Embolization of Isolated Hypogastric Artery Aneurysm: A Case Report and a Review of the Literature

Abstract

A 75-year-old man with arterial hypertension, coronary artery disease, and myocardial infarction was referred to our service because of an asymptomatic hypogastric artery aneurysm (HAA) detected by a routine computed tomography (CT) scan. As shown on the angio-CT the maximum transverse diameter (m.t.d.) of the HAA was 47 mm. There were no symptoms of distal embolization or compression on the pelvic structures. We performed the successful complete thrombosis of the aneurysm using vascular plugs via a controlateral femoral approach. The control angiogram was satisfactory and there were no intraoperative complications. A CT-angiography done 4 months after the procedure showed no signs of refilling of the aneurysm sac. This case illustrates some possible advantages of vascular plugs in the treatment of isolated HAA.

Indications for the use of the Amplatzer vascular plug in interventional radiology

“…The only alternative treatment for pulmonary AVM is the use of metallic coils [15,16], as indications for occlusion with a detachable latex balloon have become obsolete. Among later studies, a sporadic report of a ruptured isolated aneurysm of the internal iliac artery [14] described embolisation of the outflow branches and the origin of the internal iliac artery with coils and an AVP using the endue precursori per utilizzo esclusivo in ambito cardiologico per la chiusura dei difetti interatriali o dei dotti arteriosi pervii (Amplater Septal Occluder e l'Amplatzer Duct Occluder rispettivamente) [1,2]. Il VPA trova oggi indicazione in radiologia interventistica nell'occlusione di arterie o vene di medio e piccolo calibro [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…The AVP grew out of two cardiac devices used for the closure of interatrial defects or patent ductus arteriosus (the Amplatzer septal occluder and the Amplatzer duct occluder, respectively) [1,2]. The AVP in now indicated for the occlusion of medium-to small-size arteries or veins in interventional radiology [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…Over the past year, a number of early reports have been published in the literature (Table 1). These are mostly case reports regarding extracardiac applications of the Amplatzer systems for treating pulmonary AVM [4,7,9,13], subclavian [8], internal iliac [6,14], pulmonary [12] and cerebral aneurysms [5], for the occlusion of a retroperitoneal shunt in a patient with portal hypertension during transjugular intrahepatic portosystemic shunt (TIPS) creation [3] and for the occlusion of the internal iliac artery in patients with aortoiliac or iliac aneurysm [11]. One of the earliest reports described the use of the AVP to occlude the origin of the internal iliac artery in the endovascular treatment of aortoiliac and iliac aneurysms to prevent type II endoleaks [11].…”

“…The device grew out of two precursors designed exclusively for cardiological purposes, the Amplatzer septal occluder and the Amplatzer duct occluder, used for the occlusion of interatrial defects and patent ductus arteriosus, respectively [1,2]. The system's plug-like shape and availability in several sizes have progressively expanded its applications in interventional radiology, where it offers an alternative to permanent embolising material such as metallic coils or acrylic glue, in the occlusion of small-to mediumsize feeding and draining vessels in the treatment of aneurysms or arteriovenous malformations (AVM) [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…Il dispositivo è nato da due precursori per utilizzo esclusivo in ambito cardiologico, l'Amplater Septal Occluder e l'Amplatzer Duct Occluder, per l'occlusione rispettivamente dei difetti interatriali e dei dotti arteriosi pervi [1,2]. Le caratteristiche morfologiche "a tappo" e la disponibilità in più diametri ne hanno progressivamente ampliato le indicazioni specie in radiologia interventistica, in alternativa all'utilizzo di materiale embolizzante di tipo definitivo, quali spirali metalliche o la colla acrilica, nell'occlusione di afferenze o efferenze di arterie e vene di piccolo e medio calibro per il trattamento della patologia aneurismatica o delle malformazioni arterovenose (MAV) [3][4][5][6][7][8][9][10][11][12][13][14].…”