Prostatic Artery Embolization in a Rare Anatomical Variant Arising from the Superior Rectal Artery: Case Report

This case report describes a rare vascular variant identified during preparation for prostatic artery embolization (PAE), in which the right prostatic artery originated from the superior rectal artery (SRA). An 84-year-old man with benign prostatic hyperplasia and severe lower urinary tract symptoms (International Prostate Symptom Score [IPSS] 24, prostate volume 108 mL) underwent PAE after failure of medical therapy. Preprocedural CT angiography (CTA) identified the right prostatic artery originating from the SRA and the left prostatic artery originating from the internal pudendal artery. Embolization was successfully performed via left distal radial access, using 250-µm microspheres and a mixture of n-butyl cyanoacrylate and ethiodized oil. At six-month follow-up, the patient's IPSS improved to 12, Qmax increased to 21 mL/sec, and prostate volume decreased to 74 mL. Postprocedural MRI confirmed transitional zone infarction without complications. This case highlights the critical role of CTA in identifying rare anatomical variants to ensure safe and effective PAE.