True Aneurysm of Ovarian and Uterine Arteries:a Comprehensive Review

Background: Gonadal artery aneurysm represents an extremely rare condition often unrecognized until rupture. Methods: A literature review was undertaken on Pubmed from 1990 to 2020 to identify reported cases of ovarian and uterine artery aneurysms, including the index case presented here. Data about the clinical presentation, diagnostic approach, and treatment were collected. Results: Twenty-one articles reporting on data about 22 patients, including the index case, were included. The patients's median age was 46.7 years (range 30–80) and aneurysm maximal diameter 2.6 cm (range 0.75–5 cm). Except for one asymptomatic patient, the aneurysm's clinical presentation was abdominal/back pain in the majority of cases (n = 20, 90.9%). Rupture with retroperitoneal hematoma occurred in 16 cases (72.7%) and hemorrhagic shock in one case (4.5%). No history of vaginal bleeding was reported in any case. The majority of the aneurysms were diagnosed in women of childbearing age: in 50% (n = 11) of cases during the peripartum period and in 22.7% (n = 5) of cases during the postmenstruation period. The remaining cases (n = 6, 27.3%) were detected during the postmenopausal period. The majority of patients (n = 15, 68.2%) were emergently treated with an endovascular approach by embolization, achieving the total exclusion of the aneurysm in 86.7% of cases (13 patients). In 7 cases (31.8%), surgical ligation was performed, of which 2 (9.1%) were for the failure of a primarily attempted coils embolization. The spontaneous thrombosis of the uterine aneurysm was noted 3 months after the initial diagnosis in one patient. Conclusions: The Gonadal artery aneurysms are unrecognized entities until an acute rupture occurs. Endovascular treatment by embolization is progressively becoming the first-line treatment with satisfactory results.