Isolated Hypogastric Artery Aneurysms

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 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, 58%). 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. (Arch Surg 1982;117:1329-1333).