Endovascular Approach in Treatment of Hypogastric Artery Pseudoaneurysm, A Rare Condition After Aorto-biiliac Bypass

Purpose: Hypogastric artery pseudoaneurysm (HAP) has a rare incidence, and it is usually asymptomatic. It can present with neurologic symptoms such as paresthesia, sciatica, weakness of the lower extremity, drooping foot, and so on. Causes of HAP include penetrating and blunt traumas, infections, connective tissue disorders, inflammation, tumors that erode the arterial wall, and, rarely, atherosclerosis with penetrating ulcer leading to pseudoaneurysm (PSA). We present the case of a 61-year-old woman with HAP secondary to aortobiiliac bypass due to aortoiliac disease. The patient was successfully treated with endovascular approach and deployment of a balloon-expandable stent graft.

Materials and Methods: This 61-year-old woman had a history of high blood pressure, smoking, and severe aortoiliac disease that required aortobiiliac bypass 5 years earlier. The patient complained of pain in the left iliac fossa of 4 weeks’ duration. Computed tomography angiography revealed a PSA of anastomosis in the left external iliac artery with a maximum diameter of 6 cm. After the patient signed consent, she was taken to the catheterization laboratory, and ultrasound-guided puncture of the left brachial artery was performed. Long-sheet 7-Fr × 70 cm was placed, and arteriography was performed, observing bypass occlusion. The common iliac arteries were permeable, with PSA dependent on the left hypogastric artery and bilateral external iliac artery occlusion. A hydrophilic 0.035-inch guidewire was advanced to superior gluteal artery. A 6-mm × 37 iCover stent graft (iVascular) was deployed at the origin of the PSA in the left hypogastric artery.

Results: The final arteriography showed satisfactory exclusion of the PSA, with permeability of all the collateral branches that originate in the hypogastric artery. The patient was discharged the next day without pain and remains asymptomatic in follow-up 4 weeks after the procedure.

Conclusions: The endovascular approach is a safe and effective option in the treatment of HAP secondary to aortobiiliac bypass in aortoiliac disease.