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Kostov S, Kornovski Y, Watrowski R, Slavchev S, Ivanova Y, Yordanov A. Internal Iliac Artery Ligation in Obstetrics and Gynecology: Surgical Anatomy and Surgical Considerations. Clin Pract 2023; 14:32-51. [PMID: 38248429 PMCID: PMC10801552 DOI: 10.3390/clinpract14010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. Regrettably, IIA ligation has not gained widespread popularity, primarily due to limited surgical training and concerns regarding possible complications, including buttock claudication, impotence, and urinary bladder and rectum necroses. Nowadays, selective arterial embolization or temporary balloon occlusion are increasingly utilized alternatives, which can be applied preoperatively or intraoperatively for threatening severe genital or pelvic bleeding. However, IIA ligation retains its relevance, as the previously described procedures are not always available and have limitations. This article provides a step-by-step guide to the IIA ligation procedure and its possible complications. It also includes a detailed description of the anatomy of the IIA and pelvic arterial anastomoses. This review highlights the importance of a thorough understanding of pelvic anatomy as a prerequisite for safe IIA ligation and posits that training in this procedure should be an integral part of obstetrics and gynecology curricula.
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Affiliation(s)
- Stoyan Kostov
- Research Institute, Medical University Pleven, 5800 Pleven, Bulgaria;
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Yavor Kornovski
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Rafał Watrowski
- Department of Obstetrics and Gynecology, Helios Hospital Müllheim, 79379 Müllheim, Germany;
- Faculty Associate, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Stanislav Slavchev
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Yonka Ivanova
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
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Qiao Y, Patel S, Burney I, Mega JD, Kuban JD, Pisimisis GT. A case report: Retrograde arterial embolization of locally-injected SpaceOAR hydrogel material into the right common iliac artery bifurcation. Radiol Case Rep 2022; 18:719-726. [PMID: 36569226 PMCID: PMC9768241 DOI: 10.1016/j.radcr.2022.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 12/15/2022] Open
Abstract
Biodegradable hydrogel-based matrices are becoming more widely utilized for a variety of medical applications, including SpaceOAR which is a hydrogel injected into the recto-prostatic space under ultrasound guidance to protect the rectum during prostate radiation therapy. Although a greater number of these procedures are being performed, there are no case reports on the potential complications which may result. In this report, we present the first case of retrograde embolization of SpaceOAR hydrogel into the right common iliac artery during routine office administration, as well as subsequent interventional angiography, inpatient and outpatient management, and clinical and imaging results at 1.5-month patient follow-up.
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Affiliation(s)
- Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA,Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA,Corresponding author.
| | - Shrey Patel
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA
| | - Iftikhar Burney
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA,Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA,Department of Radiology, Baylor College of Medicine, 1 Baylor Plz., Houston, TX 77030, USA
| | - James D. Mega
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA,Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Joshua D. Kuban
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA,Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - George T. Pisimisis
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA,Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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Outcomes of Hypogastric Coverage and Occlusion during Endovascular Treatment of Aortoiliac Occlusive Disease. Ann Vasc Surg 2021; 77:116-126. [PMID: 34411668 DOI: 10.1016/j.avsg.2021.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/01/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The risk of hypogastric occlusion (HO) following bare-metal stent (BMS) coverage of the hypogastric origin during endovascular treatment of aortoiliac occlusive disease (AIOD) is unclear. This study sought to determine the rate and clinical significance of HO following BMS coverage during iliac stenting for complex AIOD. METHODS Consecutive patients undergoing elective iliac stenting for AIOD from 2010-2018 at Cleveland Clinic were reviewed. Patients with BMS coverage of a patent hypogastric origin were included. Rate of HO were determined by review of intraoperative angiography and follow up imaging. Predictors of HO were identified by univariable and multivariable logistic regression. Outcomes were compared between those who did and did not develop HO. RESULTS There were 251 patients (338 limbs) with BMS coverage of the hypogastric origin during treatment of AIOD. Lesion severity was classified as TASC C/D in 249/338 (73.7%) of cases. Bilateral hypogastric coverage occurred in 93/251 (37.1%) patients. Hypogastric patency was 78.1% at 24-months following coverage. Recanalization of an ipsilateral external iliac artery (EIA) occlusion was predictive of HO (HR 3.12, 95% CI: 1.33, 7.34; P= 0.009). Increased luminal diameter of the hypogastric origin protected against HO (HR 0.64; 95% CI: 0.47, 0.88; P= 0.006). Perioperative outcomes were no different between patients with and without HO. There were no cases of gluteal necrosis, spinal cord ischemia, or pelvic organ ischemia. Four-year mortality and limb salvage were not affected by HO. HO was associated with decreased primary patency of ipsilateral iliac stents and increased risk of ipsilateral reintervention (HR 5.49; 95% CI: 1.82, 16.58; P= 0.002). CONCLUSIONS HO is relatively infrequent following BMS coverage during treatment of AIOD. Luminal diameter of the hypogastric origin and ipsilateral EIA occlusion are associated with occlusion. HO is well tolerated in AIOD, though it is potentially associated with increased risk iliac stent occlusion and reintervention.
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Roncati L, Manenti A, Gasparri P, Gallo G, Farinetti A. A Pathogenetic Focus on the Aortoiliac-Mesenteric Steal Syndrome. Ann Vasc Surg 2020; 65:e302-e303. [DOI: 10.1016/j.avsg.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022]
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Katsaros I, Georgakarakos E, Frigkas K, Tasopoulou KM, Souftas V, Fiska A. Arterial collateral circulation pathways in patients with aortoiliac occlusive disease. Vascular 2019; 27:677-683. [DOI: 10.1177/1708538119859795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Aortoiliac occlusive disease is a leading cause of morbidity and mortality worldwide. Patients typically present with intermittent claudication or critical limb ischemia but the majority of them remain asymptomatic. Collateral arterial pathways restore the arterial blood supply distal to the lesions. The objective of this study is the description of collateral pathways’ patterns of aortoiliac occlusive disease. Methods Records from the Department of Vascular Surgery of University General Hospital of Alexandroupolis were retrospectively searched from March 2016 to August 2018 for patients suffering from aortoiliac occlusive disease. Results Thirty-three patients (24 males, 9 females) with a mean age of 64.2 ± 11.8 years were included in this study. Twenty-two patients had diabetes mellitus, 25 hypertension, and 16 dyslipidemia. Twenty-two were active smokers. Seventeen patients suffered from intermittent claudication and 16 patients presented with critical limb ischemia. Seven patients had TASC-II B lesions, 10 TASC-II C lesions, and 16 patients had TASC-II D lesions. Systemic collateral pathways were dominant in 17 patients, whereas visceral pathways were prominent in 16 patients. While 62.5% of patients having lesions in the abdominal aorta presented systemic pathways, the lesions located only in the iliac arteries followed visceral patterns or systematic patterns equally. Conclusions Collateral anastomotic networks provide blood supply to regions distal to aortoiliac occlusive lesions. Their pattern is defined mainly by the location of the lesion and does not seem to associate with comorbid factors or the extent of the lesion. Failure to recognize these networks during surgery could lead to limb threatening situations.
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Affiliation(s)
- Ioannis Katsaros
- Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Konstantinos Frigkas
- Department of Radiology and Medical Imaging, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Kalliopi-Maria Tasopoulou
- Department of Vascular Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Vasileios Souftas
- Department of Radiology and Medical Imaging, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Aliki Fiska
- Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Selçuk İ, Uzuner B, Boduç E, Baykuş Y, Akar B, Güngör T. Step-by-step ligation of the internal iliac artery. J Turk Ger Gynecol Assoc 2019; 20:123-128. [PMID: 30499283 PMCID: PMC6558362 DOI: 10.4274/jtgga.galenos.2018.2018.0124] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The internal iliac artery is the main vascular supply of pelvic visceral structures. All pelvic surgeons must know the anatomic landmarks and basic steps of internal iliac artery ligation in order to stop massive pelvic hemorrhage. This cadaveric demonstration and clinical review of the internal iliac artery shows the anatomic landmarks and basic steps of internal iliac artery ligation.
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Affiliation(s)
- İlker Selçuk
- Clinic of Gynecologic Oncology, Health Sciences University, Zekai Tahir Burak Woman’s Health Training and Research Hospital, Ankara, Turkey
| | - Bora Uzuner
- Department of Anatomy, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Erengül Boduç
- Department of Anatomy, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Yakup Baykuş
- Department of Obstetrics and Gynecology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Bertan Akar
- Clinic of Obstetrics and Gynecology, VM Medical Park Kocaeli Hospital, Kocaeli, Turkey
| | - Tayfun Güngör
- Clinic of Gynecologic Oncology, Health Sciences University, Zekai Tahir Burak Woman’s Health Training and Research Hospital, Ankara, Turkey
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Arfi A, Arfi-Rouche J, Barrau V, Nyangoh Timoh K, Touboul C. Three-dimensional computed tomography angiography reconstruction of the origin of the uterine artery and its clinical significance. Surg Radiol Anat 2017; 40:85-90. [DOI: 10.1007/s00276-017-1941-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/30/2017] [Indexed: 11/25/2022]
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Ahmed S, Raman SP, Fishman EK. CT angiography and 3D imaging in aortoiliac occlusive disease: collateral pathways in Leriche syndrome. Abdom Radiol (NY) 2017; 42:2346-2357. [PMID: 28401281 DOI: 10.1007/s00261-017-1137-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Collateral pathways in aortoiliac occlusive disease are essential for arterial blood flow to the abdomen, pelvis, and lower extremities. These pathways can be broadly divided into systemic-systemic, visceral-visceral, and systemic-visceral collateral networks. MDCT angiography is the most commonly used modality for the diagnostic evaluation of patients with aortoiliac occlusive disease, allowing excellent evaluation of stenotic arterial segments, as well as beautifully illustrating resulting collateral pathways (particularly when utilizing 3D reconstruction techniques). This article seeks to familiarize radiologists with the most common patterns of aortoiliac occlusion and associated arterial collateral pathways utilizing CT angiography.
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Affiliation(s)
- Sameer Ahmed
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
| | - Siva P Raman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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Multidetector Computed Tomographic Angiography for Optimal Cartography of the Visceral Abdominal Arterial Network: An Extensive Pictorial Review with Emphasis on Common and Uncommon Collateral Pathways, Complications and some Specific Syndromes. J Belg Soc Radiol 2017; 101:6. [PMID: 30038999 PMCID: PMC5854326 DOI: 10.5334/jbr-btr.1203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Multidetector computed tomographic angiography (MDCTA) is the new gold standard for diagnostic evaluation of the abdominal and/or mesenteric arteries. It is not invasive and provides a 2D and 3D global cartography of all abdominal arteries and that with only a limited amount of contrast media. MDCTA allows the optimal diagnosis of single or multiple arterial stenosis and easily analyses sometimes very complex collateral pathways. It constitutes a major advance to plan the arterial visceral safety of major commonly performed abdominal surgical procedures such as aorto-iliac surgery, endovascular aneurysm repair (EVAR), but also complex pancreatic and gastrointestinal or colonic surgery. It also allows to plan the most optimal strategy for revascularization of the mesenteric system through percutaneous angioplasty, stent placement or surgical bypass. This extensive pictorial review illustrates a large variety of situations which may be found during clinical practise. Single compression or stenosis of each digestive artery, combined and/or complex associations of stenosis and/or compressions of several arteries, secondary complications like aneurysms and classical but also sometimes unusual patterns of collateralization are richly illustrated. Specific syndromes comprising the median arcuate ligament syndrome (MALS) and the Leriche’s syndrome are also discussed.
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