Isolated Mycotic Hypogastric Artery Aneurysm
Michael Paisley, MD, Nick Faunce, MD, Stephen Hosea, MD, and Kevin Casey, MD, FACS, Santa Barbara, Calif
ABSTRACT
Isolated iliac artery aneurysms are rare and commonly associated with aortic aneurysms. Hypogastric artery aneurysms (HAAs) are exceptionally rare. The general approach to HAAs has been exclusion and bypass, although when this is complicated by mycotic disease, endovascular techniques can provide unique approaches to management. We present the case of a patient with a mycotic HAA treated with endovascular coil and exclusion followed by aortic to external iliac artery bypass with cadaveric conduit. (J Vasc Surg Cases and Innovative Techniques 2019;5:22-5.) Keywords: Aneurysm; Hypogastric artery aneurysm; Mycotic aneurysm
Iliac artery aneurysms are frequently found in conjunction with aortic aneurysms and isolated iliac aneurysms are uncommon. The incidence of hypogastric artery aneurysms (HAAs) is exceedingly low, occurring in <0.0001% of the population. Mycotic HAAs have rarely been described in the literature. The best treatment of this rare entity may be different from and more challenging than that of a mycotic aortoiliac aneurysm. We present the case of a patient with an infected HAA and discuss a unique approach to treatment of this unusual entity. The patient consented to publication of this case.
CASE REPORT
A 78-year old man wash handling and eating rattle snakes near his home when several days later he developed profound myalgias and arthralgias. He was seen by a medical provider, diagnosed with polymyalgia rheumatica, and treated with steroids. He was transferred to our medical facility with persistently high fevers and left-sided hip and testicular pain. Blood cultures identified Salmonella arizonae bacteremia, and cross-sectional imaging revealed a 3.8-cm left HAA with surrounding inflammation (Fig 1). Intravenous antibiotics were administered, and after clearance of bacteremia and systemic illness, he under went an endovascular repair. After diagnostic aortography from a percutaneous bilateral common femoral artery approach, the patient was heparinized in the standard fashion. The left HAA was first embolized from a contralateral approach with two Amplatzer (Abbott, St. Paul, Minn) vascular plugs (7 10 mm, 9 12 mm).
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