Endovascular treatment of a superior gluteal artery aneurysm

An 80-year-old white man was referred to our department because a computed tomography scan incidentally revealed a saccular 4.1- × 4.9-cm superior gluteal artery aneurysm (GAA; A and B). The patient did not complain of any symptoms referable to the lesion and denied any antecedent trauma. A physical examination identified a bounding painless and pulsatile mass over the lateral left gluteal region. Vital signs and blood chemistries were within normal limits. Informed consent was obtained. After selective angiography of the left internal iliac artery, the patient underwent a successful endovascular plug embolization of the distal segment of the superior gluteal artery at the origin of the aneurysm. A final angiogram showed the complete exclusion of the lesion (C). No postprocedure complications were noted. The patient was discharged on the first postoperative day. He had an uneventful recovery with resumption of normal daily activities. Follow-up at 1 year revealed no recurrence of clinical symptoms. The true incidence of GAAs is unknown, but they are suspected to account for <1% of all aneurysms. Most GAAs are pseudoaneurysms, with a mechanism of trauma. True aneurysms are extremely rare. The injury of the inferior branch is rarer than that of the superior branch. Men are more commonly affected than are women. The symptomatic GAAs present with a painful and pulsatile swelling in the gluteal region with associated potential signs of inflammation or sciatic nerve compression. Treatment of these lesions is recommended when the diameter is >25 mm, when they are symptomatic, and if there is risk of rupture or injury to the sciatic nerve.1Schorn B. Reitmeier F. Falk V. Oestmann J.W. Dalichau H. Mohr F.W. True aneurysm of the superior gluteal artery: case report and review of the literature.J Vasc Surg. 1995; 21: 851-854Abstract Full Text PDF PubMed Scopus (46) Google Scholar Although open surgery has been the standard treatment for many years and it rapidly decreases pressure symptoms, it is an invasive procedure with a high risk of intraoperative iatrogenic injuries.2Salcuni P. Azzarone M. Cento M. Mazzei M. Salvatore De Giorgi M. Pascarella L. A giant pseudoaneurysm of the gluteal artery.EJVES Extra. 2002; 3: 8-11Abstract Full Text PDF Scopus (4) Google Scholar The advantages of angiography with embolization include a decreased risk of infection, the avoidance of opening the retroperitoneal space, and a decreased risk of iatrogenic nerve and arterial injuries.3Johnson S.P. Wang W. Peyton B.D. Whitehill T. Endovascular therapy of superior gluteal artery aneurysms: case report and review of literature.Semin Intervent Radiol. 2007; 24: 29-33Crossref PubMed Scopus (7) Google Scholar In general, as endovascular therapy is less invasive, it can be the first line of treatment; open surgery can be used for cases in which this method fails to repair the aneurysm or to control the compressive symptoms.