Emergency embolization of a mycotic aneurysm of the superior gluteal artery: case report

First Case of 2 Synchronous Gluteal Arteries Aneurysms Treated by Endovascular Plug Embolization: Case Report and Literature Review

INTRODUCTION

Gluteal artery aneurysms (GAAs) are rare, accounting for less than 1% of all arterial aneurysms. Most of them are post-traumatic in nature and involve the superior gluteal artery (SGA), while injuries of the inferior gluteal artery (IGA) have been reported less frequently. We report an unusual case of a patient with double saccular GAA of unknown etiology, involving both the SGA and IGA, successfully treated by endovascular embolization.

CASE REPORT

A 80-year-old man referred to our hospital complaining of the progressive onset of left buttock pain and swelling exacerbated by sitting position in the last 4 months. His past medical history was positive for hypertension, prostatic adenocarcinoma treated by brachytherapy, and endocarditis diagnosed about 30 years before and treated by cardiac surgical valve replacement; no history of trauma was reported. After ultrasonography was carried out, an enhanced computed tomography (CT) scan confirmed the presence of 2 large GAAs involving both the SGA and IGA, with maximum transverse diameter of 38 and 84 mm, respectively. The patient was referred for endovascular treatment after informed consent was provided. After sequential selective catheterization of SGA and IGA, 3 Amplatzer Plugs II (St. Jude Medical, Zaventem, Belgium) were deployed inside the aneurysms. Postoperative course was uneventful as buttock pain completely disappeared on the second postoperative day. The patient was discharged to home on the third postoperative day. One-month CT scan confirmed the complete thrombosis of the aneurysms without any endoleak.

CONCLUSIONS

GAAs represent a rare pathology, and for that reason, the correct timing and choice of treatment are not clearly defined. Endovascular techniques are the first step in the approach to GAAs. In case of complex anatomy, GAAs embolization by the use of vascular plugs can be successfully performed.

Transcatheter Embolization of a Ruptured Superior Gluteal Artery Aneurysm: Case Report and Review of the Literature

Purpose:

To report the successful coil embolization of a true gluteal artery aneurysm and review therapeutic options for this rare condition.

Methods and Results:

A ruptured superior gluteal artery aneurysm in a symptomatic 80-year-old man was successfully thrombosed by embolization using a combination of Gianturco coils and helical platinum microcoils. Six-month computed tomography demonstrated persistent thrombosis of the aneurysm and resolution of the perivascular blood.

Conclusions:

This report offers support for the use of catheter-based techniques as an alternative to standard surgical repair of gluteal artery aneurysms.

True superior gluteal artery aneurysm

Gluteal artery aneurysms (GAAs), classified as true or false, account for <1% of all aneurysms. Of the 175 GAAs reported in the English literature, 20 are true aneurysms, making this case the twenty-first reported true aneurysm and sixth of atherosclerotic origin. We report a true GAA in a 72-year-old woman. Pelvic computed tomography suggested GAA (7.2 × 4.9 cm); subsequently, an endovascular approach allowed definitive diagnosis and treatment-coil embolization. In accordance with the literature and the surgical and clinical success of our case, endovascular embolization of GAAs has emerged as an effective and safe treatment.

Thrombin injection for the treatment of mycotic gluteal aneurysm

Gluteal aneurysms are rare entity, whose surgical or endovascular management is traditionally challenging. Infectious source being increasingly more common as the underlying etiology. We herein describe successful implementation of direct thrombin injection as another therapeutic option for these patients.

Mycotic aneurysm of the superior gluteal artery in a patient with bacterial endocarditis: case report and review of the literature

Mycotic aneurysm of the superior gluteal artery (SGA) is extremely rare. The review of the literature revealed only five cases of mycotic SGA aneurysms reported to date and none had a concomitant superior mesenteric artery (SMA) aneurysm. We describe a 64-year-old man with mycotic aneurysms of both the SGA and the SMA. The patient was referred to our hospital because of SMA embolism caused by bacterial endocarditis following mitral valve plasty. He was treated conservatively, but monitoring using computerized tomography (CT) scanning showed the development and growth of the SGA and the SMA aneurysms. The SMA aneurysm was resected surgically, and the SGA lesion was treated by means of selective embolization. For the treatment of SGA aneurysms, prompt and precise preoperative evaluation is important. When the anatomical feature and size of the aneurysm is suitable, endovascular treatment may be the first-line treatment, providing an efficacious and safe alternative to traditional surgical repair.

Bilateral mycotic aneurysm of the superior gluteal artery

Gluteal artery aneurysms are rare and mostly secondary to blunt or penetrating trauma. As an absolute rarity, we report an exceptional presentation of bilateral mycotic aneurysm of the superior gluteal artery in a 16-year-old boy associated with bacterial endocarditis. The left pseudoaneurysm was ruptured and treated using open surgery; 1 week later, the right location was successfully treated by embolization.

Buttock claudication disclosing a thrombosis of the superior left gluteal artery: Report of a case diagnosed by a selective arteriography of the iliac artery, and cured by per-cutaneous stenting

We report on a case of left buttock claudication, occurring consistently after 150 meters walking, and disappearing after a short rest. As magnetic resonance angiography (MRA) did not show any explanation for this claudication, a selective angiography of left internal iliac artery was requested, which clearly identified a tight stenosis of the onset of the left superior gluteal artery. A per-cutaneous angioplasty together with stenting of this artery, induced a prompt and complete relief of pain at the three months follow-up visit.

Endovascular therapy of superior gluteal artery aneurysms: case report and review of literature

We report two cases of superior gluteal artery aneurysms successfully treated with coil embolization and review treatment options for these lesions. Our experience in the treatment of three total aneurysms, two likely post-traumatic in etiology and one mycotic, suggests that endovascular therapy is an effective alternative to open surgery when treating superior gluteal artery aneurysms.

Successful stent-graft placement for the treatment of a superior gluteal artery pseudoaneurysm in a patient following complex pelvic surgery

Aneurysms of the gluteal arteries are rare and were previously managed with open surgical procedures. Recently percutaneous embolisation techniques have helped reduce morbidity and mortality. A case is presented of a 63-year-old man who presented with haemorrhage and had developed a superior gluteal artery aneurysm following treatment for an invasive squamous cell carcinoma in the sacral area. There was concern that embolisation of the aneurysm might compromise the survival of the myocutaneous buttock rotation flaps that had been used for reconstruction. To overcome this, an endovascular stent was deployed to successfully close off the aneurysm whilst at the same time maintaining blood flow through the superior gluteal artery. Aneurysms in larger peripheral vessels have been managed with stents. However, this is the first reported case of this method of treatment being used in the management of gluteal artery aneurysms.

Coil embolization of a gluteal false aneurysm in a patient with Marfan syndrome

Gluteal aneurysms, whether true or false, are exceptional. They represent less than 1% of all aneurysms and develop within the superior or inferior gluteal arteries, being branches of the internal iliac artery. We report here the case of a 35-year-old patient with Marfan syndrome in whom annuloaortic ectasia and Barlow's disease with mitral valve insufficiency successively developed followed by a gluteal false aneurysm, which led us to investigate the etiologic mechanism of the patient's conditions. The gluteal aneurysm was successfully treated by selective embolization, which would appear to be the elective therapeutic approach for these lesions.

Transcatheter embolization of a ruptured superior gluteal artery aneurysm: case report and review of the literature

PURPOSE

To report the successful coil embolization of a true gluteal artery aneurysm and review therapeutic options for this rare condition.

METHODS AND RESULTS

A ruptured superior gluteal artery aneurysm in a symptomatic 80-year-old man was successfully thrombosed by embolization using a combination of Gianturco coils and helical platinum microcoils. Six-month computed tomography demonstrated persistent thrombosis of the aneurysm and resolution of the perivascular blood.

CONCLUSIONS

This report offers support for the use of catheter-based techniques as an alternative to standard surgical repair of gluteal artery aneurysms.

True aneurysm of the superior gluteal artery: case report and review of the literature

Aneurysms of the gluteal arteries are rare and mostly are caused by pelvic fractures or penetrating injuries. As such these aneurysms are pseudoaneurysms. As an absolute rarity we report the case of a 43-year-old man with a histologically verified 5 cm-diameter, true saccular aneurysm of the left superior gluteal artery. The patient was admitted with 6-weeks ongoing sciatic pain without previous trauma. He was scheduled for surgery because an initial attempt of transcatheter embolization failed. By dividing the origin of the gluteus maximus muscle from the iliac crest, the aneurysm was exposed at the pelvic outlet by an extrapelvic approach and was excluded by endoaneurysmorrhaphy. Uncontrolled bleeding was prevented by temporary occlusion of the left iliac artery by a percutaneously inserted balloon catheter, thus avoiding an additional retroperitoneal approach. The postoperative course was uneventful, and sciatic pain had resolved completely. The chosen strategy provides safe and successful surgical management of gluteal artery aneurysms.