Congenital absence of the right common iliac artery: CT and angiographic demonstration

Unveiling the uncommon: hypoplasia of external iliac artery-a case report and literature review

The absence or dysplasia of the iliac artery(IA) is an exceedingly rare condition, with limited cases documented in the literature. In this report, we present a case of hypoplasia of the right external iliac artery (EIA) in a 69-year-old male patient. The patient presented with right lower abdominal pain attributed to an aneurysm of the right internal iliac artery (IIA), yet notably, there was no evidence of lower limb ischemia at the time of consultation. Computed tomography angiography (CTA) of the aorta revealed a slender and occluded right EIA. Additionally, aneurysms were identified in the abdominal aorta (AA), the common iliac artery (CIA), and the right IIA, with collateral circulation involving the deep femoral artery and internal pathways. We performed aortoiliac aneurysm repair with a bifurcated synthetic graft on the patient's AA and iliac artery (IA), successfully excising the abdominal aorta aneurysms (AAA) and the CIA aneurysm. Postoperatively, thrombosis of the internal iliac aneurysm was observed, and the patient experienced a resolution of pain symptoms in the right lower abdomen. This paper delineates the vascular variations and treatment strategies employed and provides a review of the existing literature on IA malformations.

The sandwich technique to preserve the internal iliac artery during EVAR for ruptured abdominal aortic aneurysm with congenital anomalies

Congenital abnormalities of the iliac artery are uncommon and often discovered incidentally during the diagnosis or treatment of peripheral vascular diseases such as abdominal aortic aneurysm (AAA) and peripheral arterial diseases. The endovascular treatment of infrarenal AAA can be complicated by anatomic abnormalities in the iliac arteries, such as the absence of the common iliac artery (CIA) or overly short bilateral common iliac arteries. We present a case of a patient with a ruptured AAA and bilateral absence of the CIA, successfully treated by endovascular intervention combined with preservation of the internal iliac artery using the sandwich technique.

Preservation of internal iliac artery flow during endovascular aortic aneurysm repair in a patient with bilateral absence of common iliac artery

Bilateral absence of the common iliac artery is an extremely rare congenital vascular malformation in which the distal aorta divides directly into two external iliac arteries and two internal iliac arteries. In the case of the presence of this vascular malformation in association with an aortic aneurysm, preservation of the internal iliac artery flow during endovascular aortic repair represents a technical challenge. We have reported a case in which the bilateral absence of the common iliac artery associated with an infrarenal abdominal aortic aneurysm was successfully treated by endovascular aortic repair using commercially available iliac branched devices to maintain pelvic perfusion.

Pelvic Lymphadenectomy in Gynecologic Oncology-Significance of Anatomical Variations

Pelvic lymphadenectomy is a common surgical procedure in gynecologic oncology. Pelvic lymph node dissection is performed for all types of gynecological malignancies to evaluate the extent of a disease and facilitate further treatment planning. Most studies examine the lymphatic spread, the prognostic, and therapeutic significance of the lymph nodes. However, there are very few studies describing the possible surgical approaches and the anatomical variations. Moreover, a correlation between anatomical variations and lymphadenectomy in the pelvic region has never been discussed in medical literature. The present article aims to expand the limited knowledge of the anatomical variations in the pelvis. Anatomical variations of the ureters, pelvic vessels, and nerves and their significance to pelvic lymphadenectomy are summarized, explained, and illustrated. Surgeons should be familiar with pelvic anatomy and its variations to safely perform a pelvic lymphadenectomy. Learning the proper lymphadenectomy technique relating to anatomical landmarks and variations may decrease morbidity and mortality. Furthermore, accurate description and analysis of the majority of pelvic anatomical variations may impact not only gynecological surgery, but also spinal surgery, urology, and orthopedics.

Retroperitoneal Major Pelvic Arteries' Anatomic Variation: Pictorial Essay and Significance in Obstetrical and Gynecological Surgery

Introduction

Congenital anomalies of the iliac arteries are rare, and are usually discovered incidentally or infrequently intraoperatively.

Aim

To show the retroperitoneal major pelvic blood vessels anatomical variation during gynecologic and obstetrics surgeries in cases of retroperitoneal dissection.

Patients

We report three cases with incidental finding of anatomical variation in retroperitoneal major pelvic blood vessels. One patient underwent staging laparotomy for endometrial cancer with intraoperative finding of bilateral long internal iliac artery with short common iliac artery. The second patient underwent staging laparotomy for suspicious ovarian mass and mesh sacrocolpopexy for uterine prolapse with accidental finding of kinked long external iliac artery with short common iliac artery. The third patient underwent total hysterectomy with pelvic lymphadenectomy for endometrial cancer with incidental finding of bilateral absent internal iliac artery with common iliac artery continuing as external iliac artery.

Conclusions

Anatomical variations in the major retroperitoneal pelvic vasculature should be familiar with during surgeries to avoid inadequate management. Internal iliac artery ligation should be done as low as possible close to the bifurcation in case of long internal iliac artery as in case of bleeding, slipped uterine or injured vesical vessels. Kinked external iliac artery should not be considered as anomaly or swollen node with trial of excision in dissection of lymph nodes in gynecological cancer or a thrombosed vessel but continue as usual in dissection and preserve any branches arising from it which is a normal variation. Also, the absent internal iliac artery is no problem as its branches may arise from the aorta or the external iliac artery. The uterine artery can be traced in this condition from the uterine side and any branches from external iliac artery in pelvis can be a normal variation.

A Case of Left Retroexternal Iliac Artery Megaureter Associated with Additional Renal and Vascular Congenital Anomalies

Introduction. A number of rare anatomical anomalies, including retroexternal iliac ureter, extrarenal calyces (ERCs), and vascular anomalies, were observed in a 96-year-old female cadaver during a routine dissection. Description. A markedly dilated left extrarenal pelvis (ERP) with a diameter of 3.15 cm was noticed. Three major calyces were found outside of the normal-sized left kidney. The abdominal aorta (AA), instead of normal bifurcation, branched to the right common, left external, and left internal iliac arteries. The median sacral artery was a direct branch from the right common iliac artery. No hydronephrosis was observed on the affected side, and no urinary tract anomalies were observed on the right side. Significance. The retroiliac megaureter is a rare congenital anomaly, with fewer than 25 cases reported to date. Additionally, the ERCs are amongst the rarest anomalies of the renal collecting system. Further, the current case is one of few reported cases where the particular branching pattern of the AA was observed. The combination of such anatomical anomalies is rare, and the relationship between them is unclear. Common clinical manifestations of retroiliac ureters are the results of ureteric obstruction, hydronephrosis, and secondary infection. Precise knowledge of anomalies of the kidney and urinary tract can help radiologists and surgeons make a definitive diagnosis and prevent inadvertent injury during surgery.

Novel, congenital iliac arterial anatomy: Absent common iliac arteries and left internal iliac artery

Congenital anomalies of the iliac arterial system are rare and can be associated with ischemia. With an increase in vascular imaging and interventions, such anomalies are likely to be encountered with greater frequency. We present the case of a 25-year-old female who was incidentally found to have absence of the common iliac arteries bilaterally and the left internal iliac artery, a constellation not previously reported in the literature. We present relevant imaging findings, review embryonic vascular development, and discuss potential clinical implications.

Congenital Absence of the Right Common Iliac Artery

Cases of vascular anomalies of the iliac and femoral vessels are rare. We report a complete absence of the right common iliac artery in a 21-year-old woman, incidentally discovered by CT during the work-up for acute abdominal pain. A network of prominent collateral arteries reconstituted the distal portion of the right external iliac artery and the common femoral artery, forming the arterial supply of the right lower limb. Multiple collaterals were also observed reconstituting the right internal iliac artery. At the time of presentation, the patient had no signs or symptoms to suggest lower extremity ischemia, however this may become a problem in the future. Recognition of vascular abnormalities can dictate extra caution when planning abdominal surgery.

Absent Right Side Iliac Arterial System, an Intraoperative Surprise during Live Related Recipient Renal Transplantation

Introduction. Renal transplantation has become the standard of care for patients with end stage renal disease. We present a rare case of an absent right sided iliac arterial system encountered during recipient renal transplantation. The presence of such vascular anomaly intraoperatively can present a technically challenging situation to the surgeon. Case Presentation. During a routine renal transplantation of a 34-year-old man, we encountered a complete absence of right side iliac arterial system and a prominent branch arising from left hemipelvis and coursing to the right lower limb and the urinary bladder. The artery to the bladder was divided and anastomosed end to end to the donor renal artery. Intraoperatively the renal perfusion and the urine output were good. A posttransplant magnetic resonance angiogram done six weeks later revealed good vascular supply to the kidney and the lower limb. Conclusion. Absent iliac artery on one or both sides is a rare phenomenon. The presence of it during an unanticipated renal transplant surgery can pose a significant technical challenge to the surgeons. We advocate routine assessment of pelvic vasculature before recipient renal transplant surgery so as to avoid a difficult situation like this.

Complete Absence of Iliac Arteries in the Left Hemipelvis in a Case of Deceased Donor Renal Transplantation

Renal transplantation is an established method of treating end-stage renal failure. Whilst the majority of procedures follow a standard technique, vascular anomalies may pose intraoperative challenges and, therefore, careful preoperative assessment is warranted. We present a unique, complex case compounded by complete absence of iliac arteries in the left hemipelvis in association with double inferior vena cava in a young recipient.

Kidney transplantation in a patient with absent right common iliac artery and congenital renal abnormalities

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Congenital atresia of the common and external iliac arteries is a rare vascular anomaly that may pose potential problems during renal transplantation.

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It may be useful to perform routine angiographic evaluation for ESRD patients with congenital genitourinary abnormalities being planned for kidney transplantation.

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As some cases of congenital iliac artery anomalies remain asymptomatic, there is some evidence in literature suggesting the usefulness of routine pre-operative CT in a selective group of patients.

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Kidney transplantation in patients with absent right common and external iliac arteries is safe with the appropriate pre-operative imaging and surgical technique.

Introduction

Congenital atresia of the common and external iliac arteries is a rare vascular anomaly that may be associated with congenital renal or genitourinary malformations. In ESRD patients, its presence may pose potential problems during renal transplantation.

Case presentation

We report a rare case of kidney transplantation in a patient with VACTERL syndrome who was found to have absent right common and external iliac arteries during pre-operative imaging. Vascular supply to the right lower limb is derived from an anomalous branch from the left internal iliac artery which takes on a convoluted course across the pelvis. Kidney transplantation was performed successfully with implantation performed on the left side.

Discussion

Isolated cases of congenital iliac artery atresia have been described in association with urological abnormalities but no clear association has yet been established. However, we feel that it may be useful to perform routine angiographic evaluation for ESRD patients with congenital genitourinary abnormalities being planned for kidney transplantation. While most cases of congenital iliac artery anomalies are symptomatic with claudication, some remain asymptomatic with normal physical examination findings. There is some evidence in literature suggesting the usefulness of routine pre-operative CT in a selective group of patients.

Conclusion

Kidney transplantation in such cases is safe and we recommend routine pre-operative imaging of patients known to have congenital genitourniary abnormalities. The kidney should be implanted heterotopically to the contralateral side of the vascular anomaly and care must be taken to preserve vascular supply to the lower limbs.

Rare cause of absence of femoral arterial pulse: bilateral common iliac artery hypoplasia

Congenital anomaly of the iliac arteries is rare, and, given that patients are generally asymptomatic, diagnosis in the newborn period is difficult. Herein is presented the case of a newborn with bilateral hypoplasia of the common iliac arteries, seen on multi-slice computed tomography while investigating the absence of femoral pulse. This anomaly is a rare cause of absence of femoral arterial pulse.

The normal growth of the common iliac arteries in human fetuses - an anatomical, digital and statistical study

BACKGROUND

The present study was carried out to compile normative data for dimensions of the common iliac arteries at varying gestational ages.

MATERIAL/METHODS

We used anatomical dissection, digital-image analysis (system of Leica QWin Pro 16) and statistical analysis (Student T test, one-way ANOVA, post-hoc RIR Tukey test, and regression analysis) to examine the increase in length (mm), proximal external diameter (mm), and volume (mm³) of the common iliac arteries in 124 (60 males, 64 females) spontaneously aborted human fetuses aged 15-34 weeks.

RESULTS

Neither sex nor right-left significant differences were found (P>0.05). The length ranged from 4.76 ± 1.05 to 15.38 ± 1.60 mm on the right, and from 4.92 ± 1.33 to 14.91 ± 1.25 mm on the left, according to the linear functions y=-3.598+0.585 × Age ± 1.522 (R²=0.83) and y=-3.107+0.554 × Age ± 1.444 (R²=0.83). The proximal external diameter increased from 0.66 ± 0.19 to 2.30 ± 0.42 mm on the right, and from 0.66 ± 0.14 to 2.16 ± 0.42 mm on the left, according to the quadratic models y=1.392-0.110 × Age + 0.004 × Age² ± 0.285 (R²=0.77) and y=1.283-0.099 × Age + 0.004 × Age² ± 0.238 (R²=0.81). The volumes were increasing from 1.93 ± 1.74 to 66.95 ± 29.31 mm³ on the right, and from 1.91 ± 1.65 to 56.86 ± 25.17 mm³ on the left, given by the quadratic functions: y=99.69-10.60 × Age+0.28 7 × Age² ± 14.40 (R²=0.67) and y=82.62-8.86 × Age + 0.242 × Age² ± 11.60 (R²=0.71).

CONCLUSIONS

The common iliac arteries grow linearly in length, and parabolically in both diameter and volume. The right common iliac artery constitutes a predominant vessel in relation to its length, external diameter and volume. The morphometric data on the common iliac arteries may serve as a useful reference in the prenatal diagnosis and monitoring of congenital aorto-iliac abnormalities.

Bilateral congenital absence of internal iliac arteries, prominent lumbar arteries, and a ruptured mycotic aneurysm of the abdominal aorta

A 46-year-old man was admitted for surgery on a ruptured mycotic abdominal aortic aneurysm. Emergency repair was performed, during which certain anomalies were noted. First, the bifurcation of the aorta was posterior to the left common iliac vein. Second there were no internal iliac arteries. Also, there were prominent lumbar arteries compensating for the absent internal iliac arteries bilaterally. This, we consider, is the first reported case of congenitally absent bilateral internal iliac arteries.