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Lateral parasacral ischial plane block: A novel approach to the sacral plexus in the supine position. J Clin Anesth 2023; 87:111108. [PMID: 36931052 DOI: 10.1016/j.jclinane.2023.111108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
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Ng KG, Ho DC, Wee TC. Ischemic lumbosacral plexopathy after embolization of type 2 endoleak: Progress and functional outcome. Clin Case Rep 2021; 9:e05182. [PMID: 34934498 PMCID: PMC8650807 DOI: 10.1002/ccr3.5182] [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: 10/16/2021] [Revised: 11/30/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
An endoleak is a complication that can occur after an endovascular aneurysm repair. We report a rare case of ischemic lumbosacral plexopathy post embolization of type 2 endoleak, including its presentation, neurological progress, rehabilitation strategy and functional outcome.
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Affiliation(s)
- Kuan Geok Ng
- Department of General Medicine/Rehabilitation MedicineSengkang General HospitalSingapore CitySingapore
| | - Derek Chunyin Ho
- Department of General SurgeryChangi General HospitalSingapore CitySingapore
| | - Tze Chao Wee
- Department of Rehabilitation MedicineChangi General HospitalSingapore CitySingapore
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Bongert M, Gehron J, Geller M, Böning A, Grieshaber P. Cannula position and Bernoulli effect contribute to leg malperfusion during extracorporeal life support with femoral arterial cannulation-an in silico simulation study†. Interact Cardiovasc Thorac Surg 2019; 29:312–319. [PMID: 30879059 DOI: 10.1093/icvts/ivz048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Limb ischaemia during extracorporeal life support (ECLS) using femoral artery cannulation is frequently observed even in patients with regular vessel diameters and without peripheral arterial occlusive disease. We investigated underlying pathomechanisms using a virtual fluid-mechanical simulation of the human circulation. METHODS A life-sized model of the human aorta and major vascular branches was virtualized using 3-dimensional segmentation software (Mimics, Materialise). Steady-state simulation of different grades of cardiac output (0-100%) was performed using Computational Fluid Dynamics (CFX, ANSYS). A straight cannula [virtualized 16 Fr (5.3 mm)] was inserted into the model via the left common femoral artery. The ECLS flow was varied between 1 and 5 l/min. The pressure boundary conditions at the arterial outlets were selected to demonstrate the downstream vascular system. Qualitative and quantitative analyses concerning flow velocity and direction were carried out in various regions of the model. RESULTS During all simulated stages of reduced cardiac output and subsequently adapted ECLS support, retrograde blood flow originating from the ECLS cannula was observed from the cannulation site up to the aortic bifurcation. Analysis of pressure showed induction of zones of negative pressure close to the cannula tip, consistent with the Bernoulli principle. Depending on cannula position and ECLS flow rate, this resulted in negative flow from the ipsilateral superficial femoral artery or the contralateral internal iliac artery. The antegrade flow to the non-cannulated side was generally greater than that to the cannulated side. CONCLUSIONS The cannula position and ECLS flow rate both influence lower limb perfusion during femoral ECLS. Therefore, efforts to optimize the cannula position and to avoid limb malperfusion, including placement of a distal perfusion cannula, should be undertaken in patients treated with ECLS.
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Affiliation(s)
- Markus Bongert
- Research Center for BioMedical Technology (BMT), University of Applied Sciences and Arts, Dortmund, Germany
| | - Johannes Gehron
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Marius Geller
- Research Center for BioMedical Technology (BMT), University of Applied Sciences and Arts, Dortmund, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
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Muniz Neto FJ, Kihara Filho EN, Miranda FC, Rosemberg LA, Santos DCB, Taneja AK. Demystifying MR Neurography of the Lumbosacral Plexus: From Protocols to Pathologies. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9608947. [PMID: 29662907 PMCID: PMC5832061 DOI: 10.1155/2018/9608947] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/29/2017] [Indexed: 12/14/2022]
Abstract
Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating different neurological pathologies in correlation to clinical and the electrophysiological data. The aim of this article is to present a review on the anatomy of the lumbosacral plexus nerves, along with imaging protocols, interpretation pitfalls, and most common pathologies that should be recognized by the radiologist: traumatic, iatrogenic, entrapment, tumoral, infectious, and inflammatory conditions. An extensive series of clinical and imaging cases is presented to illustrate key-points throughout the article.
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Affiliation(s)
- Francisco J. Muniz Neto
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Eduardo N. Kihara Filho
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Frederico C. Miranda
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Laercio A. Rosemberg
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Durval C. B. Santos
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Atul K. Taneja
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Gluteal Necrosis and Lumbosacral Plexopathy in a Diabetic Patient after Renal Transplantation. Case Rep Urol 2016; 2015:976912. [PMID: 26793402 PMCID: PMC4697094 DOI: 10.1155/2015/976912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/09/2015] [Accepted: 11/29/2015] [Indexed: 11/18/2022] Open
Abstract
A 34-year-old diabetic patient underwent a renal transplant which was complicated by right side lower extremity paresis and numbness with gluteal necrosis. The main reason was ligation of internal iliac artery of the same side as a result of extensive microvascular obstruction due to severe atheromatous plaque. This is a rare complication which is mostly reported in aneurysmal patients after bypass surgery. The gluteal necrosis is a serious complication which, as in our patient, resulted in patient's death in most of the reported cases. Because of catastrophic nature of this condition, identifying preventive measures is extremely important.
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Abstract
PURPOSE OF REVIEW This article provides an up-to-date review of the clinical features and pathogenesis of different types of lumbosacral plexopathy and a clinical approach to their evaluation and management. Often, the pathologic involvement is not limited to the plexus and also involves the root and nerve levels. These conditions are called lumbosacral radiculoplexus neuropathies. RECENT FINDINGS The pathophysiology of diabetic and nondiabetic lumbosacral radiculoplexus neuropathy has been elucidated; it is ischemic injury due to a perivascular inflammatory process and microvasculitis. The clinical and neurophysiologic features of these two entities have been found to be similar, consisting of acute or subacute onset of pain and paresthesia followed by profound motor weakness asymmetrically involving the lower limbs and associated with weight loss. A lower limb and motor predominant neuropathy without pain also occurs in diabetes mellitus and has been shown to be a form of diabetic lumbosacral radiculoplexus neuropathy and not diabetic chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The pathophysiology of some cases of postsurgical lumbosacral plexopathies has recently been shown also to be inflammatory from microvasculitis, and treatment with immunotherapy in a timely fashion may be desirable. SUMMARY Many pathophysiologic processes, such as neoplastic, traumatic, infectious, radiation, and inflammatory/microvasculitic processes, can affect the lumbosacral plexus causing lumbosacral plexopathy. The clinical symptoms and signs depend on the part of the plexus involved and the temporal course. Management depends on the cause of the lumbosacral plexopathy. Many cases of lumbosacral plexopathy previously thought to be idiopathic have been shown to be caused by ischemic injury from microvasculitis; despite lack of evidence for efficacy in improving neurologic deficits, the authors of this article include immunotherapy in their management of patients with this condition.
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Neufeld EA, Shen PY, Nidecker AE, Runner G, Bateni C, Tse G, Chin C. MR Imaging of the Lumbosacral Plexus: A Review of Techniques and Pathologies. J Neuroimaging 2015; 25:691-703. [PMID: 25940664 DOI: 10.1111/jon.12253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 11/29/2022] Open
Abstract
The lumbosacral plexus is a complex anatomic area that serves as the conduit of innervation and sensory information to and from the lower extremities. It is formed by the ventral rami of the lumbar and sacral spine which then combine into larger nerves serving the pelvis and lower extremities. It can be a source of severe disability and morbidity for patients when afflicted with pathology. Patients may experience motor weakness, sensory loss, and/or debilitating pain. Primary neurologic processes can affect the lumbosacral plexus in both genetic and acquired conditions and typically affect the plexus and nerves symmetrically. Additionally, its unique relationship to the pelvic musculature and viscera render it vulnerable to trauma, infection, and malignancy. Such conditions are typically proceeded by a known history of trauma or established pelvic malignancy or infection. Magnetic resonance imaging is an invaluable tool for evaluation of the lumbosacral plexus due to its anatomic detail and sensitivity to pathologic changes. It can identify the cause for disability, indicate prognosis for improvement, and be a tool for delivery of interventions. Knowledge of proper MR protocols and imaging features is key for appropriate and timely diagnosis. Here we discuss the relevant anatomy of the lumbosacral plexus, appropriate imaging techniques for its evaluation, and discuss the variety of pathologies that may afflict it.
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Affiliation(s)
- Ethan A Neufeld
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Peter Yi Shen
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Anna E Nidecker
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Gabriel Runner
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Cyrus Bateni
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Gary Tse
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Cynthia Chin
- University of California San Francisco Medical Center, Department of Radiology, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628
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Bilateral ischemic lumbosacral plexopathy from chronic aortoiliac occlusion presenting with progressive paraplegia. J Vasc Surg 2014; 59:241-3. [DOI: 10.1016/j.jvs.2013.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/02/2013] [Accepted: 04/10/2013] [Indexed: 11/22/2022]
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Hans SS, Ngo W, McAllister M. Paraplegia after aortic and superior mesenteric artery stenting for occlusive disease. Ann Vasc Surg 2013; 28:492.e17-9. [PMID: 24295883 DOI: 10.1016/j.avsg.2013.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 05/04/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
Paraplegia after endovascular therapy for aortic and visceral artery occlusive disease is an extremely uncommon occurrence. Two cases of paraplegia after placement of an aortic covered stent for infrarenal aortic stenosis and a superior mesenteric artery stent for chronic visceral ischemia are presented. In both patients, embolization of the arterial supply to the spinal cord was the presumed cause. One patient had a slight recovery after intense physical therapy and rehabilitation. The second patient did not have any recovery from her paraplegia.
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Affiliation(s)
- Sachinder S Hans
- Division of Vascular Surgery, Henry Ford Macomb Hospital in Clinton Township, Michigan; Division of Vascular Surgery, St. John Macomb Hospital in Warren, Michigan.
| | - William Ngo
- Division of Vascular Surgery, Henry Ford Macomb Hospital in Clinton Township, Michigan
| | - Michael McAllister
- Division of Vascular Surgery, St. John Macomb Hospital in Warren, Michigan
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Ioannou CV, Tsetis DK, Kardoulas DG, Katonis PG, Katsamouris AN. Spinal Cord Ischemia After Endovascular Embolization of a Type II Endoleak Following Endovascular Aneurysm Repair. Ann Vasc Surg 2012; 26:860.e1-7. [DOI: 10.1016/j.avsg.2011.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/19/2011] [Accepted: 12/27/2011] [Indexed: 11/15/2022]
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Bani-Hani MG, Friere V, Byrne BE, Plant GR, Moawad MR. Spinal cord ischemia following external iliac artery angioplasty: a case report. Vasc Endovascular Surg 2011; 45:467-9. [PMID: 21571775 DOI: 10.1177/1538574411408443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spinal cord ischemia (SCI) is a rare disease that leads to variable degrees of neurological deficit including permanent paraplegia. It has been reported after open and endovascular interventions of the thoracic and abdominal aorta, but it is extremely rare after interventions involving peripheral vessels. We present a case of permanent paraplegia after iliac angioplasty and stenting for critical limb ischemia and a related review of the literature.
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Stone PA, Campbell JE, Hass SM, Jain A, Kazmi H. Kissing Iliac Artery Stent Technique for Salvage of Hypogastric Artery Occlusion Secondary to Iliac Artery Dissection During Endovascular Aneurysm Repair. Vasc Endovascular Surg 2011; 45:174-7. [PMID: 21382835 DOI: 10.1177/1538574410377240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While undergoing endovascular aneurysm repair (EVAR), dissection occurred in bilateral common and external iliac arteries resulting in acute bilateral hypogastric artery occlusion. Attempts were made to reestablish flow to the left internal iliac artery via retrograde ipsilateral approach without success. A left brachial approach was used to gain access to the left internal iliac artery and kissing angioplasty and subsequent stent placement with 2 self-expanding stents was performed raising the iliac bifurcation to the level of the stent graft to salvage the internal iliac artery.
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Affiliation(s)
- Patrick A. Stone
- Division of Vascular and Endovascular Surgery, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine Charleston Division, Charleston, WV, USA
| | - John E. Campbell
- Division of Vascular and Endovascular Surgery, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine Charleston Division, Charleston, WV, USA
| | - Stephen M. Hass
- Division of Vascular and Endovascular Surgery, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine Charleston Division, Charleston, WV, USA
| | - Akhilesh Jain
- Robert C. Byrd health Sciences Center, West Virginia University School of Medicine Charleston Division, Charleston, WV, USA
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13
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Deylgat B, Wallaert P, De Smul G, Van Lysebeth L, Ceuppens H. Unilateral lower limb paralysis after aortobifemoral bypass graft for ruptured abdominal aortic aneurysm: a case report. Vasc Endovascular Surg 2009; 43:606-9. [PMID: 19828587 DOI: 10.1177/1538574409345032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An 81-year-old man underwent an aortobifemoral bypass graft because of a ruptured abdominal aortic aneurysm. His postoperative recovery was complicated by unilateral lower limb paralysis caused by perioperative ischemia of the lumbosacral plexus. Ischemic lumbosacral plexopathy is an uncommon complication after infrarenal aortic surgery with serious morbidity. Despite a good surgical technique and knowledge of the vascularization of the spinal cord, its occurrence remains unpredictable.
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Affiliation(s)
- Bert Deylgat
- Department of Vascular and Thoracic Surgery, AZ Groeninge Kortrijk, Belgium.
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Tochii M, Takagi Y, Hoshino R, Yamashita M, Sato M, Kaneko K, Ishida M, Watanabe T, Akita K, Kondo H, Higuchi Y, Watanabe T, Ando M. Paraplegia following the emergency surgical repair of a nonruptured symptomatic abdominal aortic aneurysm: report of a case. Surg Today 2009; 39:603-5. [PMID: 19562449 DOI: 10.1007/s00595-008-3896-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 12/01/2008] [Indexed: 11/24/2022]
Abstract
This report presents an extremely rare case of paraplegia following emergency surgery for a nonruptured symptomatic abdominal aortic aneurysm. A 62-year-old man underwent an emergency surgical repair for a symptomatic nonruptured infrarenal abdominal aortic aneurysm. On postoperative day 2 paraplegia following spinal cord ischemia occurred at the T8 level. The site of the ischemia was situated too high for clamping to have caused this condition, unless the patient had a congenital anomaly in the blood supply to the spinal cord or it had been caused by the previously occluded great radicular artery, which was maintained by the collateral blood supply from the iliac circulation.
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Affiliation(s)
- Masato Tochii
- Department of Cardiovascular Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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Chang CK, Chuter TAM, Reilly LM, Ota MK, Furtado A, Bucci M, Wintermark M, Hiramoto JS. Spinal arterial anatomy and risk factors for lower extremity weakness following endovascular thoracoabdominal aortic aneurysm repair with branched stent-grafts. J Endovasc Ther 2008; 15:356-62. [PMID: 18540712 DOI: 10.1583/08-2426.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate spinal arterial anatomy and identify risk factors for lower extremity weakness (LEW) following endovascular thoracoabdominal aortic aneurysm (TAAA) repair. METHODS A retrospective review was conducted of 37 patients (27 men; mean age 74.8+/-7.1 years, range 58-86) undergoing endovascular TAAA repair with branched stent-grafts at a single academic institution from July 2005 to December 2007. Data were collected on preoperative comorbidities, duration of operation, blood loss, type of anesthesia, extent of aortic coverage, blood pressure, cerebrospinal fluid (CSF) pressure and drainage, and postoperative development of LEW. Pre- and postoperative contrast-enhanced computed tomographic angiograms (CTA) in a 26-patient subset were analyzed to evaluate the number of patent intercostal and lumbar arteries before and after repair. RESULTS All patients were neurologically intact at the end of the operation. Seven (19%) patients developed LEW postoperatively: 6 perioperatively and 1 after discharge. LEW was associated with postoperative hypotension, internal iliac artery (IIA) occlusion, and fewer patent segmental arteries on preoperative CTA. Lowest mean systolic blood pressure was <90 mmHg in all 6 (100%) patients who developed LEW in hospital compared to 12 (44%) of the 27 patients who did not develop LEW (p = 0.02). Complete resolution of LEW (n = 4) followed prompt measures to raise blood pressure and lower CSF pressure. Persistent LEW (n = 3) was associated with sustained hypotension from sepsis, postoperative bleeding, and hemodialysis, respectively. Two (29%) of 7 patients with LEW either lost prograde flow to an IIA during repair or had bilaterally occluded IIAs preoperatively compared to 2 (7%) of 30 patients without LEW (p = 0.16). Comparison of pre- and postoperative CTAs showed no reduction in the mean number of patent segmental arteries in patients with or without LEW. CONCLUSION Endovascular TAAA repair inevitably occludes direct inflow to lumbar and intercostal arteries. The distal segments of these arteries to the spine, however, are seen to remain patent through collaterals. Measures to preserve collateral pathways and increase perfusion pressure may help prevent or treat LEW.
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Affiliation(s)
- Catherine K Chang
- Department of Surgery, Division of Vascular Surgery, University of California at San Francisco, CA 94143-0222, USA
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Lefebvre S, Pierrejean C, Jacob-Chia T, François JB, Tarall A, Sengler J. Ischémie bilatérale des plexus lombosacrés avec atteinte de la marche suite à une réparation de fistule aortodigestive secondaire : à propos d’un cas. ACTA ACUST UNITED AC 2008; 51:207-11. [DOI: 10.1016/j.annrmp.2008.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
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Armon MP, Wenham PW, Whitaker SC, Gregson RH, Hopkinson BR. Common iliac artery aneurysms in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 1998; 50:474-9. [PMID: 9587341 DOI: 10.1016/j.ejvs.2015.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the incidence of common iliac artery (CIA) aneurysms in patients with abdominal aortic aneurysms (AAA) and to evaluate the relationship between AAA and CIA diameter. METHODS Spiral CT angiography was used to measure the maximum diameters of the abdominal aorta and the common iliac arteries of 215 patients with AAA. RESULTS The median CIA diameter was 1.7 cm--significantly greater than the published mean of 1.25 (2 S.D. = 0.85-1.65) cm of an age-matched, non-vascular population. Thirty-four patients (16%) had unilateral and 26 patients (12%) bilateral CIA aneurysms > or = 2.4 cm diameter. Eight-six vessels (20%) were affected. Right CIA diameters were wider than left CIA diameters (p < 0.0001, Wilcoxon matched-pairs signed rank test). The correlation between AAA size and CIA diameter was weak. CONCLUSIONS The AAA population has abnormally dilated common iliac arteries. In this population, common iliac artery aneurysms should be defined as those greater than 2.4 cm diameter. 20% of CIAs in patients with AAA are aneurysmal according to this definition.
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Affiliation(s)
- M P Armon
- Department of Vascular and Endovascular Surgery, University Hospital, Nottingham, U.K
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