Successful Embolization of a Ruptured Ovarian Artery Aneurysm in a Postmenopausal Woman: Case Report and Literature Review of Gonadal Artery Aneurysms

Gonadal artery aneurysms (GADs) are extremely rare; their prevalence and natural history are unknown and their pathogenesis remains poorly understood. Based on the limited literature reports, these might present with rupture (ovarian artery) or pain and acute thrombosis (testicular artery). The present article reports the case of an 80-year-old woman who came to the emergency department (ED) with acute onset of abdominal and left flank pain. A computed tomography angiography (CTA) revealed a large retroperitoneal hematoma associated with the presence of a left ovarian artery aneurysm. The patient was taken to the angiography suite for a selective vessel catheterization and embolization with N-butyl-2-cyanoacrylate (NBCA). Following the procedure, her serial hemoglobin remained stable, her symptoms subsided, and she was discharged home 2 days later. The GADs are unrecognized entities until an acute event such as rupture occurs, and vessel embolization is effective for hemorrhage control. Close communication and collaboration with gynecologists and urologists are crucial to better define the prevalence, natural history, and the appropriate behavior and timing for elective treatment. With this article, the authors additionally present a review of the literature.

A study of Gonadal Arteries in 30 Adult Human cadavers

The gonadal arteries normally arise from the abdominal aorta. There are reports about the variant origin of these arteries. In the present study, we investigated the origin and course of the gonadal arteries and clinical implications of variant gonadal arteries are discussed. Out of 60 dissections, in 55 cases the gonadal artery was seen arising from abdominal aorta. In the remaining 5 cases, gonadal artery of renal origin was present in 3 cases, two on right and one on left side and of middle suprarenal origin was present in 2 cases on the left side. The present study agreed with the text book account i.e. right testicular artery passing anterior to inferior vena cava in majority of the cases i.e. 27 (90%). In the remaining 3 cases (10%), the right testicular artery was posterior to inferior vena cava. In our study, out of a total of 60 dissections, 57 dissections confirmed to type I pattern (95%). In 2 cases (3.3%) (11 M, 16 M) a type II pattern was seen on the right side. In 1 case (1.7%) (20 M), the left testicular artery arose directly from the aorta and arched over the renal vein giving a type III pattern. Awareness of variations of the testicular arteries such as those presented here becomes important during surgical procedures like varicocele and undescended testes. The variations described here are unique and provide significant information to surgeons dissecting the abdominal cavity.