Isolated hypogastric artery aneurysms
B. J. Brin and R. W. Busuttil
Isolated hypogastric artery aneurysms are unusual variants of aortoiliac
aneurysmal disease. These vascular lesions can pose a diagnostic dilemma
and are difficult to manage operatively. Five patients with six isolated
hypogastric artery aneurysms were treated at UCLA Hospital, Los Angeles, in
addition to 59 patients with 76 isolated hypogastric artery aneurysms
previously described in the literature, to form a collected series.
Although the aneurysms were asymptomatic in 43% of cases, symptoms were
often due to rupture or expansion of the rupture of expansion of the
aneurysms, with pressure on adjacent structures commonly causing
genitourinary tract obstruction, thrombophlebitis, and/or lumbosacral nerve
root compression. The overall incidence of rupture in 82 aneurysms was 38%
(mortality, 56%). There was no correlation between aneurysm size and
incidence of rupture. Eleven aneurysms were identified at autopsy or
laparotomy; of the remaining 71 aneurysms, 15 were managed nonoperatively,
with a mortality of 71% because of subsequent rupture. Proximal and distal
ligation or endoaneurysmorrhaphy achieved the best results. Large blood
losses commonly encountered with resection of the aneurysms contributed to
a 55% mortality. Simple proximal ligation of the hypogastric artery
aneurysm was followed by recurrence in two cases and in persistence of the
aneurysmal mass in two other cases. Based on this analysis, surgical
therapy for all isolated hypogastric aneurysms should be prompt.
