasia but can be challenging in complex anatomy. Study Sample: An 86-year-old male with history of abdominal aortic aneurysm repair and aortobifemoral bypass presented with gross hematuria and urinary retention. Imaging and clinical evaluation confirmed BPH-related clot retention as the etiology. Careful review of preprocedural CT angiography revealed occluded bilateral internal iliac arteries, a right aberrant obturator artery (AOA) (corona mortis variant), arising from the inferior epigastric artery, which itself originated from the native right external iliac artery. The AOA supplied the entire prostate, perfusing both lobes and contributing to the contralateral pelvic circulation as well. Cone-beam CT and angiography confirmed the perfusion to both prostatic lobes. PAE was performed by accessing the native common femoral artery and selectively catheterizing the AOA. Embolization of the prostatic parenchyma was completed successfully while preserving flow to adjacent pelvic structures, avoiding non-target embolization. Results: The patient had complete resolution of hematuria and urinary retention and remained catheter-free at 1-year follow-up. Conclusions: This case highlights the importance of pre-procedural evaluation and planning, demonstrating that PAE can be safely and effectively performed even in variant vascular anatomy.