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Konarska-Włosińska M, Ostrowski P, Del Carmen Yika A, Dziedzic M, Bonczar M, Wojciechowski W, Walocha J, Koziej M. Exploring the Topography of the Obturator Artery and Corona Mortis: a Detailed Analysis with Surgical Implications. Int Urogynecol J 2024:10.1007/s00192-024-05774-8. [PMID: 38635039 DOI: 10.1007/s00192-024-05774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The obturator artery (ObA) is described as a branch of the anterior division of the internal iliac artery. It arises close to the origin of the umbilical artery, where it is crossed by the ureter. The main goal of the present study was to create an anatomical map of the ObA demonstrating the most frequent locations of the vessel's origin and course. METHODS In May 2022, an evaluation of the findings from 75 consecutive patients who underwent computed tomography angiography studies of the abdomen and pelvis was performed. RESULTS The presented results are based on a total of 138 arteries. Mostly, ObA originated from the anterior trunk of the internal iliac artery (79 out of 138; 57.2%). The median ObA diameter at its origin was found to be 3.34 mm (lower quartile [LQ] = 3.00; upper quartile [UQ] = 3.87). The median cross-sectional area of the ObA at its origin was found to be 6.31 mm2 (LQ = 5.43; UQ = 7.32). CONCLUSIONS Our study developed a unique arterial anatomical map of the ObA, showcasing its origin and course. Moreover, we have provided more data for straightforward intraoperative identification of the corona mortis through simple anatomical landmarks, including the pubic symphysis. Interestingly, a statistically significant difference (p < 0.05) between the morphometric properties of the aberrant ObAs and the "normal" ObAs originating from the internal iliac artery was found. It is hoped that our study may aid in reducing the risk of serious hemorrhagic complications during various surgical procedures in the pelvic region.
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Affiliation(s)
- Monika Konarska-Włosińska
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Alicia Del Carmen Yika
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Wadim Wojciechowski
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland.
- Youthoria, Youth Research Organization, Kraków, Poland.
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Liao H, Zhou E, Tang Y, He C. Endovascular repair of bilateral isolated common iliac artery aneurysms with unsuitable anatomy utilizing an aortic bifurcated unibody endograft and modified sandwich technique to preserve pelvic blood flow: a case series. J Cardiothorac Surg 2024; 19:210. [PMID: 38616244 PMCID: PMC11017656 DOI: 10.1186/s13019-024-02674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 03/23/2024] [Indexed: 04/16/2024] Open
Abstract
Bilateral isolated common iliac artery aneurysms (CIAAs) are rare, and endovascular repair of CIAAs has emerged as an alternative to traditional open surgical repair. The primary goal of therapy is to exclude the aneurysm sac while maintaining perfusion of at least one internal iliac artery (IIA) to prevent pelvic ischemia. Although the iliac branch device (IBD) has improved the feasibility of preserving the IIA, its applicability is limited to a specific subset of aneurysm anatomy. We present a case series of three patients with bilateral isolated CIAAs in whom preoperative CT scans revealed an absence of a landing zone, the diameter of proximal CIA diameter was less than 13.0 mm, and normal diameter of the nonaneurysmal infrarenal aorta, making it challenging to use an IBD alone or a standard bifurcated aortic endograft to provide a proximal landing zone for iliac artery stenting. To overcome the small diameter of the infrarenal aorta, we implanted an aortic bifurcated unibody endograft. Then, we utilized a balloon-expandable covered stent-graft with overdilation as a modified sandwich technique to create an "eye of the tiger" configuration to prevent gutter leakage. The final angiography performed during the procedure revealed successful exclusion of the aneurysms, with blood flow to the right IIA and no type III endoleak. During the postoperative follow-up period, no patients exhibited symptoms associated with pelvic ischemia. There were no endoleaks or sac expansions on the two-year follow-up CT scans, and all external and internal iliac graft limbs were patent. This study demonstrated that a combination of an aortic bifurcated unibody endograft and a modified sandwich technique can effectively treat bilateral isolated CIAAs with certain anatomical constraints.
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Affiliation(s)
- Haodong Liao
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, CN, China
| | - Enquan Zhou
- Department of Interventional Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, CN, China
| | - Yongjiang Tang
- Department of Vascular Disease, Panzhihua Municipal Central Hospital, Panzhihua, Sichuan, CN, China
| | - Chunshui He
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, CN, China.
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Oztunali C, Acu B. Fourth lumbar artery continuation of the common iliac artery with a retro-psoas course demonstrated by CT. Surg Radiol Anat 2023; 45:1545-1550. [PMID: 37870604 DOI: 10.1007/s00276-023-03252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE To describe a case of an anomalous common iliac artery (CIA) arising from the aorta as the fourth lumbar artery (4th LA) and following a retro-psoas course as the continuation of the 4th LA. METHODS Contrast-enhanced abdominopelvic computed tomography (CT) findings of an incidentally detected anomalous CIA are described in an 8-year-old girl. CASE REPORT CT showed that the right CIA originated from the distal aorta at the L3-L4 level with an acute angle and continued posteriorly in the course of the 4th LA. The right CIA descended into the iliac fossa as a single artery, lying posterior to the psoas muscle. It gave off the internal iliac artery (IIA) low in the iliac fossa and continued as the external iliac artery (EIA). The median sacral artery (MSA) originated from the left proximal CIA and joined the posterior division of the right IIA. DISCUSSION Fourth LA continuation of the CIA is a rare vascular anomaly with a few published reports to date. The anomaly occurs far more on the right side than the left and is mostly asymptomatic. An abnormal connection between the umbilical artery and the distal aorta probably results in this anomaly, as well as in another group of CIA anomalies that are characterized by the absence of one or two CIAs with trifurcation or quadrifurcation of the distal aorta. CONCLUSION Although the vascular anomaly is mostly asymptomatic, knowledge of it is important in the interventions of the area to prevent complications.
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Affiliation(s)
- Cigdem Oztunali
- Faculty of Medicine, Department of Radiology, Eskişehir Osmangazi University, 26040, Eskisehir, Turkey.
| | - Berat Acu
- Faculty of Medicine, Department of Radiology, Eskişehir Osmangazi University, 26040, Eskisehir, Turkey
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Mastrorilli D, Mezzetto L, Antonello M, D'Oria M, Simonte G, Isernia G, Chisci E, Migliari M, Bonvini S, Veraldi GF. Results of iliac branch devices for hypogastric salvage after previous aortic repair. J Vasc Surg 2023; 78:963-972.e2. [PMID: 37343732 DOI: 10.1016/j.jvs.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE The aim of this multicentric study was to assess the "REsults of iliac branch deviceS for hypogastriC salvage after previoUs aortic rEpair (RESCUE)." METHODS All consecutive patients who underwent implantation of iliac branch devices (IBDs) after previous open aortic repair (OAR) or endovascular aortic repair (EVAR) at seven centers were captured. The study cohort was divided into two groups according to the type of repair originally performed. Early outcomes included immediate technical success and perioperative adverse events. Late outcomes included survival, side branch (SB) primary patency, SB instability, and new onset buttock claudication. RESULTS A total of 94 patients (82 male) were included in the study, 10 of them received bilateral implantation of IBDs. This resulted in a total of 104 devices included in the final analysis. Indication for treatment were endoleak 1b or progressive iliac aneurysmal degeneration or distal para-anastomotic aortic aneurysms; 73 were implanted after previous EVAR and 31 after previous OAR. Technical success was 100% in both groups. The 3-year rate of freedom from SB instability was 90.1% after previous EVAR and 85.4% after previous OAR, respectively (P = .05). The 3-year estimates of SB primary patency were significantly lower in patients who had received OAR as compared with those that had received EVAR (89.8% vs 94.9%; P = .05). CONCLUSIONS Endovascular treatment with IBDs following previous OAR or EVAR is safe and effective up to 3 years. Freedom from SB instability during follow-up was lower in patients who had previously undergone OAR than EVAR.
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Affiliation(s)
- Davide Mastrorilli
- Department of Vascular Surgery, University of Verona School of Medicine, University Hospital of Verona, Verona, Italy.
| | - Luca Mezzetto
- Department of Vascular Surgery, University of Verona School of Medicine, University Hospital of Verona, Verona, Italy
| | - Michele Antonello
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, School of Medicine, University of Padua, Padua, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Gioele Simonte
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Giacomo Isernia
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Emiliano Chisci
- Department of Surgery, Vascular and Endovascular Surgery Unit, Usl Toscana Centro, "San Giovanni di Dio" Hospital, Florence, Italy
| | - Mattia Migliari
- Division of Vascular Surgery, University Hospital of Modena and Reggio Emilia, Baggiovara, Italy
| | - Stefano Bonvini
- Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery, University of Verona School of Medicine, University Hospital of Verona, Verona, Italy
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Spath P, Cardona-Gloria Y, Torsello G, Gallitto E, Öz T, Beropoulis E, Stana J, Gargiulo M, Tsilimparis N. Use of Secondary Iliac Branch Devices after Previous Endovascular Abdominal and Thoraco-Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2023; 65:819-826. [PMID: 36707020 DOI: 10.1016/j.ejvs.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/20/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess the safety and effectiveness of iliac branch devices (IBDs), as secondary procedure, for the treatment of type Ib endoleak or evolution of iliac artery disease after prior endovascular aortic repair (EVAR) for thoraco-abdominal (TAAAs) or abdominal aortic aneurysms (AAAs). METHODS A multicentre observational study of three European centres. The study included 75 patients (age 71 ± 9 years, 96% men) with previous EVAR (n = 64, 85%) or fenestrated or branched (FB) EVAR (n = 11, 15%). Overall, 88 IBDs were implanted to treat aneurysmal iliac artery evolution in 40 (53%) and type Ib endoleak in 35 (47%) cases, respectively. Thirteen (17%) patients received bilateral IBDs. Internal iliac artery (IIA) catheterisation was done through a transaxillary access (n = 82, 93%) or up and over (n = 6, 7%) technique. The primary endpoint was technical success. Secondary endpoints were 30 day major adverse event, early and long term freedom from re-intervention and target vessel instability. RESULTS All procedures were technically successful (100%). During hospitalisation, there were four (5%) major adverse events and three (4%) early re-interventions, but no death, stroke, or damage to previous endografts. The median follow up was 47 (interquartile range 42) months, and the five year survival rate was 78 ± 6% with no aortic related death. Cox's regression analysis showed pre-operative renal function impairment (hazard ratio [HR] 3.4; 95% confidence interval [CI] 1.1 - 10.1; p = .033), and primary TAAA repair (HR 6.1; 95% CI 1.6-22.3; p = .006) as independent factors for long term mortality. Freedom from re-interventions was 85 ± 4% at five years with 11 (12%) cases (five endoleaks, four IBD thromboses, two stenoses). IIA instability was reported in three (3%) limbs and freedom from IIA instability was 95 ± 3% after 60 months. CONCLUSION Secondary IBD after EVAR is a safe and effective procedure with high technical success and low complication rates. The technique of choice to revascularise the IIA seems not to affect early and follow up results. Long term durability of IBD repair is acceptable with low rates of IIA re-intervention.
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Affiliation(s)
- Paolo Spath
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany; Department of Vascular Surgery, DIMEC, University of Bologna, Bologna, Italy.
| | - Yamel Cardona-Gloria
- Department of Vascular Surgery and Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery and Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | - Enrico Gallitto
- Department of Vascular Surgery, DIMEC, University of Bologna, Bologna, Italy; Metropolitan Unit of Vascular Surgery, IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Tugce Öz
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Efthymios Beropoulis
- Department of Vascular Surgery and Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | - Jan Stana
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Mauro Gargiulo
- Department of Vascular Surgery, DIMEC, University of Bologna, Bologna, Italy; Metropolitan Unit of Vascular Surgery, IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
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Aljutaili H, Altun I, Toursavadkohi SA, Nezami N. Superior gluteal artery as a reliable back door to embolize mycotic pseudoaneurysm of an isolated Internal Iliac artery. CVIR Endovasc 2023; 6:17. [PMID: 36964881 PMCID: PMC10039965 DOI: 10.1186/s42155-023-00367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/14/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Antegrade access through the origin of the internal iliac and direct percutaneous access under cross-sectional imaging guidance are commonly used for embolization of internal iliac artery aneurysms, pseudoaneurysms, or endoleaks. Here, we report superior gluteal artery retrograde access to treat internal iliac artery mycotic pseudoaneurysm in a patient with failed direct percutaneous access. CASE PRESENTATION We present a 65-year-old female with a history of diverticulitis and sigmoidectomy. Post-sigmoidectomy course was complicated by left common iliac artery (CIA) iatrogenic injury which required surgical ligation of the left CIA and graft placement. However, the graft was subsequently resection due to infection. Follow up CT imaging showed a 6 cm mycotic pseudoaneurysm (PSA) of the left internal iliac artery. Initially, the PSA sac was directly accessed and embolized under direct CT-guidance using Onyx. However, enlargement of the PSA sac was noted on one week follow-up CT images. Then, superior gluteal artery was accessed under ultrasound guidance, and the PSA sac and feeding vessels were re-embolized with coil and Onyx under fluoroscopy. CONCLUSION Retrograde access through superior gluteal artery is a feasible and safe approach to embolize internal iliac aneurysms, pseudoaneurysms, or endoleaks, when the antegrade or direct percutaneous access is limited.
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Affiliation(s)
- Hamad Aljutaili
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, N2W79A, Baltimore, MD, 21201, USA
| | - Izzet Altun
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, N2W79A, Baltimore, MD, 21201, USA
| | - Shahab A Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, N2W79A, Baltimore, MD, 21201, USA.
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
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Bilhim T. Prostatic Artery Embolization: An Update. Korean J Radiol 2023; 24:313-323. [PMID: 36788767 PMCID: PMC10067687 DOI: 10.3348/kjr.2022.0814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Tiago Bilhim
- Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal.,Department of Interventional Radiology, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
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Kim J, Chun JY, Ameli-Renani S, Ratnam L, Mailli L, Pavlidis V, Das R, Morgan R. Outcome of endovascular treatment of internal iliac artery aneurysms: a single center retrospective review. CVIR Endovasc 2022; 5:53. [PMID: 36255546 PMCID: PMC9579245 DOI: 10.1186/s42155-022-00330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/11/2022] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To evaluate the technical feasibility and clinical outcomes of endovascular treatment for internal iliac artery (IIA) aneurysms. MATERIAL AND METHODS This was a retrospective analysis of 25 patients with 32 IIA aneurysms (mean diameter: 39.1 ± 12.6 mm) who underwent endovascular treatment over a 10-year period, and were available for follow-up. Univariate analysis was used to determine the association between variables (including aortoiliac involvement and technique) and outcome. RESULTS The IIA inflow was covered with an iliac stent graft (N = 29) or embolized with a plug (N = 3). The IIA outflow was embolized in all but one case in which there was thrombotic occlusion of outflow branches. Outflow embolization using plugs or coils was performed in the distal IIA or anterior/posterior trunks in 9 cases and distal IIA branches in 22 cases. During a mean follow-up period of 39.9 months, 31.2% of aneurysms demonstrated endoleak and 12.5% demonstrated enlargement. Univariate analysis revealed that endoleak was associated with technical failure (p = 0.01) and that endoleak rate was higher in patients who underwent distal IIA branch embolization (p = 0.03). No variable was associated with sac expansion. Major complication occurred in one patient who died from aneurysm rupture. Minor complications were reported in six patients who developed femoral pseudoaneurysm (N = 2, 8%), buttock claudication (N = 3, 12%), and limb graft occlusion (N = 1, 4%). CONCLUSION Endovascular treatment of IIA aneurysms effectively prevents sac expansion. Endoleak was more frequently observed in cases of technical failure and those in which distal IIA branches were embolized. LEVEL OF EVIDENCE Level 3b, retrospective cohort study.
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Affiliation(s)
- Jinoo Kim
- grid.451349.eDepartment of Radiology, St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK ,grid.411261.10000 0004 0648 1036Department of Radiology, Ajou University Hospital, Suwon, Gyeonggi-do Republic of Korea
| | - Joo-Young Chun
- grid.451349.eDepartment of Radiology, St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - Seyed Ameli-Renani
- grid.451349.eDepartment of Radiology, St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - Lakshmi Ratnam
- grid.451349.eDepartment of Radiology, St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - Leto Mailli
- grid.451349.eDepartment of Radiology, St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - Vyzantios Pavlidis
- grid.451349.eDepartment of Radiology, St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - Raj Das
- grid.451349.eDepartment of Radiology, St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - Robert Morgan
- grid.451349.eDepartment of Radiology, St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
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Balcerzak A, Hajdys J, Shane Tubbs R, Karauda P, Georgiev GP, Olewnik Ł. Clinical importance of variability in the branching pattern of the internal iliac artery - An updated and comprehensive review with a new classification proposal. Ann Anat 2021; 239:151837. [PMID: 34601060 DOI: 10.1016/j.aanat.2021.151837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022]
Abstract
The main aim of this study is to present, describe and compare the most significant anatomical classifications of the internal iliac artery (IIA) and its branches, their pros and cons, to relate them to clinical practice and note their clinical importance, and to offer a new classification based on number of main vessels origins. Many classifications covering the detailed morphology of the IIA have been developed, focusing on the destination of vessels making it possible to determine the name and type of branching precisely. However, because the allocation criteria are overdetailed and of doubtful accuracy, these classifications have become impractical for clinical practice and advanced statistical calculations. The argument of this research paper is that highly variable vascularized regions should be classified from either an anatomical point of view to determine detailed morphology aspects or a clinical perspective. Presented classification proposes unification of many branching types presented among various classifications, which look identical when determining the origin pattern from the main vessel and differ only in the destination point of the vessel, what brings clarity and increases the statistical usefulness of the collected data. This should translate into better cooperation between scientists and clinicians and thus benefit patients. The paper proposes a new, clinically useful classification based on the model of vessel origins from the main stem. The IIA is the main vascular supply to the pelvic region, so precise knowledge of origin and its branching pattern is essential for all clinicians, especially for general and orthopaedic surgeons, gynecologists, obstetricians and urologists.
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Affiliation(s)
- Adrian Balcerzak
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Joanna Hajdys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, Grenada; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA; University of Queensland, Brisbane, Australia.
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Georgi P Georgiev
- Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Sofia, Bulgaria.
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
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Li H, Hu P. Letter to the Editor: Non-selective bilateral internal iliac artery embolization is a safe and effective way in hemorrhage control for hemodynamically unstable pelvic fractures. BMC Musculoskelet Disord 2021; 22:355. [PMID: 33853573 PMCID: PMC8048307 DOI: 10.1186/s12891-021-04212-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
A recently published article by Lai et al. in BMC Musculoskeletal Disorders trying to show that patients with pelvic fractures undergoing non-selective internal iliac artery embolization may lead to a higher rate of surgical site infection. The authors also noted that only a small percentage of patients with contrast extravasation detected by emergency contrast-enhanced CT were subsequently confirmed by angiography, thus, considered that the value of enhanced CT in predicting arterial injury was limited. The authors also believe that embolization of the main stem may cause incomplete hemostasis due to the abundant collateral circulations in the pelvic cavity. Although the author’s findings are mentioned in other studies, the article’s data and pictures only partially supported its inferences, and the conclusions cannot be drawn directly. In this Correspondence, we tried to reinterpret the additional findings in the article from our perspective. Through this discussion, we hope that more colleagues can re-understand the safety and effectiveness of non-selective internal iliac artery embolization in treating hemodynamically unstable pelvic fractures during the early resuscitation stage.
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Affiliation(s)
- Hui Li
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, 1 Jiankang Road, 400014, Yuzhong District, Chongqing, China
| | - Ping Hu
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, 1 Jiankang Road, 400014, Yuzhong District, Chongqing, China.
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Nishi S, Hayashi S, Omotehara T, Kawata S, Suematsu Y, Itoh M. Pelvic collateral pathway during endovascular aortoiliac aneurysm repair with internal iliac artery interruption: a retrospective observational study. BMC Cardiovasc Disord 2020; 20:480. [PMID: 33176687 PMCID: PMC7659198 DOI: 10.1186/s12872-020-01764-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ipsilateral branches of the deep femoral artery (DFA) are qualitatively identified as collateral arteries based on angiography after internal iliac artery (IIA) interruption. The purpose of this study was to quantitatively identify the major collateral pathway after unilateral IIA interruption during endovascular aortoiliac aneurysm repair to preserve the pelvic circulation and reduce the risk of ischemic complications. METHODS The study population included 28 patients (mean age 76.3 years) with aortoiliac aneurysm who underwent endovascular aneurysm repair with unilateral IIA interruption from August 2012 to January 2020. The diameters of the bilateral preoperative and postoperative DFA, lateral femoral circumflex artery (LFCA), medial femoral circumflex artery (MFCA) and obturator artery (ObA) were measured on contrast-enhanced computed tomography using a 3-dimensional image analysis system. The measured values were evaluated and analyzed with a repeated measures two-way analysis of variance and Dunnett's test. RESULTS The postoperative diameters of the MFCA (P = 0.051) and ObA (P = 0.016) were observed to be larger than the preoperative diameters. Such increases in the MFCA (P < 0.001) and ObA (P < 0.001) diameters were only found to be significant on the unilateral side of the IIA interruption, and the diameter of the ipsilateral LFCA (P < 0.001) was also found to have significantly increased in size. However, no significant arterial extension was found on the contralateral side. CONCLUSIONS The ipsilateral MFCA-ObA pathway might therefore be a major collateral pathway arising from the DFA to preserve pelvic circulation after unilateral IIA interruption.
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Affiliation(s)
- Satoshi Nishi
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan. .,Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, 1187-299, Kaname, Tsukuba, Ibaraki, Japan.
| | - Shogo Hayashi
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, Japan
| | - Takuya Omotehara
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Shinichi Kawata
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Yoshihiro Suematsu
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, 1187-299, Kaname, Tsukuba, Ibaraki, Japan
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
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Comploj E, Pycha A, Trenti E, Palermo S, Bonatti M, Krause P, Folchini DM, Pycha A. Transarterial Embolization in the Management of Intractable Haemorrhage. Urol Int 2020; 105:95-99. [PMID: 33070141 DOI: 10.1159/000511123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effectiveness and long-term results of selective transarterial iliac embolization (STIE) in patients with intractable bladder haemorrhage (IBH). METHODS Twenty-five patients with a median age of 84 (range 65-94) years underwent STIE because of IBH between 2002 and 2020. The median follow-up time was 3 (mean 13.9) months. Patients were treated because of bleeding bladder or prostate cancer, radiation-induced haemorrhagic cystitis, and other conditions. Success was defined as technical success (feasibility to embolize bilateral hypogastric arteries or neoplastic arteries) and as clinical success (absence of further or additional therapy). RESULTS Twenty-five patients with a median age of 84 years with a median hospital stay of 7 days were embolized at our institution. In total, 60% required additional therapy. Only 20% had minor complications, but no complication major was seen; 60% needed an additional therapy because of continuous bleeding. Our 30-day, 90-day, 6-month, and 12-month mortality rates were 28, 44, 64, and 76%, respectively. CONCLUSIONS STIE in IBH is a safe, well-tolerated, and feasible procedure for palliating haematuria patients in poor general condition. Major complications are very rarely seen. However, patients often need additional therapy after STIE.
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Affiliation(s)
- Evi Comploj
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy, .,College of Health-Care Professions, Claudiana, Bolzano, Italy,
| | - Alexander Pycha
- Department of Psychiatry, Cantonal Psychiatric Hospital of Lucerne, Lucerne, Switzerland
| | - Emanuela Trenti
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Matteo Bonatti
- Department of Radiology, Central Hospital of Bolzano, Bolzano, Italy
| | - Philipp Krause
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Armin Pycha
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy.,Sigmund Freud Private University, Medical University, Vienna, Austria
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13
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Li CP, Liu BN, Wu JH, Hao CY. Contralateral internal iliac artery transposition for retroperitoneal sarcoma involving common iliac artery. Updates Surg 2020. [PMID: 32602011 DOI: 10.1007/s13304-020-00843-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/25/2020] [Indexed: 01/20/2023]
Abstract
Complete resection for retroperitoneal sarcoma (RPS) involving major vessels frequently requires vascular resection and reconstruction. The use of artificial grafts often leads to postoperative vascular graft infection (VGI), which usually requires reoperation and sometimes leads to death. In the present study, the data of RPS patients who underwent contralateral iliac artery (IIA) transposition for reconstruction of the common iliac artery (CIA) after RPS resection from 2015-2019 were retrospectively analyzed. Clinical, intraoperative, and postoperative outcomes were described. Contralateral IIA transposition was performed to reconstruct the CIA after segmental resection in three patients. All patients underwent concomitant organ resection. Colon resection was performed for all patients, nephrectomy was performed for two patients, and segmental resection of the left ureter with transurethral ureterostomy was performed for one patient. Complete resection was achieved in all patients, and microscopic tumor infiltration to the CIA was observed in all patients (tunica adventitia: 2, tunica media: 1). No major complications occurred during the hospital stay. During the follow-up period (6.0-29.1 months), one patient died from tumor recurrence, and the other two patients did not have any evidence of recurrence or metastatic disease at the latest follow-up. The level of lower limb function was favorable (MSTS93 scores: 28-30). The pelvic organ functions, including bowel, bladder, and sexual functions, were not impaired in any of the patients. This novel technique in which contralateral IIA transposition is performed to reconstruct the CIA after RPS resection is simple and reliable and may be a good alternative to artificial grafts.
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14
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Yang M, Li L, Liu Y, Su Q, Dong Z, Li G, Jiang J, Ding X. Therapeutic management of isolated internal iliac artery aneurysms. J Vasc Surg 2020; 72:1968-1975. [PMID: 32276024 DOI: 10.1016/j.jvs.2020.02.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Isolated internal iliac artery aneurysms (IIIAAs) are rare, life-threatening entities for which the optimal treatment strategy has not been established. This study aimed to evaluate the outcomes of open and endovascular treatment of IIIAAs. METHODS IIIAA cases between January 2009 and March 2019 at two hospitals were retrospectively reviewed. Demographic, clinical, ancillary testing, treatment, and outcome data were collected and analyzed. RESULTS Forty-two patients (37 men and 5 women) with a mean age of 71 years were included. Twenty-five patients (60%) had a history of hypertension. Twenty-two patients (52%) were asymptomatic, and 16 (38%) presented with abdominal pain (12 with ruptured aneurysms). The 42 included patients had 43 treated IIIAAs. The following surgical techniques were used: surgical resection (n = 6), endovascular coil embolization (n = 12), endovascular stent graft placement across the internal iliac artery origin (n = 8 with 9 aneurysms), and combined coil embolization and stent graft placement (n = 16). The immediate technical success rate was 67%, 67%, and 88% for embolization, stent graft placement, and combined method, respectively. Open surgery was associated with the longest operative time and hospital stay. Overall 30-day mortality was 5% for all patients and 17% for patients with ruptured IIIAAs. Buttock claudication occurred in 7 of 40 patients who survived (18%). The median follow-up time was 56 months. The combined approach was associated with the lowest rates of endoleak (6% vs 25% and 29%) and reintervention (6% vs 17% and 29%) of the three endovascular methods. CONCLUSIONS Endovascular coil embolization with stent graft placement is a feasible, safe, and effective treatment approach for large IIIAAs without adequate aneurysm necks.
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Affiliation(s)
- Meng Yang
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Lecong Li
- Department of Intervention, Central People's Hospital of Tengzhou, Tengzhou, People's Republic of China
| | - Yang Liu
- Department of Vascular Surgery, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Qingbo Su
- Department of Vascular Surgery, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Zhaoru Dong
- Department of Vascular Surgery, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Guangzhen Li
- Department of Vascular Surgery, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Jianjun Jiang
- Department of Vascular Surgery, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Xiangjiu Ding
- Department of Vascular Surgery, Qilu Hospital, Shandong University, Jinan, People's Republic of China; School of Basic Medical Science, Shandong University, Jinan, People's Republic of China.
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Khilchuk A, Vlasenko S, Muradyan M, Agarkov M, Abdulkarim D, Shcherbak S, Gladyshev D, Sarana A, Litvinovskii S, Kovalik V. CT-fusion-guided endovascular repair of iatrogenic common iliac artery aneurysm: A case report. Radiol Case Rep 2019; 14:1394-1400. [PMID: 31700554 PMCID: PMC6823823 DOI: 10.1016/j.radcr.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022] Open
Abstract
We present a case of a CT-fusion-guided endovascular repair of an iatrogenic common iliac artery aneurysm in a 60-year-old male with a history of robotic prostatectomy with wide lymphadenectomy. Taking into account iatrogenic nature, rapid evolvement, previous surgical intervention, and oncological history, our team, including vascular and endovascular surgeons, refused open surgery in favor of endovascular iliac repair. We coiled the ipsilateral hypogastric artery and then deployed 2 Fluency Plus stent grafts from the common iliac into the external iliac artery. All manipulations were made under CT-fusion vascular mask control, which provided precise neck positioning, a minimal contrast infusion, reduced radiation dose, and better overall control. Our results suggest that anatomically suitable isolated iliac aneurysms can be successfully and safely treated with CT-fusion-guided endovascular repair without major perioperative and mid-term complications. The case is highlighting the potential complexity of repeated surgery with previously operated patients and the necessity of surgical and endovascular team interactions, especially in case of iatrogenic vascular complications.
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Affiliation(s)
- Anton Khilchuk
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation.,Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation.,Endovascular and Arrhythmology Department, Russian National Research Center of Surgery Named After Academician B.V. Petrovsky, Moscow, Russian Federation
| | - Sergei Vlasenko
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation.,Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Musheg Muradyan
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation
| | - Maksim Agarkov
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation
| | - Dana Abdulkarim
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation
| | - Sergei Shcherbak
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Dmitrii Gladyshev
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation.,General Surgery Department, City Hospital №40, Saint-Petersburg, Russian Federation
| | - Andrei Sarana
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Sergei Litvinovskii
- Department of Cardiovascular Surgery, City Hospital №40, Saint-Petersburg, Russian Federation
| | - Vladislav Kovalik
- Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation
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16
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Huang GB, Hu P, Gao JM, Lin X. Analysis of early treatment of multiple injuries combined with severe pelvic fracture. Chin J Traumatol 2019; 22:129-133. [PMID: 31076162 PMCID: PMC6543179 DOI: 10.1016/j.cjtee.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/19/2019] [Accepted: 03/27/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. METHODS A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200-10,000 mL, with an average volume of 2850 mL. Postoperative follow-up ranged from 6 months to 1.5 years. RESULTS The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral artery thrombosis), and 18 cases of consumptive coagulopathy. CONCLUSION The early treatment of multiple injuries combined with severe pelvic fractures should focus on pelvic hemostasis. Massive bleeding-induced hemorrhagic shock is one of the main causes of poor prognosis. The technique of internal iliac artery devasculization including ligation and embolization can be used as an effective measure to stop or reduce bleeding. Consumptive coagulopathy is difficult to deal with, which should be detected and treated as soon as possible after surgical measures have been performed. The effect of using recombinant factor VII in treating consumptive coagulopathy is satisfactory.
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17
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Yanai A, Uchiyama K, Ishibashi Y. Long-term peritoneal dialysis followed by kidney transplantation for Takayasu arteritis: a case report. BMC Nephrol 2019; 20:131. [PMID: 30999953 PMCID: PMC6471901 DOI: 10.1186/s12882-019-1302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Takayasu arteritis (TA) is a chronic vasculitis of unknown etiology that primarily affects large vessels. Although renal involvement is frequent in TA, patients with TA undergoing renal replacement therapy, especially long-term peritoneal dialysis (PD) and kidney transplantation (KTx), are rarely reported. We herein present the case of an elderly patient with TA treated by PD for more than 5 years and underwent KTx thereafter. Case presentation A 69-year-old female diagnosed with TA at the age of 19 was treated by PD for seven and a half years for end-stage renal disease due to TA. Dialysate-to-plasma ratio of creatinine, which was well maintained during this period, reflected the efficacy of long-term PD. However, her residual renal function declined; she developed malnutrition, inflammation, and atherosclerosis syndrome and underwent living-related KTx from her husband. Due to the total occlusion of the external iliac arteries with compensatory development of the internal iliac arteries, the right internal iliac artery was used as the anastomosis site. After KTx, the patient developed chronic active antibody-mediated rejection; however, the graft function was maintained throughout the follow-up period. Despite severe aortic calcification and intermittent claudication in the legs, her condition did not worsen, and the blood flow of the graft was preserved. Conclusions The current case illustrating the success of long-term PD and living-related KTx in maintaining kidney function in an elderly patient with TA is the first to demonstrate the potential of PD and KTx as feasible options for renal replacement therapy in TA accompanied by severe cardiac involvement.
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Affiliation(s)
- Akane Yanai
- Division of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
| | - Kiyotaka Uchiyama
- Division of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.,Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoshitaka Ishibashi
- Division of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
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Ramakrishnan P, Hote MP, Sreedhar N, Kumar S, Malik V, Choudhary SK. Internal iliac artery pseudoaneurysm: a rare presentation with foot drop and sciatica. Indian J Thorac Cardiovasc Surg 2019; 35:222-225. [PMID: 33061011 DOI: 10.1007/s12055-018-0760-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 11/30/2022] Open
Abstract
Internal iliac artery pseudoaneurysm is rare in incidence with most of them being asymptomatic. It may present with neurologic symptoms like paraesthesia, sciatica, weakness of lower limb, foot drop, etc., and in such scenario, high index of suspicion is needed to diagnose. Early intervention should be the strategy in all symptomatic and in asymptomatic cases with size > 4 cm diameter. We present a case of a 40-year-old female with left internal iliac artery pseudoaneurysm who presented with foot drop and sciatica, which is a very rare presentation, and was managed successfully by resection and interposition grafting.
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Affiliation(s)
- Pradeep Ramakrishnan
- Department of Cardiothoracic and Vascular Surgery, CTVS Office, All India Institute of Medical Sciences(AIIMS), 7th floor, C N centre, New Delhi, 110029 India
| | - Milind Padmakar Hote
- Department of Cardiothoracic and Vascular Surgery, CTVS Office, All India Institute of Medical Sciences(AIIMS), 7th floor, C N centre, New Delhi, 110029 India
| | - Nanditha Sreedhar
- Department of Cardiac Anaesthesia, CTVA Office, AIIMS, 7th Floor, C N Centre, New Delhi, 110029 India
| | - Sanjeev Kumar
- Department of Cardiac Radiology, Cardiac Radiology Office, AIIMS, Ground floor, C N Centre, New Delhi, 110029 India
| | - Vishwas Malik
- Department of Cardiac Anaesthesia, CTVA Office, AIIMS, 7th Floor, C N Centre, New Delhi, 110029 India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular Surgery, CTVS Office, All India Institute of Medical Sciences(AIIMS), 7th floor, C N centre, New Delhi, 110029 India
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19
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Sankaranarayanan G, Rajasekhar SSSN. Anatomical variations of the principal nutrient pedicle for iliac crest graft: the ilio-lumbar artery. Surg Radiol Anat 2019; 41:125-32. [PMID: 30315350 DOI: 10.1007/s00276-018-2111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study is to observe the origin, course, length, diameter and termination of the ilio-lumbar artery (ILA) and its variations in south Indian population. MATERIALS AND METHODS The study was carried out in 34 sides in 19 cadavers (R-18, L-16) used for routine dissection for undergraduate students during the period of 2017-2018 in Department of Anatomy, JIPMER, Puducherry. On each side of the pelvis, the origin, length, diameter, course of the ILA and its relations to the surrounding anatomical structures was observed and documented. RESULTS Out of 34 formalin-fixed pelvis halves of human cadavers, the ILA originated from the common iliac artery (CIA), the trunk of the internal iliac artery (IIA) and posterior division of IIA in around 0%, 61.76%, and 38.23% of the cases, respectively. In all the cadavers, the ILA passes in between the obturator nerve anteriorly and the lumbosacral trunk posteriorly and ILA terminates by giving iliac and lumbar arteries medial to the psoas major muscle. CONCLUSIONS In our study, we observed that the mean distance between the origin of ILA and the bifurcation of the CIA is significantly less than the study done previously. The knowledge about the variations in the origin, course, length, diameter, and termination of ILA is very important to the surgeon to avoid iatrogenic injury during surgeries in lumbosacral region and moreover, it will be easy to access the ILA for clamping or embolization. A similar study can be done with more sample size in different population to increase the knowledge base regarding ILA anatomy.
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20
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Fänder J, Büttner M, Kielstein H, Jasinski-Bergner S. A Missing Posterior Division of the Internal Iliac Artery. EJVES Short Rep 2018; 40:18-20. [PMID: 30294684 PMCID: PMC6170930 DOI: 10.1016/j.ejvssr.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction To date, multiple variations in the pelvic vasculature have been reported. In this case report, a rare, so far unreported, branching anomaly of the internal iliac artery on the left side of a male human pelvis is described. Report The complete posterior division of the internal iliac artery was shown to be missing on dissection of a 73 year old male cadaver. The iliolumbar artery, the lateral sacral arteries, and the superior gluteal artery originated unilaterally (on the left pelvis) directly from the common iliac artery. Discussion No alteration was observed in the supplied structures of the left pelvic region, including the respective muscles, the sacrum, or the hip joint. A rare, so far unreported, branching anomaly of the internal iliac artery is described. The complete posterior division of the internal iliac artery is missing. The ILA, the LSA, and the SGL originate unilaterally directly from the common iliac artery. No alteration of the supplied structures of the left pelvic region is observed.
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Affiliation(s)
- Johannes Fänder
- Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Maximilian Büttner
- Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Heike Kielstein
- Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Simon Jasinski-Bergner
- Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
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21
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Selçuk İ, Yassa M, Tatar İ, Huri E. Anatomic structure of the internal iliac artery and its educative dissection for peripartum and pelvic hemorrhage. Turk J Obstet Gynecol 2018; 15:126-129. [PMID: 29971190 PMCID: PMC6022419 DOI: 10.4274/tjod.23245] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/08/2018] [Indexed: 12/01/2022] Open
Abstract
The abdominal aorta is divided into two parts (right and left) at the level of the fourth-fifth lumbar vertebra and called the common iliac artery. Anterior to the sacroiliac joint, common iliac arteries are divided into external and internal iliac arteries. The external iliac artery supplies the lower limb, and the internal iliac artery is the major vascular supply of the pelvis. Internal iliac artery is divided into anterior and posterior trunk. The anterior trunk supplies the pelvis, visceral organs, and the posterior trunk supplies pelvic parietal structures. The broad ligament envelopes the uterus anteriorly and posteriorly with its sheets and continues as the pelvic peritoneum at the lateral side of the pelvic wall. After cutting the pelvic peritoneum, the retroperitoneal area is visualized and the internal iliac artery with other great vessels of the abdomen can be noted.
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Affiliation(s)
- İlker Selçuk
- University of Health Sciences, Zekai Tahir Burak Woman's Health Health Practice and Research Center, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Murat Yassa
- İstanbul Fatih Sultan Mehmet Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - İlkan Tatar
- Hacettepe University Faculty of Medicine, Department of Anatomy, Ankara, Turkey
| | - Emre Huri
- Hacettepe University Faculty of Medicine, Department of Urology, Ankara, Turkey
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22
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Robaldo A, Pagliari S, Piaggio F, Colotto P. Persistent Buttock Claudication after Endovascular Abdominal Aortic Aneurysm Repair. Aorta (Stamford) 2018; 5:173-176. [PMID: 29766009 DOI: 10.12945/j.aorta.2017.17.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/15/2017] [Indexed: 11/18/2022]
Abstract
We describe the successful surgical treatment of a 71-year-old man affected by right buttock claudication after a right internal iliac artery (IIA) coil embolization as an adjunct to endovascular iliac artery aneurysm repair. Computed tomography angiography revealed extensive aortoiliac calcifications and thrombus in the vessel walls. Despite patency of the contralateral IIA and preservation of right distal collateral flow through ipsilateral hypogastric branches, the symptom was persistent and disabling. The high-risk patient underwent an "open" repair of the infrarenal abdominal aneurysm with removal of the entire stent-graft and concomitant revascularization of the right IIA. Post-operative recovery was uneventful, and the patient remained asymptomatic during a 30-month follow-up. This case underscores the importance of considering all potential solutions, including open surgery, to preserve pelvic inflow after aortoiliac stent grafting, particularly for high-risk patients with vulnerable plaque and higher risk of thrombus embolization.
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Affiliation(s)
- Alessandro Robaldo
- Vascular and Endovascular Surgery Unit, Imperia Hospital, Imperia, Italy
| | - Stefano Pagliari
- Vascular and Endovascular Surgery Unit, Imperia Hospital, Imperia, Italy
| | - Filippo Piaggio
- Vascular and Endovascular Surgery Unit, Imperia Hospital, Imperia, Italy
| | - Patrizio Colotto
- Vascular and Endovascular Surgery Unit, Imperia Hospital, Imperia, Italy
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Zhang N, Lou WH, Zhang XB, Fu JN, Chen YY, Zhuang ZG, Lin JH. Vascular complications following prophylactic balloon occlusion of the internal iliac arteries resolved by successful interventional thrombolysis in a patient with morbidly adherent placenta. J Zhejiang Univ Sci B 2017; 18:272-276. [PMID: 28271663 DOI: 10.1631/jzus.b1600315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The increasing incidence of morbidly adherent placenta (MAP) is placing women at a higher risk of life-threatening massive hemorrhage. The involvement of interventional radiology to manage this complex condition by performing prophylactic iliac artery balloon occlusion has been reported recently. However, the effectiveness and safety of this technique have not been fully determined. Here we report the case of a 25-year-old woman with placenta increta with preemptive bilateral internal iliac artery balloons who had external iliac artery thrombosis detected by computed tomography angiography (CTA) 72 h post cesarean section. A digital subtraction angiogram (DSA) and intra-arterial thrombolysis were instantly performed followed by supplementary conservative treatments, leading to a desirable resolution of thrombus without sequela. This is the first report of vascular complications with successful interventional thrombolysis in this setting. Our experience suggests that prophylactic iliac artery balloon occlusion should be used cautiously in cases of MAP and consideration given to minimizing vascular complications given the hypercoagulable state of pregnancy.
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Affiliation(s)
- Ning Zhang
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China
| | - Wei-Hua Lou
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China
| | - Xue-Bin Zhang
- Department of Interventional Oncolog, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China
| | - Jia-Ning Fu
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA
| | - Yun-Yan Chen
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China
| | - Zhi-Guo Zhuang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China
| | - Jian-Hua Lin
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China
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24
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Coscas R, Fillet P, Lamas H, Javerliat I, Goeau-Brissonniere O, Coggia M. Embolization of a Previously Excluded Symptomatic Internal Iliac Aneurysm Through the Iliac Vein. Cardiovasc Intervent Radiol 2017; 40:1954-7. [PMID: 28681223 DOI: 10.1007/s00270-017-1737-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
A 69-year-old man was referred urgently for a 58-mm enlarging painful right internal iliac artery (IIA) aneurysm. Since exclusion through proximal IIA coverage and distal IIA branches embolization had been previously performed, aneurysm sac puncture through the iliac vein was decided. The ipsilateral common femoral vein was antegradely punctured, and a 16.5 G Ross modified Colapinto needle from a transjugular intrahepatic access set was used to puncture the sac and fill the aneurysm with coils. Embolization of an IIA aneurysm through the iliac vein may represent an alternative when prior IIA aneurysm exclusion has been performed.
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25
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de Treigny OM, Roumiguie M, Deudon R, de Bonnecaze G, Carfagna L, Chaynes P, Rimailho J, Chantalat E. Anatomical study of the inferior vesical artery: is it specific to the male sex? Surg Radiol Anat 2017; 39:961-965. [PMID: 28229186 DOI: 10.1007/s00276-017-1828-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of our study was to clarify the origin of the inferior vesical artery and determine its existence in women. METHODS This descriptive study is based on 25 dissections (6 male and 19 female cadavers). We dissected the internal iliac artery and its branches from the iliac bifurcation, bilaterally and comparatively. Each arterial branch supplying the bladder was identified and dissected as far as the bladder. RESULTS In total, 50 topographies of the bladder vascularization were visualised. The inferior vesical artery was observed in 92% of the male subjects and in 47.4% of the female subjects. In the male cadavers, it arose from the internal iliac artery in 72.7% of cases and from the umbilical artery in 27.3% of cases. In the female cadavers, it arose from a common trunk with the umbilical artery and the uterine artery in 33.3% of cases and directly from the umbilical artery in 33.3% with one terminal branch supplying the upper part of the vagina. In two female subjects, the inferior vesical artery arose from the first segment of the uterine artery (22.2%), and in one subject from the obturator artery (11.1%). CONCLUSIONS The inferior vesical artery is not specific to the male sex. The contradictions found in the literature of this artery are due to the variations observed in pelvic vascularization and to the close connections between vaginal and bladder vascularisation in women. However, surgeons should consider these variations, to prevent bladder devascularization by non-selective ligation.
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Affiliation(s)
- O Merigot de Treigny
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Urology, Rangueil Hospital, CHU Toulouse, Toulouse, France
| | - M Roumiguie
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Urology, Rangueil Hospital, CHU Toulouse, Toulouse, France
| | - R Deudon
- Department of Gynecological Surgery, Rangueil Hospital, CHU Toulouse, 1 avenue J Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - G de Bonnecaze
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Head and Neck Surgery, Larrey Hospital, CHU Toulouse, Toulouse, France
| | - L Carfagna
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Pediatric Surgery, CHU Paule de Viguier, Toulouse, France
| | - P Chaynes
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Neurosurgical Department, Pierre Paul Riquet Hospital, CHU Toulouse, Toulouse, France
| | - J Rimailho
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Gynecological Surgery, Rangueil Hospital, CHU Toulouse, 1 avenue J Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - E Chantalat
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France. .,Department of Gynecological Surgery, Rangueil Hospital, CHU Toulouse, 1 avenue J Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.
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26
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Lo TK, So CH, Yeung SW, Fung M, Lui KY, Pan NY. Comparison of selective and non-selective internal iliac artery embolization for abnormal placentation with major postpartum hemorrhage. Int J Gynaecol Obstet 2016; 136:103-104. [PMID: 28099712 DOI: 10.1002/ijgo.12014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/30/2016] [Accepted: 10/11/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Tsz-Kin Lo
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, Kowloon, Hong Kong, China
| | - Chun-Hong So
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, Kowloon, Hong Kong, China
| | - Sik-Wing Yeung
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, Kowloon, Hong Kong, China
| | - Mimi Fung
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, Kowloon, Hong Kong, China
| | - Kwai-Ying Lui
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, Kowloon, Hong Kong, China
| | - Nin-Yuan Pan
- Department of Radiology, Princess Margaret Hospital, Kowloon, Hong Kong, China
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27
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Kouvelos GN, Katsargyris A, Antoniou GA, Oikonomou K, Verhoeven EL. Outcome after Interruption or Preservation of Internal Iliac Artery Flow During Endovascular Repair of Abdominal Aorto-iliac Aneurysms. Eur J Vasc Endovasc Surg 2016; 52:621-34. [PMID: 27600731 DOI: 10.1016/j.ejvs.2016.07.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim was to conduct a systematic review of the literature investigating outcomes after interruption or preservation of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR). METHODS A systematic review was undertaken using the MEDLINE and EMBASE databases to identify studies reporting IIA management during EVAR. The search identified 57 articles: 30 reported on IIA interruption (1468 patients) and 27 on IIA preservation (816 patients). RESULTS The pooled 30 day buttock claudication (BC) rate was 29.2% (95% CI 24.2-34.7). Patients undergoing bilateral IIA interruption had a higher incidence of BC than patients with unilateral IIA interruption (36.5% vs. 27.2%, OR 1.7, 95% CI 1.11-2.6, p = .01). During a median follow up of 17 months, the pooled rate of persistent BC was 20.5% (95% CI 15.7-26.2). Of the patients, 93.9% underwent an endovascular revascularization procedure for IIA preservation. Most patients (87.6%) had an iliac branched device, and technical success was 96.2%. Within 30 days of EVAR, 4.3% of internal iliac branches occluded. During a median follow up of 15 months, the pooled occlusion rate at the site of IIA revascularization was 8.8% (95% CI 6.8-11.3). In patients treated with an iliac-branched device, 5.2% of internal iliac branches and 1.7% of external iliac arteries occluded. The pooled BC rate on the side of the IIA revascularization during follow up was 4.1% (95% CI 2.9-5.9). Pooled rates of late device related endoleak type I or III and secondary procedures on the side of the previous IIA revascularization were 4.6% (95% CI 3.2-6.5) and 7.8% (95% CI 5.7-10.7) respectively. CONCLUSION Unilateral or bilateral IIA occlusion during EVAR seems to carry a substantial risk of significant ischemic complications in nearly one quarter of patients. Bilateral IIA occlusion was related to a significantly higher rate of BC. IIA preservation techniques represent a significant improvement in the treatment of aorto-iliac aneurysms and have been associated with high technical success and low morbidity.
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28
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Kouvelos GN, Katsargyris A, Antoniou GA, Oikonomou K, Verhoeven ELG. Outcome after Interruption or Preservation of Internal Iliac Artery Flow During Endovascular Repair of Abdominal Aorto-iliac Aneurysms. Eur J Vasc Endovasc Surg 2016; 52:621-634. [PMID: 27600731 DOI: 10.1016/j.ejvs.2016.07.081] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
AIM The aim was to conduct a systematic review of the literature investigating outcomes after interruption or preservation of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR). METHODS A systematic review was undertaken using the MEDLINE and EMBASE databases to identify studies reporting IIA management during EVAR. The search identified 57 articles: 30 reported on IIA interruption (1468 patients) and 27 on IIA preservation (816 patients). RESULTS The pooled 30 day buttock claudication (BC) rate was 29.2% (95% CI 24.2-34.7). Patients undergoing bilateral IIA interruption had a higher incidence of BC than patients with unilateral IIA interruption (36.5% vs. 27.2%, OR 1.7, 95% CI 1.11-2.6, p = .01). During a median follow up of 17 months, the pooled rate of persistent BC was 20.5% (95% CI 15.7-26.2). Of the patients, 93.9% underwent an endovascular revascularization procedure for IIA preservation. Most patients (87.6%) had an iliac branched device, and technical success was 96.2%. Within 30 days of EVAR, 4.3% of internal iliac branches occluded. During a median follow up of 15 months, the pooled occlusion rate at the site of IIA revascularization was 8.8% (95% CI 6.8-11.3). In patients treated with an iliac-branched device, 5.2% of internal iliac branches and 1.7% of external iliac arteries occluded. The pooled BC rate on the side of the IIA revascularization during follow up was 4.1% (95% CI 2.9-5.9). Pooled rates of late device related endoleak type I or III and secondary procedures on the side of the previous IIA revascularization were 4.6% (95% CI 3.2-6.5) and 7.8% (95% CI 5.7-10.7) respectively. CONCLUSION Unilateral or bilateral IIA occlusion during EVAR seems to carry a substantial risk of significant ischemic complications in nearly one quarter of patients. Bilateral IIA occlusion was related to a significantly higher rate of BC. IIA preservation techniques represent a significant improvement in the treatment of aorto-iliac aneurysms and have been associated with high technical success and low morbidity.
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Affiliation(s)
- G N Kouvelos
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany.
| | - A Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - G A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - K Oikonomou
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
| | - E L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Germany
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29
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Kansal V, Jetty P, Kubelik D, Hajjar G, Hill A, Brandys T, Nagpal S. Internal iliac coverage during endovascular repair of abdominal aortic aneurysms is a safe option: A preliminary study. Vascular 2016; 25:28-35. [PMID: 27000384 DOI: 10.1177/1708538116640077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endovascular aneurysm repairs lacking suitable common iliac artery landing zones occasionally require graft limb extension into the external iliac artery, covering the internal iliac artery origin. The purpose of this study was to assess incidence of type II endoleak following simple coverage of internal iliac artery without embolization during endovascular aneurysm repair. Three hundred eighty-nine endovascular aneurysm repairs performed by a single surgeon (2004-2015) were reviewed. Twenty-seven patients underwent simple internal iliac artery coverage. Type II endoleak was assessed from operative reports and follow-up computed tomography imaging. No patient suffered type II endoleak from a covered internal iliac artery in post-operative computed tomography scans. Follow-up ranged from 0.5 to 9 years. No severe pelvic ischemic complications were observed. In conclusion, for selected cases internal iliac artery coverage without embolization is a safe alternative to embolization in endovascular aneurysm repairs, where the graft must be extended into the external iliac artery.
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Affiliation(s)
- Vinay Kansal
- 1 Faculty of Medicine, University of Ottawa, Ottawa, Canada.,2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada
| | - Prasad Jetty
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Dalibor Kubelik
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - George Hajjar
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Andrew Hill
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Tim Brandys
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sudhir Nagpal
- 2 Division of Vascular Surgery, University of Ottawa, Ottawa, Canada.,3 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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30
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Zou J, Sun Y, Yang H, Ma H, Jiang J, Jiao Y, Zhang X. Laparoscopic ligation of inferior mesenteric artery and internal iliac artery for the treatment of symptomatic type II endoleak after endovascular aneurysm repair. Int Surg 2014; 99:681-3. [PMID: 25216443 DOI: 10.9738/INTSURG-D-13-00152.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present a case undergoing successful laparoscopic ligation of the inferior mesenteric artery (IMA) and internal iliac artery (IIA) for the treatment of a symptomatic type II endoleak (T2E) after endovascular aneurysm repair (EVAR). The patient presented with abdominal and back pain 1 year after EVAR. Subsequent enhanced computed tomography scan showed aneurysm sac enlargement from 60 mm to 70 mm, and digital substraction angiography revealed a T2E caused by patent IMA and right IIA. Then the patient underwent successful laparoscopic ligation of the IMA and right IIA. Postprocedural angiogram demonstrated complete resolution of the type II endoleak, and no intraoperative complications occurred. Also, there was no remaining abdominal pain or back pain after the operation.
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31
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Boulouis G, Shotar E, Dangouloff-Ros V, Janklevicz PH, Boddaert N, Naggara O, Brunelle F. Progressive paralyzing sciatica revealing a pelvic pseudoaneurysm a year after hip surgery in a 12yo boy. Eur J Paediatr Neurol 2016; 20:179-82. [PMID: 26545958 DOI: 10.1016/j.ejpn.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 09/14/2015] [Accepted: 10/11/2015] [Indexed: 11/26/2022]
Abstract
Identifying extra spinal causes of a lumbar radiculopathy or polyneuropathy can be a tricky diagnosis challenge, especially in children. Among them, traumatic or iatrogenic pseudoaneurysms of iliac arteries have been seldom reported, in adults' series. The authors report an unusual case of progressive paralyzing left sciatica and lumbar plexopathy in a 12 years old boy, 12 months after a pelvic osteotomy for bilateral hip luxation secondary to osteochondritis dissecans. Spine MRI and pelvic CT angiography revealed a giant internal iliac artery pseudoaneurysm, enclosed in a chronic hematoma. The patient was successfully treated with endovascular coil embolization, and subsequent surgical hematoma evacuation. However, three months after treatment, neurological recovery was incomplete. This case highlights the importance of a rapid and extensive diagnosis work up of all causes of lower limb radiculopathies in children, including pelvic arteries lesions especially after pelvic surgery to avoid therapeutic delays that may jeopardize the chances of neurological recovery.
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Affiliation(s)
- Grégoire Boulouis
- Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France.
| | - Eimad Shotar
- Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France
| | | | | | - Nathalie Boddaert
- Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France
| | - Olivier Naggara
- Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France; Department of Neuroradiology, INSERM U894, Descartes University, CH Sainte Anne, Paris, France
| | - Francis Brunelle
- Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France
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32
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McGarry JG, Alenezi AO, McGrath FP, Given MF, Keeling AN, Moneley DS, Leahy AL, Lee MJ. How safe is internal iliac artery embolisation prior to EVAR? A 10-year retrospective review. Ir J Med Sci 2015; 185:865-869. [PMID: 26597950 DOI: 10.1007/s11845-015-1384-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Internal iliac artery (IIA) embolisation is commonly performed prior to endovascular aneurysm repair (EVAR) of aortoiliac aneurysms to prevent type 2 endoleaks via the internal iliac arteries. The safety of this procedure is controversial due to the high incidence of pelvic ischaemic complications. METHODS We undertook a retrospective review of all patients undergoing IIA embolisation before EVAR from 2002 to 2012, to determine incidence of, and factors associated with pelvic ischaemia. RESULTS Eight of 25 patients (32 %) experienced new-onset ischaemia, including erectile dysfunction (4 %), and buttock claudication (28 %) that persisted >6 months in only four patients (16 %). Both bilateral IIA embolisation and a shorter time interval to EVAR correlate with increased risk (p = 0.006 and p = 0.044). No co-morbidities or demographic factors were predictive. CONCLUSIONS We conclude that IIA embolisation remains a beneficial procedure, however, to minimise the risk of buttock claudication we advise against both bilateral IIA embolisation and short time intervals between embolisation and subsequent EVAR.
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Affiliation(s)
- J G McGarry
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland.
| | - A O Alenezi
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland
| | - F P McGrath
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland
| | - M F Given
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland
| | - A N Keeling
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland
| | - D S Moneley
- Department of Surgery, Beaumont Hospital Dublin, Dublin, Ireland
| | - A L Leahy
- Department of Surgery, Beaumont Hospital Dublin, Dublin, Ireland.,Faculty of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M J Lee
- Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland.,Faculty of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rajive AV, Pillay M. A Study of Variations in the Origin of Obturator Artery and its Clinical Significance. J Clin Diagn Res 2015; 9:AC12-5. [PMID: 26435935 DOI: 10.7860/jcdr/2015/14453.6387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/29/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The large number of organs and anatomical structures within the cramped pelvic cavity makes the study of vascular pattern and their variations of much importance in this particular anatomical region. Clear awareness of the vascular anatomy of pelvis is critical in surgeries performed here, which require ligation of the arteries concerned and also because such anomalous origins may cause profuse bleeding during surgical procedures. This is particularly true with regard to the variations in the origin of the obturator artery, while performing pelvic and groin surgeries. AIM The aim of the present study was to find out the prevalence of normal and aberrant origins of obturator artery and to describe its surgical implications. MATERIALS AND METHODS The study was carried out on fifty hemipelvises of embalmed cadavers and the origin and course of the arteries were traced and noted. RESULTS Of the 50 pelvic halves, in 27 specimens, the obturator took origin from the anterior division of internal iliac artery. Remaining 23 specimens showed variations. The origin of the obturator artery was from the inferior epigastric artery in 11 cases, from the common stem of the internal iliac artery and the external iliac artery in 2 cases each, from the posterior trunk of the internal iliac artery in 5 and one each from superior gluteal, inferior gluteal, and internal pudendal artery. CONCLUSION The present study indicates that the origin of the obturator artery is highly variable. It can take origin from the stem of the internal iliac artery or from its anterior or posterior division, or from one of the branches of the divisions. It can also take origin from external iliac artery or its inferior epigastric branch. Advancements in diagnostic and surgical techniques in obstetric procedures and urogenital interventions make it essential to have a clear-cut understanding of the vasculature in the abdomen and pelvis.
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Affiliation(s)
- Akshara Venmalassery Rajive
- Assistant Professor, Department of Anatomy, PK Das Institute of Medical Sciences Vaniamkulam, Ottapaalam, Palghat, Kerala, India
| | - Minnie Pillay
- Clinical Professor, Department of Anatomy, Amrita School of Medicine, Amrita Vishwa Vidyapeetham , Kochi, Kerala, India
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34
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Chaus GW, Heng M, Smith RM. Occult internal iliac arterial injury identified during open reduction internal fixation of an acetabular fracture: a report of two cases. Injury 2015; 46:1417-22. [PMID: 25986669 DOI: 10.1016/j.injury.2015.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/25/2015] [Indexed: 02/02/2023]
Abstract
We present two cases of occult internal iliac arterial injury identified during operative reduction of a widely displaced posterior column posterior wall acetabular fracture. This complication was not recognised until reduction of the column fracture. There were no preoperative signs or symptoms indicative of a vascular injury. These cases emphasise the heightened awareness one must have when treating widely displaced posterior column fractures of the acetabulum, especially those fractures with extension into the greater sciatic notch, as previously formed clot can become dislodged and hemostasis lost. We also present management options when this complication occurs. We believe any surgeon treating acetabular fractures should be aware of this serious and potentially fatal complication.
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Affiliation(s)
- George W Chaus
- Harvard University, Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, United States.
| | - Marilyn Heng
- Harvard University, Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, United States
| | - Raymond M Smith
- Harvard University, Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, United States
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Byun CS, Park IH, Do HJ, Bae KS, Oh JH. Left External Iliac and Common Femoral Artery Occlusion Following Blunt Abdominal Trauma without Associated Bone Injury. Korean J Thorac Cardiovasc Surg 2015; 48:214-6. [PMID: 26078931 PMCID: PMC4463231 DOI: 10.5090/kjtcs.2015.48.3.214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/04/2014] [Accepted: 10/13/2014] [Indexed: 12/29/2022]
Abstract
Blunt abdominal trauma may cause peripheral vascular injuries. However, blunt abdominal trauma rarely results in injuries to the external iliac and common femoral arteries, which often stem from regional bone fractures. Here, we present the case of a patient who had experienced trauma in the lower abdominal and groin area three months before presenting to the hospital, but these injuries did not involve bone fractures and had been managed conservatively. The patient came to the hospital because of left lower leg claudication that gradually became severe. Computed tomography angiography confirmed total occlusion of the external iliac and common femoral arteries. The patient underwent femorofemoral bypass grafting and was discharged uneventfully.
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Affiliation(s)
- Chun Sung Byun
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine
| | - Il Hwan Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine
| | - Hye-Jin Do
- Department of Andesthesiology, Yonsei University Wonju College of Medicine
| | - Keum Seok Bae
- Department of General Surgery, Yonsei University Wonju College of Medicine
| | - Joong Hwan Oh
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine
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Nayak SB, Shetty SD, Sirasanagandla SR, P V, Jetti R. Multiple variations in the pelvic vasculature - a case report. J Clin Diagn Res 2015; 9:AD01-2. [PMID: 25859441 DOI: 10.7860/jcdr/2015/10775.5526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/18/2014] [Indexed: 11/24/2022]
Abstract
A thorough knowledge of possible variations of pelvic vasculature is very useful for surgeons, gynaecologists, radiologists, urologists and orthopaedic surgeons. We report multiple vascular variations in the left half of the pelvis of an adult male cadaver. Iliolumbar artery arose from the main trunk of the internal iliac artery. Posterior division of the internal iliac artery gave two lateral sacral arteries and a superior gluteal artery. The anterior division of the internal iliac artery gave origin to superior vesical, inferior vesical, inferior gluteal and internal pudendal arteries. The internal pudendal artery gave origin to a common trunk before leaving the pelvis. The common trunk divided into middle rectal artery and deep artery of the penis. The obturator artery took origin from the inferior epigastric artery and descended downward to the pelvis and left the pelvis by passing through the obturator foramen. Most of the other veins accompanying the arteries joined to form a plexus on the superior surface of the pelvic diaphragm. This plexus condensed to form anterior and posterior divisions of the internal iliac vein. Apart from this, the posterior part of the plexus drained directly into the common iliac vein through a large unnamed vein.
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Affiliation(s)
- Satheesha B Nayak
- Professor, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
| | - Surekha D Shetty
- Lecturer, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
| | - Srinivasa Rao Sirasanagandla
- Lecturer, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
| | - Vasanthakumar P
- Assistant Professor, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
| | - Raghu Jetti
- Senior Grade Lecturer, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
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Won HS, Won HJ, Oh CS, Han SH, Chung IH, Kim DH. The inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery. Anat Cell Biol 2013; 45:285-7. [PMID: 23301197 PMCID: PMC3531593 DOI: 10.5115/acb.2012.45.4.285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/09/2012] [Accepted: 11/14/2012] [Indexed: 11/27/2022] Open
Abstract
We report a rare case of a left inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery in an 84-year-old female cadaver. A common trunk for the inferior epigastric and obturator arteries firstly originated from the left internal iliac artery, at 3.0 mm below the bifurcation of the left common iliac artery. This trunk ran straight between the left external iliac artery and left external iliac vein, and was finally divided into the left inferior epigastric and left obturator arteries just superior to the inguinal ligament.
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Affiliation(s)
- Hyung-Sun Won
- Department of Anatomy, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Korea
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Mamatha H, Hemalatha B, Vinodini P, Souza AS, Suhani S. Anatomical Study on the Variations in the Branching Pattern of Internal Iliac Artery. Indian J Surg 2015; 77:248-52. [PMID: 26730003 DOI: 10.1007/s12262-012-0785-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022] Open
Abstract
The internal iliac artery (IIA) arises from the common iliac artery at the level of the sacroiliac joint. It descends as trunk, divides into anterior and posterior divisions. From the anterior division it gives superior vesical, obturator, middle rectal, inferior vesical, inferior gluteal, and internal pudendal arteries. In females, inferior vesical artery is replaced by vaginal artery and gives an additional branch, uterine artery. The branches from the posterior division are ilio lumbar, lateral sacral, and superior gluteal arteries. An accidental hemorrhage and neurovascular injuries are common due to erroneous interpretation of variant arteries during surgical procedures. Hence the present study has been undertaken with reference to highlight its clinical and surgical significances. The study included 50 human bisected pelvises irrespective of their side and sex. Formalin-fixed specimens were selected and the branching patterns of IIA were studied. The level of origin, length, and the branching pattern of the IIA were examined and tabulated. The present study highlighted the variation seen in the origin, division branches of the IIA. The detailed knowledge of morphology is essential for successful ligation of the IIA during acute hemorrhage. This will guide the interventional radiologist in intra-arterial procedures during arterial embolization for hemorrhage, control of pelvic fractures, during selective catheterization of the intra-arterial chemotherapy, and embolization of the pelvic tumors.
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Gilleard O, Stammers J, Ali F. Gluteal necrosis following pelvic fracture and bilateral internal iliac embolization: Reconstruction using a transposition flap based on the lumbar artery perforators. Int J Surg Case Rep 2011; 3:86-8. [PMID: 22288054 DOI: 10.1016/j.ijscr.2011.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 10/15/2011] [Accepted: 11/07/2011] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION The use of bilateral internal iliac artery embolization to control hemorrhage associated with pelvic fractures is a life saving intervention. Gluteal necrosis is a rare but potentially fatal complication of this procedure. Following debridement, reconstruction can present a considerable challenge due to the compromised vascularity of local tissue. PRESENTATION OF CASE A 17 year old girl suffered an open book pelvic fracture following a road traffic accident. In order to stop profuse bleeding, bilateral internal iliac artery embolization was performed. This procedure was complicated by the development of right sided gluteal necrosis. Following extensive debridement, a transposition flap based on the lumbar artery perforators was performed to cover the soft tissue defect. DISCUSSION Gluteal necrosis occurs in approximately 3% of cases following internal iliac artery embolization. Following complete excision of the devitalised tissue reconstructive surgery is necessary. Local flaps are suboptimal options when the integument supplied by branches of the internal iliac arteries has been compromised following embolization. Furthermore, the use of a free flap is restricted by the lack of a readily accessible undamaged recipient vessel. In the present case a transposition flap based on the lumbar artery perforators facilitated robust reconstruction of the buttock region. CONCLUSION To avoid sepsis, it is imperative that gluteal necrosis following internal iliac artery embolization is recognized and promptly debrided. A transposition flap based on the lumbar artery perforators is a good option for subsequent soft tissue coverage, which avoids use of tissue supplied by the branches of the internal iliac arteries.
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Affiliation(s)
- Onur Gilleard
- Department of Plastic and Reconstructive Surgery, St Georges Hospital, Blackshaw Road, Tooting, London SW17 0QT, United Kingdom
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Abstract
INTRODUCTION General surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery that crosses the superior pubic ramus and is susceptible to injuries during dissection of the Bogros space and mesh stapling onto Cooper's ligament. The obturator artery is usually described as a branch of the anterior division of the internal iliac artery, although variations have been reported. MATERIALS AND METHODS The present study was conducted on 98 pelvic halves of embalmed cadavers, and the origin and course of the obturator artery were traced and noted. RESULTS In 79% of the specimens, the obturator artery was a branch of the internal iliac artery. It branched off at different levels either from the anterior division or posterior division, individually or with other named branches. In 19% of the cases, the obturator artery branched off from the external iliac artery as a separate branch or with the inferior epigastric artery. However, in the remaining 2% of the specimens, both the internal and the external iliac arteries branched to form an anastomotic structure within the pelvic cavity. CONCLUSION The data obtained in this study show that it is more common to find an abnormal obturator artery than was reported previously, and this observation has implications for pelvic surgeons and is of academic interest to anatomists. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these variations and their close proximity to the femoral ring.
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Affiliation(s)
- Mangala M Pai
- Department of Anatomy, Kasturba Medical College, Manipal University, Bejai, Mangalore, Karnataka, India.
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Choi I, Im SB, Kim BT, Shin WH. Radiculopathy caused by internal iliac artery pseudoaneurysm managed with endovascular embolization. J Korean Neurosurg Soc 2008; 42:484-6. [PMID: 19096595 DOI: 10.3340/jkns.2007.42.6.484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 11/12/2007] [Indexed: 11/27/2022] Open
Abstract
The authors describe a case of pseudoaneurysm arising from internal iliac artery presented with radiculopathy mimicking the symptoms of lumbar disc disease or spinal cord tumor. Among the several preoperative evaluation including CT, MRI, electrophysiologic study and ultrasonography, important diagnostic clue was obtained by ultrasonographic findings of turbulence flow at the core of partially enhanced mass in the pelvic cavity. The patient was managed with endovascular coil embolization successfully. The current case makes us remind that assessment of neurological symptoms on lower extremity should include consideration of extraspinal cause in pelvis.
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Affiliation(s)
- Il Choi
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon, Korea
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