Bilateral Internal Iliac Artery Research Articles

A novel method to establish a rat ED model using internal iliac artery ligation combined with hyperlipidemia.

ObjectiveTo investigate a novel method, namely using bilateral internal iliac artery ligation combined with a high-fat diet (BCH), for establishing a rat model of erectile dysfunction (ED) that, compared to classical approaches, more closely mimics the chronic pathophysiology of human ED after acute ischemic insult.Materials and MethodsForty 4-month-old male Sprague Dawley rats were randomly placed into five groups (n = 8 per group): normal control (NC), bilateral internal iliac artery ligation (BIIAL), high-fat diet (HFD), BCH, and mock surgery (MS). All rats were induced for 12 weeks. Copulatory behavior, intracavernosal pressure (ICP), ICP/mean arterial pressure, hematoxylin-eosin staining, Masson's trichrome staining, serum lipid levels, and endothelial and neuronal nitric oxide synthase immunohistochemical staining of the cavernous smooth muscle and endothelium were assessed. Data were analyzed by SAS 8.0 for Windows.ResultsSerum total cholesterol and triglyceride levels were significantly higher in the HFD and BCH groups than the NC and MS groups. High density lipoprotein levels were significantly lower in the HFD and BCH groups than the NC and MS groups. The ICP values and mount and intromission numbers were significantly lower in the BIIAL, HFD, and BCH groups than in the NC and MS groups. ICP was significantly lower in the BCH group than in the BIIAL and HFD groups. Cavernous smooth muscle and endothelial damage increased in the HFD and BCH groups. Cavernous smooth muscle to collagen ratio, nNOS and eNOS staining decreased significantly in the BIIAL, HFD, and BCH groups compared to the NC and MS groups.ConclusionsThe novel BCH model mimics the chronic pathophysiology of ED in humans and avoids the drawbacks of traditional ED models.

Robot-Assisted Uterine Artery Embolization: A First-in-Woman Safety Evaluation of the Magellan System

PurposeTo provide a technical description of robot-assisted uterine artery embolization and to investigate the safety and feasibility of the Magellan (Hansen Medical, Mountain View, California, USA) robotic catheter in this complex arterial bed. Materials and MethodsFive women (mean age, 48.8 y) underwent robot-assisted bilateral uterine artery embolization over a 10-month period using the Magellan robotic catheter. Demographic, clinicopathologic, and endovascular performance metric data (fluoroscopy and cannulation times) were recorded as well as short-term outcomes. ResultsRobotic cannulation of bilateral internal iliac and uterine arteries was successful in all cases. Median right and left internal iliac artery cannulation and total fluoroscopy times were 3 minutes (interquartile range [IQR], 1.5–4 min), 2 minutes (IQR, 1.5–4 min), and 11 minutes (IQR, 9.5–14 min). Median right and left uterine artery cannulation times were both 11 minutes (IQR, 6.5–15 min and 8–12 min, respectively). Technical success was 100%. All patients were discharged on postoperative day 1, and there were no major or access site complications. At 6 months after the procedure, all patients reported significant improvement of symptoms, with a median increase in health-related quality-of-life score of 58% (48.5%–61.75%). ConclusionsThe use of the new-generation Magellan system in uterine artery embolization is feasible and appears to be safe. The additional navigational capability and added maneuverability of the NorthStar catheter (Hansen Medical, Mountain View, California) may facilitate selective catheterization of small iliac artery divisions and may be useful in any procedure where complex arterial selection is needed.

PMM.10 Is there a role for internal iliac artery ligation in post caesarean uterine artery pseudo-aneurysm: A case report

ObjectiveTo describe the diagnosis and management of uterine artery pseudoaneurysm after caesarian section.DesignCase report.SettingDepartment of Obstetrics and Gynaecology.PatientA 25-year-old woman developed uterine artery pseudoaneurysm after caesarean section.InterventionUterine artery pseudoaneurysm after...

Early outcomes of iliac branch grafts in the endovascular repair of abdominal aortic aneurysms with concomitant bilateral common iliac artery aneurysms at a Japanese institution.

Endovascular aneurysm repair (EVAR) is used to treat abdominal aortic aneurysms (AAAs) with bilateral common iliac artery aneurysms (CIAAs), and an interruption of the bilateral internal iliac arteries (IIAs) is often needed, which may cause postoperative ischemic complications. An iliac branch device (IBD) has thus been introduced as an endovascular technique to preserve the IIA flow. This study aimed to evaluate the technical feasibility and short-term results of using an IBD when treating AAA with bilateral CIAAs in a Japanese institution, where IBD use has still not been approved by the government. EVAR was performed using an IBD in six patients at high risk for open repair of an AAA with bilateral CIAAs. Advanta V12 stent grafts were successfully placed in the IIA, bridging between the IIA and the IBD side branch from the contralateral iliac artery. Subsequently, EVAR was performed as usual. The technical success rate was 100%. At the most recent follow-up (mean follow-up period, 14.2months), all IBDs were patent. No patients complained of buttock claudication or ischemic colitis. The implantation of an IBD during EVAR is technically feasible in Japanese AAA patients with bilateral CIAAs, and may be a viable method to avoid pelvic ischemic complications, such as intractable buttock claudication.

TCTAP A-209 Inferior Mesenteric Artery Preservation with Bare Stent in Endovascular Bilateral Iliac Aneurysm Repair Using a Bifurcated Stent Graft with Bilateral Internal Iliac Artery Coil Embolization

Endovascular aneurysm repair (EVAR) has become a first-line therapy for treating abdominal aortic aneurysms (AAAs). The endovascular treatment for common iliac artery aneurysms (CIAAs) must consist of two parts: first, the branching vessels of the internal iliac artery (IIA) are embolized using

232 The temporary bilateral internal iliac arteries clamping during robot-assisted laparoscopic simple prostatectomy (RASP): Our experience

232 The temporary bilateral internal iliac arteries clamping during robot-assisted laparoscopic simple prostatectomy (RASP): Our experience

Balloon tamponade for the management of postpartum uterine hemorrhage

To evaluate the use of the Bakri balloon in postpartum hemorrhage (PPH) resistant to medical treatment. The Bakri balloon was applied to 45 women with PPH after failure of initial management. Bilateral internal iliac artery ligation (BIIAL) and hysterectomy were performed if necessary. The Bakri balloon was applied in 45 women; an additional BIIAL was required in nine women. The mean inflation volume of the Bakri balloon was 571±264 mL (range: 240-1300 mL). Hemostasis was achieved in 34 (75.5%) women with the Bakri balloon alone, and in six women with an additional BIIAL. The Bakri balloon was effective with additional procedures overall in 40 of 45 (88.8%) women. In 34 women with uterine atony, the Bakri balloon was successful alone in 27 (79.4%) and with an additional BIIAL in 30 (88.2%) women. An inflation volume of >500 mL was necessary in 18 women with uterine atony. The Bakri balloon may be performed as a first line of treatment for PPH resistant to uterotonic agents, and can be used not only in tertiary centers but also in limited-resource centers. The inflation volume of the Bakri balloon should be adjusted according to the type of PPH; a volume exceeding 500 mL may be necessary in uterine atony.

Approach to cases with postpartum haemorrhage: Retrospective analysis of 41 cases

Objective: To assess treatment approaches and outcomes in 41 cases with postpartum haemorrhage (PPH). Methods: Screening the electronic database of the hospital identified 41 cases admitted to the obstetrics clinic with a diagnosis of PPH (ICD codes: O72, O72, O72.2) between January 1, 2010, and June 30, 2013. The clinical findings and the results of the surgical and medical treatments used were noted in all the patients. Results: Forty-one cases with PPH were detected who had been managed at the clinic during a 3-year period. Normal spontaneous vaginal delivery (26 patients; 63.4%) was the most common type of delivery. Uterine atony was the most common cause of PPH in 30 patients (73.2%). Medical therapy was the most common therapeutic approach in PPH caused by uterine atony (16 patients; 53.3%), followed by total abdominal hysterectomy (TAH) plus bilateral hypogastric artery ligation (9 patients; 30.0%), uterine packing sutures plus bilateral hypogastric artery ligation (BHAL) (4 patients; 13.3%) and intrauterine balloon tamponade (IUBT) (one patient; 2.4%). Only one of 3 patients with uterine rupture underwent a hysterectomy. Three patients in whom placental adhesion anomalies were detected were treated by a combination of manual removal of the placenta, uterine curettage and IUBT. Conclusion: The results suggest that care should be taken regarding PPH in pregnant women, even in those without any risk factors. In particular, the third phase of labour should be carefully monitored. Medical treatment and organ-sparing surgery are generally associated with positive outcomes in patients with stable haemodynamic status.

Huge giant cell tumor of the sacrum: A case report

The current report describes the case of a 29-year-old female with a sacral giant cell tumor (GCT) during pregnancy. Originally, the patient presented with severe pain in the lumbosacral region, radiating posterolaterally from the lumbar spine into the bilateral thigh and subsequently, into the bilateral crus posterolaterally. Plain X-rays, computed tomography and magnetic resonance imaging showed osteolytic destruction of the sacrococcygeal bones and a huge soft-tissue mass with features of a chordoma. The patient underwent a partial en bloc sacrectomy (partial S1 and completely below) and curettage for tumors located at the sacroiliac joint and underlying left ilium, with bilateral internal iliac arteries ligated to control intraoperative hemorrhage. The patient’s bilateral S2 nerve roots were killed. The diagnosis of conventional GCT was determined based on the histopathological examination of the resected specimen. Urinary and bowel functions were recovered by exercising.

A change in the management of intractable obstetrical hemorrhage over 15 years in a tertiary care center.

Context:Peripartum hysterectomy was the gold standard to save a woman with persistent obstetrical bleeding, but compromised the menstrual and reproductive functions. Bilateral internal iliac artery ligation (BIAL) is a potentially effective, fertility preserving means of controlling pelvic hemorrhage, but with surgical and anesthetic risks and low success. Angiographic embolization has the potential to arrest severe pelvic hemorrhage without removing the uterus and without hazarding general anesthesia in a hemodynamically unstable patient.Aims:The aim of this study is to discuss change in the management of intractable obstetrical hemorrhage from removing to conserving the uterus over 15 years.Settings and Design:A retrospective analysis of 122 cases of intractable obstetrical hemorrhage over a period of 15 years (January 1997 to December 2011) was done. We started uterine artery embolization (UAE) in 2007 for obstetrical hemorrhage. The patients were analyzed for maternal characteristics, indications, treatment modality, maternal morbidity, and mortality.Statistical Analysis Used:Descriptive.Results:We analyzed 12,055 deliveries, (6029 cesarean sections; 6026 vaginal deliveries). One hundred and twenty-two cases of intractable obstetrical hemorrhage were managed with obstetrical hysterectomies in 63, UAE in 53 cases and BIAL in six cases. During the period between 1997 and 2006 intractable obstetrical hemorrhage was managed by hysterectomy/internal iliac artery ligation. The last 5 years of the study period had 80 patients with intractable obstetrical hemorrhage, 53 patients underwent arterial embolization and 35 had a hysterectomy and two had internal artery ligation. There was no mortality and significantly less morbidity in embolization group in our study.Conclusions:Embolization should be tried in patients with intractable obstetrical hemorrhage before proceeding for surgical intervention.

Prophylactic bilateral internal iliac artery ligation for management of low-lying placenta accreta: a prospective study

Background Morbidly adherent placenta is one of the most feared complications causing high morbidity and mortality in obstetrics. Cesarean hysterectomy is still the main procedure in the current management of patients diagnosed with morbidly adherent placenta. Objective To evaluate the efficacy of prophylactic bilateral hypogastric arteries ligation on maternal outcome in diagnosed cases of morbidly adherent placenta. Design Prospective study. Setting Obstetrics and Gynecology Department, Mansoura University Hospital, Egypt. Methods This was a prospective cohort study of 51 pregnant women with a history of previous cesarean sections and diagnosed with low-lying abnormally adherent placenta. All patients underwent prophylactic internal iliac artery ligation after fetal delivery and before extraction of the placenta, the placenta was removed manually in a piecemeal manner and any remaining bleeding points from the placental site were then controlled by hemostatic sutures. Results Bilateral internal iliac artery ligation was performed in patients with invasive placenta (accreta and increta) (46/51 = 90.1%) and satisfactory hemostasis was achieved in 38 patients (38/46 = 82.6%). In five patients with placenta previa increta (5/17 = 29.4%), there was uncontrolled blood loss; thus, we proceeded to cesarean hysterectomy. The mean intraoperative blood loss was 1255 ± 589 ml. Blood transfusion was necessary in 35 patients (35/46 = 76%) during the operations. The mean hemoglobin and hematocrit 1 day after the operation were 9.8 ± 1.3 and 31.4 ± 2.3, respectively. Conclusion Prophylactic bilateral internal iliac artery ligation before extraction of placenta accrete seemed to be an effective technique to decrease cesarean complications and avoid emergent peripartum hysterectomy.

Emergency Bilateral Internal Iliac Ligation for Managing Postpartum Hemorrhage as Life Saving Measure in Private Nursing Homes in Semi-urban Settings

ABSTRACT A study of 30 cases that underwent emergency bilateral internal iliac artery ligation (EBIIAL) from June 2006 to April 2013 at private nursing homes, which can be best described as secondary level healthcare units, was undertaken to assess the efficacy and the outcome of the procedure in managing labors complicated by postpartum hemorrhage (PPH). The obstetricians managing the cases preferred to preserve the uterus for menstrual and future child bearing option and deferred obstetric hysterectomy. The procedure of embolization of uterine artery is available at tertiary care setups which are about 20 to 50 km away from the place of delivery requiring transfer of the parturient increasing the burden on the family and relatives of the parturient. EBIIAL done at the place where the parturient delivers has helped in stemming the transfers and preserving the menstrual and fertility options. The early diagnosis and recognition of failure of the uterotonic agents to control PPH helps in identifying those cases that would benefit from EBIIAL. This helps in reducing the inadvertent blood loss that occurs during atonic PPH and also minimizing the requirement for blood transfusions. In our study three parturient had to be transferred following EBIIAL for management of early disseminated intravascular coagulation (DIC) and one for diagnosing of associated Berger's disease that was suspected after noticing temperature difference in the limbs following ligation of her iliac arteries. How to cite this article Shete A, Kulkarni M, Shete K, Walimbe K, Mulla F. Emergency Bilateral Internal Iliac Ligation for Managing Postpartum Hemorrhage as Life Saving Measure in Private Nursing Homes in Semi-urban Settings. J South Asian Feder Obst Gynae 2014;6(2):79-82.

A case of placenta percreta with massive hemorrhage during cesarean section

We describe a case of a 39-year-old woman diagnosed with placenta percreta complicated by massive hemorrhage during a cesarean section. At 27 weeks of gestation, she underwent an emergency cesarean section under general anesthesia for vaginal bleeding and an intrauterine infection. Soon after delivery, a massive hemorrhage was encountered while attempting to separate the placenta percreta from the bladder wall. Although total abdominal hysterectomy and partial cystectomy were performed, massive hemorrhaging persisted. Bleeding was finally controlled following bilateral internal iliac artery embolization. We used a cell salvage device and a rapid infuser for hemodynamics stabilization. Total blood loss was 47,000 mL, and anesthesia time was 12 h and 47 min. The patient was discharged on the 32(nd) postoperative day without major complications. Placenta accreta can be associated with life-threatening hemorrhage and it is vital to plan accordingly preoperatively.

Complex Common and Internal Iliac or Aortoiliac Aneurysms and Current Approach: Individualised Open-Endovascular or Combined Procedures

Objective. Bilateral internal iliac artery aneurysms constitute the utmost configuration of infrarenal aortoiliac disease. We detail characteristic aortoiliac disease patterns and reconstructive techniques we have used, along with a visualized decision-making chart and a short review of the literature. Material and Methods. A retrospective, observational study of twelve clinical cases of patients with aortoiliac disease are described. Two patients had a common iliac artery aneurysm and were managed by the application of inversed stent-grafts; another case was repaired by the insertion of a standard bifurcated stent-graft flared in the right common iliac artery and with an iliac branched device in the left iliac arterial axis. Open approach was used in 5 cases and in 4 cases a combination of aortouniliac stent-grafting with femoral-femoral bypass was applied. Results. Technical success was 100%. One endoleak type Ib in a flared iliac limb was observed and corrected by internal iliac embolism and use of an iliac limb stent-graft extension. We report 100% patency rate during 26.3 months of followup. Conclusion. Individualized techniques for the management of isolated iliac or aortoiliac aneurismal desease with special concern in maintaining internal iliac artery perfusion lead to elimination of perioperative complications and long-term durability and patency rates.

Reconstruction of the internal iliac artery in patients with aneurysmal disease: Two case reports

During the endovascular repair of aortoiliac aneurysm, bilateral internal iliac artery (IIA) occlusion may give rise to significant morbidities such as ischemia of buttock or sigmoid colon and erectile dysfunction. Open and endovascular approaches are used to maintain IIA circulation in such cases. The present report describes the cases of two patients who underwent external-to-internal iliac artery bypass surgery, one via a novel hybrid approach. The first patient had a right common iliac artery aneurysm without a sufficient distal landing zone for endovascular repair. The distal landing of the device was therefore placed in the right external iliac artery (EIA). The tortuous portion of the right EIA was excised and anastomosed in an end-to-end fashion. An external-to-internal iliac artery bypass was then performed. The second patient underwent endovascular repair of the IIA aneurysm with a Gore® Viabahn®-covered stent (W. L. Gore and Associates, Inc., Flagstaff, AZ, USA). This covered stent was anastomosed with the iliac bypass graft. Postoperative pelvic circulation was maintained. In conclusion, this strategy for maintaining IIA flow is a potential novel approach for future use.

Reproductive performance after conservative surgical treatment of postpartum hemorrhage

ObjectiveTo evaluate the impact of bilateral internal iliac artery ligation (BIL), bilateral uterine artery ligation (BUAL), step-wise uterine devascularization (SWUD), and B-Lynch on infertility, ovarian reserve, and pregnancy outcome. MethodsThe study included 168 infertile or pregnant patients—recruited at outpatient clinics in Egypt—who had previously undergone uterine-sparing surgery (BIL [group I], n=59; SWUD [group II], n=65); BUAL [group III], n=2; and B-Lynch [group IV], n=42). One-way analysis of variance was used to compare the prevalence of infertility, the status of ovarian reserve, and the prevalence and type of relevant maternal and/or fetal obstetric complications between the groups. ResultsGroups II and IV had the highest prevalences of infertility. The ovarian reserve was significantly lower in group II. Unexplained infertility was the predominant cause of infertility in group I, anovulation and premature ovarian failure in group II, and endometriosis and intrauterine adhesions in group IV. The frequency of obstetric complications, particularly placenta previa and preterm labor, was high in group IV. ConclusionOf the 4 procedures, BIL had the least deleterious effect on reproductive performance; SWUD increased the risk of premature ovarian failure, and B-Lynch increased the risks of endometriosis, intrauterine adhesions, placenta previa, and preterm labor.

Buttock necrosis after hypogastric artery embolization for postpartum hemorrhage

Abstract Background: Uterine or hypogastric artery embolization is a useful alternative to hysterectomy in the treatment of postpartum hemorrhage. Case: Puerpera requiring a bilateral hypogastric artery embolization for postpartum hemorrhage after cesarean section in a term twin pregnancy. Unexpected unilateral buttock necrosis appeared 5 days later. Treatment consisted of debridement, the use of vacuum-assisted closure therapy and skin grafting. Conclusion: Buttock necrosis is a rare complication after hypogastric artery embolization in the treatment of postpartum hemorrhage.

Clinical outcome, fertility and uterine artery Doppler scans in women with obstetric bilateral internal iliac artery ligation or embolisation

The objective of our study was to report on the clinical outcome, fertility and uterine artery Doppler scans in patients with major postpartum haemorrhage, treated with bilateral internal iliac artery ligation or embolisation. We performed an observational analysis of successful bilateral internal iliac artery ligation or embolisation for postpartum haemorrhage in a tertiary hospital between 2001 and 2006. Clinical data and other medical/ surgical manoeuvres were recorded. Fertility data, menstrual cycle characteristics and uterine artery Doppler scans were assessed. Our success rate in bleeding control was 81%. Three patients got pregnant again 13, 16 and 23 months after the procedure. The one patient whose uterine artery was not identified in the Doppler scan was the only one who presented with secondary infertility. Three patients presented with secondary dysmenorrhoea. We concluded that internal iliac artery occlusion is an effective fertility-sparing procedure for postpartum haemorrhage. The absence of uterine revascularization could be a negative factor in future reproduction. Due to our limited sample size, larger studies are required to confirm these findings.

Prophylactic bilateral internal iliac arteries balloon occlusion in 13 patients of pernicious placenta previa with placenta accreta

Objective To explore the efficacy of prophylactic bilateral internal iliac arteries balloon occlusion in treatment of women with pernicious placenta previa complicated with placenta accreta. Methods A retrospective analysis was conducted on 41 cases of pernicious placenta previa with placenta accreta admitted to Guangzhou Women and Children＇s Medical Centre from January 2010 to December 2012. The study group （n=13） underwent prophylactic bilateral internal iliac arteries balloon placement before cesarean section and occlusion after delivery. The control group （n= 28） received conventional haemostasis during cesarean section. The amount of blood loss and blood transfusion during the operation, the perioperative hemoglobin level, operation time and duration of hospitalization of the two groups were compared with t-test or Chi-square test. Results The volume of intraoperative hemorrhage of the study group was lower than of the control group [（1429±875） ml vs （4600±2090） ml, t= 6. 840, P=0. 000], the amount of intraoperative blood transfusion in the study group was also lower [（920±438） ml vs （3600±1225） ml, t=10.251, P=0.000]. Operation time and postoperative duration of hospitalization of the study group were shorter than those of the control group [（197±45） min vs （284±44） min, t=5.850,P=0.000; （6.7±1.3） d vs （8.2±2.2） d, t=2.272,P=0.029]. There was no statistical difference on hysterectomy rate between the two groups [11/13 vs 89%（25/28）, ）C2-0.181,P=0. 670）]. In addition, two cases of reoperation, one case of pulmonary edema, two cases of coagulation disorder, one case of venous thrombosis in lower limbs, one case of renal dysfunction and pulmonary edema were reported in the control group, but none in the study group. Conclusions Prophylactic bilateral internal lilac arteries balloonocclusion is effective in reducing intraoperative blood loss, transfusion, and relative complications in patients with pernicious placenta previa complicated with placenta accreta. Key words: Placenta previa ; Placenta accreta ; Iliac artery ; Embolization, therapeutic

The Control of Haemostasis of Presacral Venous Haemorrhage with Sterile Thumbtacks and Roller Gauze—Experience in Managing a Case of Recurrent Ovarian Cancer

Decision of relaparotomy is usually become a surgical dilemma as one may encounter dense adhesion before reaching the target site. This may end up with unwanted complication such as iatrogenic injury to adjacent structures as well as bleeding. This is a case of a 46-year-old lady with underlying history of ovarian carcinoma who needed to go for relaparotomy and debulking of recurrent tumour. The attempt to release adhesions was complicated with bleeding at presacral venous plexus. Due to difficulty in achieving haemostasis, bilateral internal iliac artery ligation was done. This procedure did not completely solve the bleeding, so the subsequent step to apply thumbtacks and roller gauze packing were done to create tamponade. The gauzes were removed piece by piece starting from day 8 through small incisional wound without needing to go for another laparotomy.