Internal Iliac Artery Aneurysm Research Articles

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 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.

Aneurysms of the Hypogastric Artery: Etiology Presentation and Management

Twenty-seven patients with isolated hypogastric artery aneurysms and 35 patients with multiple aneurysms associated with hypogastric lesions previ ously reported are analyzed. The incidence and etiology of hypogastric aneurysms in addition to the age, symptoms, physical findings, evaluation, and treatment of patients with such lesions are discussed. The high incidence of rupture is noted, and operative considerations for such patients are stressed. Anatomical considerations influencing maintainence of the pelvic circulation in the presence of bilateral hypogastric aneurysms or those in conjunction with aortic aneurysms are discussed.

Extrinsic stretching, narrowing and anterior indentation of the rectosigmoid junction

Thirty-five cases of extrinsic narrowing or anterior indentation of the rectosigmoid junction (RSJ) have been studied. The RSJ lies directly behind the pouch of Douglas which is a favoured site for peritoneal metastasis, abscess and endometriosis. Any space-occupying lesion of sufficient size at this site will indent the anterior aspect of the RSJ. Causes include distension or tumour of the ileum or sigmoid colon, gross ascites (when the patient is erect), and tumours below the pelvic peritonium, such as gynaecological neoplasm and internal iliac artery aneurysm. When a desmoplastic metastasis in the pouch of Douglas infiltrates the outer layers of the RSJ, the fibrosis produces an eccentric shortening on its anterior aspect, which in turn causes a pleating of the mucosa with the folds radiating towards the shortened area. This is also seen with primary pelvic carcinomas directly adherent to the rectum, endometriosis with repeated bleeding and increasing eccentric, submucosal fibrosis, and chronic abscess in the pouch of Douglas. Not all extrinsic narrowings of the RSJ are pathological. One case of anterior indentation followed operation for rectal prolapse. Ten additional cases showed narrowing due to a technical artefact air-distended colon rising into the upper abdomen to cause stretching at the RSJ. As with ascites, this narrowing due to ‘high-rise sigmoid’ disappeared when the patients became recumbent and the colonic air redistributed.

Ruptured hypogastric artery aneurysms

Isolated hypogastric artery aneurysms are rare lesions, and preoperative diagnosis may be very difficult. This report deals with the diagnosis and management of two cases of ruptured aneurysms of the hypogastric artery.

Isolated Hypogastric Artery Aneurysm

ALTHOUGH aneurysms of the abdominal aorta and iliac arteries have received much attention in recent years, very little has been written about hypogastric artery aneurysms. A recent experience with a patient who had rectal, urethral, and ureteral obstruction from a large hypogastric artery aneurysm prompted this review. A review of 671 hospital records containing the diagnosis of aortic or iliac artery aneurysm, or both, disclosed only three cases of isolated hypogastric artery aneurysms. One of these patients has been studied and treated by the authors. His case will be presented in detail, and the other two cases will be briefly presented. Report of Cases Case 1. —An 86-year-old white man had a six-month history of increasing difficulty with urination and bowel movements. He had noted frequency, hesitancy, intermittency, dribbling, strangury, and nocturia two to three times. He had also noted abdominal fullness, flatulence, increasing difficulty with bowel movements, and intermittent