Ruptured Hypogastric Artery Aneurysms

Abstract

The ruptured hypogastric artery aneurysm (RHAA) is a rare clinical entity with an evolving and dynamic therapeutic armamentarium. The anatomical location and varied clinical presentation can pose a challenge for successful repair. Recently, endovascular and hybrid operative repairs have significantly improved the historically high-operative mortality rate. We present an illustrative case and contemporary review of the literature with respect to RHAA.

The JOTEC iliac branch device for exclusion of hypogastric artery aneurysms: ABRAHAM study

“…[5][6][7] Progression of aneurysm diameter causes inconsistent symptoms, such as bladder obstruction with hydronephrosis, palpable pelvic tumor mass, and back or abdominal pain. 8,9 If left untreated, progressive aneurysm expansion can lead to fistulization into adjacent visceral organs, erosions, and ruptures. 10 Even a rupture may cause mild early symptoms, such as hypotension or back, groin, and thigh pain, but it can become suddenly life-threatening because of hemorrhagic shock, especially in cases of intraperitoneal rupture.…”

“…10 Even a rupture may cause mild early symptoms, such as hypotension or back, groin, and thigh pain, but it can become suddenly life-threatening because of hemorrhagic shock, especially in cases of intraperitoneal rupture. 9 Reported mortality rates for HAA rupture are as high as 52% to 53%. 10,11 Surgical HAA therapy is a combination of various open and endovascular techniques.…”

Few internal iliac artery aneurysms rupture under 4 cm

“…Mortality rates in ruptured cases have been reported to be >50%, 2,3,7 although some evidence suggests that the contemporary mortality rate may be lower with endovascular techniques. 15 Operative mortality rates for nonruptured patients have been reported as being >10%; however, these seem to be lower as well in more recent reports. 7 In a Japanese report of ruptured and nonruptured patients (26 patients), including aneurysms of both the CIAs and IIAs managed by open repair, the 30day mortality was only 3.9% (1 patient), and there were no additional deaths during the 5-year follow-up.…”

Off-label use of a reversed flared endurant iliac limb stengraft for the management of a life-threatening internal iliac artery aneurysm rupture

“…Rupture is the most feared complication with a mortality rate reaching up to 70%. 2 Open surgery was the traditional treatment of choice with internal iliac artery (IIA) ligation and aneurysmectomy but endovascular management has recently gained popularity and became the preferred treatment, especially in cases of life-threatening rupture where it reduces significantly the mortality and morbidity rates.…”