Hypogastric artery aneurysms: indications for preservation or occlusion

Internal iliac (hypogastric) artery aneurysms are extremely rare: They account for only an estimated 0.3-0.4% of all intraabdominal aneurysms, or approximately less than 20% of all isolated iliac aneurysms.1 The diagnosis is tricky because of their location deep in the pelvis; thus, they often present late and with a large size. When left untreated, like most aneurysms, they will continue to expand and may rupture. The risk of aneurysm rupture is high-an estimated 38% have ruptured at initial presentation-as is mortality (reported at 58%). Furthermore, conservative management may be associated with a mortality rate of up to 71% due to rupture. Hence, early and aggressive management of hypogastric artery aneurysms is mandatory to avoid the high morbidity and mortality of rupture.