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True Aneurysm of the Inferior Gluteal Artery: Case Report and Review of the Literature

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True Aneurysm of the Inferior Gluteal Artery: Case Report and Review of the Literature Eur J Vasc Endovasc Surg 22, 379–380 (2001) doi:10.1053/ejvs.2001.1450, available online at http://www.idealibrary.com on CASE REPORT True Aneurysm of the Inferior Gluteal Artery: Case Report and Review of the Literature S. E. Duff∗ and N. M. Wilson Department of Surgery, Royal Hampshire County Hospital, Winchester, U.K. Introduction observed. The aneurysm was ligated, back-bleeding vessels were underrun and the wound was drained Aneurysms of the gluteal arteries are rare, the majority and closed. Postoperatively, she recovered quickly and are pseudoaneurysms secondary to trauma.1 True an- went home 7 days later. eurysms of the gluteal arteries are due to athero- sclerosis, infections or polyarteritis nodosa. We report a case of a true inferior gluteal artery aneurysm man- aged by a one-stage extrapelvic approach. Case Report A 76-year-old woman presented with a painful swell- ing in the left buttock and upper thigh which had gradually enlarged and become uncomfortable. She had no history of trauma, infection or peripheral vas- cular disease. On examination, she was hypertensive with a blood pressure of 190/90 mmHg. There was a large tender swelling in the left buttock and upper third of the thigh, measuring 15 cm by 35 cm. The diagnosis of an inferior gluteal artery aneurysm was made and confirmed by ultrasound scan and com- puterised tomography (Fig. 1). Arteriography con- firmed an inferior gluteal artery aneurysm, which did not contribute to the distal limb circulation. The patient was placed in the left lateral position and surgery performed via a left posterior approach through the buttock and upper thigh. The gluteus maximus muscle was divided to expose a 6 cm inferior gluteal artery aneurysm, the sciatic nerve was iden- tified and preserved. The aneurysm was controlled and clamped with no reduction of foot perfusion ∗ Please address all correspondence to: S. E. Duff, 5 Westholme Fig. 1. Computed tomograms showing inferior gluteal artery an- Road, Didsbury, Manchester M20 3QZ, U.K. eurysm (arrow) in the left buttock and thigh. 1078–5884/01/100379+02 $35.00/0 2001 Harcourt Publishers Ltd. 380 S. E. Duff and N. M. Wilson Table 1. Literature relating to true gluteal artery aneurysms. Author Year Number of cases Aetiology Gostigian and Schlitt4 1963 1 Polyarteritis nodosa Meek and Hill5 1968 3 2 mycotic (1 syphilitic, 1 streptococcal) Scotti6 1980 1 Possible mycotic origin Grand7 1992 1 Mycotic Schorn3 1995 1 Atherosclerosis Discussion managed from the buttock alone, as demonstrated by this case. The majority of gluteal artery aneurysms are pseudo- Internal iliac artery ligation alone should not be aneurysms secondary to trauma,1,2 pelvic fractures recommended because backfilling can occur due to or iatrogenic causes. They present with a painful, the extensive collateral blood supply in the gluteal sometimes pulsatile, swelling in the buttock, there may area.3 Most cases present with symptoms related to be a bruit and signs of inflammation, or symptoms of aneurysm size and pressure effects, consequently sur- sciatic nerve compression.3 They may mimic a buttock gical treatment and aneurysmectomy is the treatment abscess with disastrous results.2 True gluteal artery of choice. In all cases, care must be taken to avoid aneurysms are rare. Their aetiology is secondary to damage to the sciatic nerve, which is often adherent atherosclerosis, infection and polyarteritis nodosa to the aneurysm sac.1 (Table 1). Diagnostic investigations used include ultrasound, computed tomography, magnetic resonance imaging References and arteriography. Arteriography is particularly valu- able in demonstrating the anatomy and excluding the 1Williams W, Jackson GF, Greene C. Superior gluteal artery diagnosis of a persistent sciatic artery (PSA) aneurysm. aneurysm. J Trauma 1977; 17: 477–479. A PSA is a rare developmental abnormality rep- 2Demetriades D, Rabinowitz B, Sofianos C. Gluteal artery aneurysms. Br J Surg 1988; 75: 494. resenting the original embryological axial limb vessel. 3Schorn B, Reitmeier F, Falk V et al. True aneurysm of the When present, the PSA provides the main blood sup- superior gluteal artery: case report and review of the literature. ply to the lower limb; thus a PSA aneurysm must be J Vasc Surg 1995; 21: 851–854. 4Gostigian J, Schlitt RJ. Aneurysm of the gluteal artery sec- treated with reconstruction to maintain lower limb ondary to polyarteritis nodosa. Am J Surg 1963; 105: 267–268. bloodflow.8 5Meek GN, Hill RL. Surgical treatment of gluteal artery an- Traditionally, the approach to gluteal artery an- eurysms. Am J Surg 1968; 116: 731–734. 6Scotti DM, Leiber C, Hur G, Marks G. Ruptured inferior eurysms is in two stages. A transperitoneal or re- gluteal artery aneurysm with exsanguinating rectal hemorrhage troperitoneal approach to gain proximal control of the controlled by transcatheter coil embolization. Dis Col & Rect internal iliac artery and a buttock approach to the 1980; 23: 313–317. 7Grand C, Delcour C, Bank WO et al. Emergency embolization aneurysm itself. Interventional radiological techniques of a mycotic aneurysms of the superior gluteal artery: case report. have been used to try to reduce surgical morbidity Cardiovasc Intervent Radiol 1992; 15: 117–119. 8Steele G, Sanders RJ, Riley J, Lindenbaum B. Pulsatile buttock associated with the surgical approach to the internal masses: gluteal and persistent sciatic artery aneurysms. Surgery 9 iliac artery. These have included coil embolisation and 1977; 82: 201–204. balloon occlusion3 of the aneurysm. Similar techniques 9Herber SC, Ajalat GM, Smith DC, Hinshaw DB, Killeen D. 6 Transcatheter embolization facilitating surgical management of have been used in the control of acute bleeding, a giant inferior gluteal artery pseudoaneurysm. J Vasc Surg 1988; 10 and in definitive treatment. The two-stage approach 8: 716–720. should be used in the treatment of pseudoaneurysms, 10 Rankin RN, Youngson GG, McKenzie FN. Management of superior gluteal artery aneurysm by percutaneous balloon cath- ruptured aneurysms or aneurysms involving the artery eter occlusion: a case report. Surgery 1979; 85: 235–237. before its exit from the sciatic foramen. True gluteal artery aneurysms that are solely extrapelvic can be Accepted 29 May 2001 Eur J Vasc Endovasc Surg Vol 22, October 2001.
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