Branches Of Iliac Artery Research Articles

Risk factors of pelvic ischemic symptoms after iliac artery occlusion during endovascular aneurysm repair

To analyze risk factors of pelvic ischemia after occlusion of the internal iliac artery during endovascular aneurysm repair (EVAR) surgery. The clinical data, preoperative CT angiography (CTA) findings and follow-up results of 82 patients with unilateral embolization of internal iliac artery undergoing EVAR were analyzed retrospectively. Among 82 patients, pelvic ischemic symptoms were developed in 20 patients (ischemia group) and the remaining patients served as control group. The risk factors for pelvic ischemia after occlusion of internal iliac artery during EVAR surgery were explored using univariate and multivariate analysis, and the clinical value was evaluated using ROC curves. The univariate analysis showed that the numbers of the contralateral internal iliac artery and the ipsilateral deep femoral artery stenosis in the pelvic ischemia group were less than those in the control group (both P<0.05). Multivariate Logistic regression analysis showed that the decreased number of internal iliac artery branches (OR=8.383, 95%CI:1.469-47.841, P<0.05) was an independent risk of pelvic ischemia. The ROC curve analysis showed that AUC of the decreased number of contralateral internal iliac artery branches for predicting the incidence of pelvic ischemia was 0.816; when the number of 3.5 was taken as cut-off value, the corresponding sensitivity was 0.861 and the specificity was 0.167. The decrease in number of the contralateral internal iliac artery branches on preoperative CTA is an independent risk factor for pelvic ischemia after occlusion of the internal iliac artery during EVAR surgery, but it does not show enough clinical value.

Traumatic arterial injuries: endovascular management

Objective The purpose of this study is to evaluate the efficacy of endovascular management of traumatic arterial injuries. Patients and methods We conducted our prospective study at Vascular Surgery Department and Radiology Department, Zagazig University Hospitals, Egypt, and intervention Radiology Department, Alnoor Specialist Hospital, Makkah, Saudi Arabia, from January 2015 to March 2019. Seventeen interventions were performed. The mean age was 39±3.6 years (range, 27–49 years), and 13 (76.5%) patients were males. The site of arterial injuries included superficial femoral artery in seven (41.2%) patients, deep femoral artery in one (5.9%) patient, one of the branches of internal iliac artery in five (29.4%) patients, anterior division of right hepatic artery in one (5.9%) patient, and subclavian artery in three (17.6%) patients. The injuries were extravasation in seven (41.2%) patients, pseudoaneurysm in five (29.4%) patients, and arteriovenous fistula in five (29.4%) patients. Results Initial success was achieved in 15 (88.2%) patients. We failed in two (11.8%) patients who were converted to open surgery. Nine covered stents were deployed, gelfoam embolization in one patient, microparticles embolization in two patients (successful in one patient and failed in the other in whom vascular plug was used), and coil embolization in three patients. Early complications occurred in four patients (extravasation in one patient, puncture site hematoma in two patients, and partially occlusive thrombus/spasm of deep femoral artery in one patient). Late complications occurred in two patients in the form of stent graft occlusion who underwent short bypass. The median follow-up time was 15 months (range, 5–24 months). Mean intervention-free period was 6.5 months. Conclusion Endovascular management of arterial injuries in hemodynamically stable patients can be a good alternative to open surgery in anatomic regions that are difficult to access and unfit patients for major surgery with possibility of massive blood loss.

Anatomic variability of branches of iliac and femoral arteries in human fetuses

Anatomic variability of branches of iliac and femoral arteries in human fetuses

Angiographic evaluation of the internal iliac artery branch in pelvic tumour patients: Diagnostic performance of multislice computed tomography angiography.

The aim of the present study was to explore the classification of the internal iliac artery (IIA) and the diagnostic value of the pelvic tumour-feeding artery by multislice computed tomography angiography (MSCTA) compared with digital subtraction angiography (DSA). A total of 43 patients with pelvic tumours were enrolled between January 2013 and August 2017. The classification of the IIA and the quality of the feeding artery of the pelvic tumours were analysed by Yamaki's classification (Groups A-D according to IIA branching) and the 5-point scoring system. The degree of feeding artery stenosis, caused by tumour compression or invasion, was analysed by a 4-point scoring system. The Wilcoxon signed-rank test was used to determine the vascular diagnostic quality identified by MSCTA and DSA. MSCTA of the pelvic arteries was successfully performed in all patients. The main classifications of the IIA were Group A, followed by Group C, then Group B and with no cases of Group D. There was no significant difference in the classification of the IIA between the left and right sides on MSCTA and DSA. The visualization quality of the IIA and its main branches showed excellent consistency, but the difference in the terminal branches of the feeding arteries in the pelvic tumours was statistically significant between MSCTA and DSA. MSCTA has great advantages in evaluating the classification of the IIA, the imaging quality evaluation of the IIA and its main branches, and in the evaluation of the pelvic tumour-feeding artery. However, in the display of the terminal arterial branches of the pelvic tumours, DSA remains irreplaceable, particularly in cases of interventional embolization.

Use of Interventional Radiology in Critically Injured Children Admitted in a Pediatric Intensive Care Unit of a Developing Country.

ObjectiveThe aim of this study was to describe the outcome of the use of interventional radiological procedures (IRP) (angioembolization) in critically injured children.MethodsA retrospective review of medical records of all children who underwent an IRP from January 2010 to December 2015 was done. Data were collected on a structured proforma and results are presented as mean with standard deviation and frequency with percentages.ResultEighteen patients were identified who underwent IRP during the study period. The mean age was 10.4 ± 4.3 years and 10 (55%) were males. Ten patients had a road traffic accident, four had a history of fall, one patient had glass cut pelvic injury, and two patients had blunt abdominal trauma, while one patient had bleeding secondary to hemipelvectomy. The genitourinary system was involved in five patients, liver in four, and spleen in two and pancreas in one patient. Bleeding was from branches of internal iliac artery in seven patients, hepatic artery in three patients, splenic artery in two patients, and middle colic artery in one patient, while one patient had blood oozing from the bone after hemi-pelvictomy. Four French vascular access sheath was placed under ultrasound guidance; this was followed by the placement of C1 catheter (Cordis, Miami, FL). After vessel identification, a 2.7F Progreat microcatheter (Terumo, Tokyo) was used for super-selective cannulation of the bleeding vessel. Intravascular coil, polyvinyl alcohol (PVA) particles, or gel foam was used for the embolization of bleeding vessels. No procedural complications were observed except minor oozing in one patient. One patient expired due to multiorgan dysfunction.ConclusionAngioembolization is a useful and relatively safe procedure in the management of vitally stable children with hemorrhagic abdominopelvic injuries. However, further studies may be needed to evaluate the efficacy and cost-effectiveness of this practice, especially in resource-constrained settings.

Anomalous origin of the obturator artery in a Goan population: A study linked with hernia reduction surgery

Introduction: The “corona mortis” or “crown of death” occurs when an accessory obturator artery (OA) is also present, having rich anastomosis with the normal OA around the obturator canal. The OA can take origin from various arteries such as the common iliac, anterior or posterior divisions of the internal iliac, inferior epigastric, superior or inferior gluteal, internal pudendal, or even external iliac arteries. Accessory OA has an incidence of 30%–40% in earlier studies.To find out the incidence, location, and dimensions of aberrant, retropubic, anastomosing vessels and the corona mortis that connects the external iliac and obturator vessels and to determine their interference with various surgical approaches. Material and Methods: Twenty-five cadaveric pelvises were dissected in the pelvic and retropubic inguinal regions. The origin and course of the OA and the presence of venous plexuses were recorded. We studied the frequencies of occurrence of abnormal obturator vessels and also their variant patterns of origin from and drainage into the iliac vessels. Student's t-test was the statistical analysis used. Results: We found a higher incidence, i.e., 44% of internal iliac artery branching pattern as Group Ia. Vasa corona mortis was seen in two pelvises showing an arterial connection around the superior pubic ramus, whereas venous corona mortis was seen in twenty pelvises and five hemipelvises showing an aberrant OA. Discussion and Conclusions: Cadaveric dissections have shown a vascular connection between the obturator, external iliac, and inferior epigastric vessels, and these variations are important specially when doing pelvic and groin surgeries.

Bladder wall and surrounding tissue necrosis following bilateral superselective embolization of internal iliac artery branches due to uncontrollable haematuria related to bladder tumor: case report

BackgroundCase of urinary bladder wall and surrounding tissue necrosis following bilateral superselective embolization of internal iliac artery branches due to unmanageable haematuria associated with aggressive bladder tumor.CaseWe achieved the bleeding control, but patient demonstrated severe postembolization syndrome at follow-up (low abdominal pain, arterial hypertension, hyperthermia). Severe bladder tissue and surrounding neoplastic tissue necrosis developed several days after procedure. Patient died from multiple organ dysfunction syndrome due to longstanding peritonitis.ConclusionsTumor ischemia and bladder wall and surrounding tissue necrosis, are possible serious complications ofembolization using calibrated microspheres. These complications can be very dangerous, and even fatal.

Institutional Review of Hemorrhagic Pelvic Emergencies Effectively Managed with Percutaneous Arterial Embolization.

Objective: Our aim was to review the results of pelvic arterial embolization (PAE) performed in the interventional radiology suite.Method: The data of all patients in whom pelvic angioembolization was performed was collected from July 2011 to June 2017. Procedures were performed by an experienced interventional radiologist. The clinical and laboratory data, as well as the outcome data, were obtained from the medical records of our hospital. The following parameters were collected for each patient, including the age, gender, presenting symptoms, site of bleeding, catheters used for embolization, material used for embolization, previous computed tomography (CT) scan and/or focused assessment with sonography for trauma (FAST) ultrasound, average hemoglobin before the procedure, and patient clinical status on discharge.Result: A total of 37 patients underwent pelvic angiography for acute hemorrhage at our institution. They had contrast blush, active extravasation, or abnormal vascularity from the branches of the internal iliac artery and underwent therapeutic transcatheter embolization. A total of 29 patients (78.3%) were male and 8 (21.7%) were female. The average age was 30.0 years (range: 6-90 year). Of these, 16 patients (43.2%) presented with road traffic accidents (RTAs), six with gunshot injuries (16.2%), six with iatrogenic injuries (16.2%), four with a history of a fall (10.8%), two with bomb blast injuries (5.4%), one with a history of a glass injury (2.7%), one had a history of a roof falling on her during an earthquake, and one patient had a pelvic pseudoaneurysm secondary to an abscess. The type of embolic material used for embolization included coils in 16 patients, polyvinyl alcohol (PVA) particles were used in eight patients, both PVA particles and coils were used in 11 patients, and glue was used in one patient. All were successfully embolized. Thirty-four were discharged while three patients expired during the course of hospital stay due to other coexisting morbidities.Conclusion: The management of pelvic injuries has always been a topic of debate, with multiple methods reported to date but growing evidence supports the use of pelvic arterial embolization in hemorrhagic pelvic injuries. The formulation of a standardized protocol is the need of the day.

Prognostic factors in endovascular treated pelvic haemorrhage after blunt trauma

BackgroundAngioembolization is the method of choice for treating haemorrhage after blunt pelvic trauma. The aim of this study was to determine technical factors related to endovascular procedures which might be related to patient outcome.MethodsThis retrospective study included 112 consecutive patients (40 women and 72 men; mean age 57.2 ± 20.0).ResultsThere were age peaks at 43 and at 77 years. Patients over 65 years had mainly “low-energy” trauma; younger patients were more likely to have polytraumas. Younger patients were more severely injured and had more surgical interventions, larger haematoma volumes, lower Hb levels and required more transfusions than older patients. Women were older than men, had fewer surgeries and waited longer for an angiography (p < 0.05 each). Logistic regression analyses identified the injury severity score (ISS) as relevant for survival before age, haematoma volume and Hb. Propensity score analyses showed that in addition to the need for transfusions, haemoglobin, and haematoma volume, the length of the coils and the number of microcoils used were relevant (p < 0.05 each). The location of haemorrhage in peripheral parietal arteries (superior and inferior gluteal artery) was an influencing factor for re-angiographies, which were associated with considerably longer hospital stays of more than 40 days. Fewer particles had generally been used in these patients.ConclusionsThe use of too few coils and not using microparticles in angioembolization for pelvic haemorrhage are major influencing factors for the mortality or re-angiography rate. Special attention should be given to thorough peripheral embolization with microcoils, in particular for haemorrhage from the parietal branches of the internal iliac artery.

The Pararectus approach provides secure access to the deep circumflex iliac vessel for harvest of a large sized and vascularized segment of the iliac crest

BackgroundThe feasibility of harvesting a vascularized iliac crest utilizing the Pararectus approach was assessed in cadavers and then this new technique was implemented in a clinical case. MethodsBilaterally in five cadavers the branches of both external iliac arteries were injected with colored silicone to assess their position to each other and to harvest a bone graft vascularized by the deep circumflex iliac artery (DCIA) through the Pararectus approach. This technique was implemented in a 68-years-old female patient, initially admitted to a level-I-trauma center after sustaining multiple injuries by falling from great height. For definitive treatment of a severely contaminated medially open (Gustilo-Anderson Type 3A) calcaneal luxation fracture (Sanders type IIIBC) in this patient a vascularized iliac crest autograft harvest by the Pararectus approach was used for reconstructive surgery. ResultsThe DCIA and the deep inferior epigastric vessels (DIEV: vascularizing the rectus abdominis muscle and main pedicle of the inferiorly based rectus abdominis myocutaneous flap) are very close on the lateral and medial border of the external iliac artery, respectively. As a consequence, the retrograde dissection of the DIEV towards the DCIA through the Pararectus approach made the dissection of the vascularized iliac crest more amenable, preserving both the lateral femoral cutaneous and the genitofemoral nerves. Four months after the surgery the patient was able to fully weight-bear in orthopedic shoes. Radiographs and CT scans showed correct hind foot alignment and bony integration of the vascularized iliac crest graft into the residual calcaneal body. ConclusionThe Pararectus approach allowed for secure collection of large vascularized iliac grafts. The presented technique was successful as a salvage procedure in a clinical case with substantial bone loss after an open calcaneal fracture.

A study on internal iliac artery branching pattern and its clinical significance

A study on internal iliac artery branching pattern and its clinical significance

Clinical characteristics of external iliac artery branch injury in pelvic trauma

IntroductionThe clinical characteristics of an injury of external iliac artery branches in blunt pelvic trauma have not yet been sufficiently studied. We evaluated the relationship between injury characteristics and the presence of an injury to external iliac artery branches in blunt pelvic trauma. Materials and methodsA retrospective review of patients admitted with blunt pelvic trauma was conducted over an 11-year period. Charts were reviewed for age, gender, injury characteristics, injury severity score, length of stay in the intensive care unit, transfusion requirements, and fracture pattern. ResultsOf 286 blunt pelvic trauma patients, 90 patients (31%) underwent pelvic angiography. Of those patients, 10 (11%) had the injuries of the branches of external iliac artery and 88 (97%) had the injuries of the branches of internal iliac artery. Those patients with external iliac artery branch injuries were significantly associated with hemodynamic instability, when compared to those without external iliac artery branch injuries. There were no significant differences between the patients with and without external iliac artery branch injury with regard to the anatomical characteristics of pelvic trauma. ConclusionBlunt pelvic trauma with hemodynamic instability may be associated with concomitant external iliac artery branch injury.

The influence of downstream branching arteries on upstream haemodynamics

The accuracy and usefulness of computed flow data in an artery is dependent on the initial geometry, which is in turn dependent on image quality. Due to the resolution of the images, smaller branching arteries are often not captured with computed tomography (CT), and thus neglected in flow simulations. Here, we used a high-quality CT dataset of an isolated common iliac aneurysm, where multiple small branches of the internal iliac artery were evident. Simulations were performed both with and without these branches. Results show that the haemodynamics in the common iliac artery were very similar for both cases, with any observable differences isolated to the regions local to the small branching arteries. Therefore, accounting for small downstream arteries may not be vital to accurate computations of upstream flow.

Ethylene-vinyl alcohol copolymer (Onyx®) transarterial embolization for post-traumatic high-flow priapism

We report a case of high-flow priapism treated successfully with superselective embolization of the cavernous artery. A 16-year-old male developed post-traumatic priapism subsequent to a fall causing blunt perineal trauma. He presented to our hospital four days after trauma. Immediately after the injury, he suffered painless sustained incomplete erection. High-flow priapism was diagnosed on the basis of color doppler ultrasonography findings. Computed tomography scan showed a high-flow arterio-venous fistula with feeders from branches of the right internal iliac artery. Selective arteriography of the right internal pudendal artery demonstrated an arterio-cavernous fistula. The fistula was superselectively embolized with ethylene-vinyl alcohol copolymer (Onyx(®)) liquid agent and disappeared completely. Improvement was noted, with significant detumescence on table. This was later confirmed on repeat color Doppler imaging. At follow-up 3 months later, he had normal erectile function. To our knowledge, transarterial embolization of high-flow priapism with Onyx(®) has never been reported and appears to be a safe and effective treatment for managing patients with such a condition.

A study of variations of origin of obturator artery: Review in south Indian population

IntroductionObturator artery is usually derived from the anterior division of internal iliac artery. It is the most variable vessel among the branches of the internal iliac artery. This variable course of obturator artery is responsible for vascular injury during laparoscopic herniorrhaphy. Material and methodsThe present prospective study was conducted on 30 pelvic halves from formaldehyde preserved cadavers and was dissected in the Department of Anatomy, MIMS, Mandya, and origin of the obturator artery was noted. ResultOut of 30 specimens, obturator artery has following origin: 66.6% of anterior division, 20% of posterior division, 10% from the external iliac artery and 3.3% from both external iliac and internal iliac arteries. DiscussionObviously the variation in the origin of obturator artery had always been a curious topic not only throughout history of anatomic literature but also among surgeons and radiologists. Most of the time it originates from the anterior division of internal iliac artery. But it originated from the posterior division in significant numbers as in our study.

Internal iliac artery pseudoaneurysm in primary total hip arthroplasty.

Vascular injury is one of the rare complications of primary total hip arthroplasty (THA). We report an unusual case of lobulated pseudoaneurysm arising from one of the branches of the left internal iliac artery during acetabulum preparation in THA, which was successfully treated with coil embolization and multidisciplinary care. After 6 years follow up, patient did not have any symptoms related to the hip replacement. We recommend that surgeons should be extremely cautious while drilling medial wall of the acetabulum for depth assessment. Aggressive multidisciplinary approach, including possible support from an interventional radiologist is required for the treatment of such vascular injuries.

The pararectus approach to harvest large scale of vascularized iliac crest. An anatomical study of feasibility

The use of the vascularized iliac crest to reconstruct bone defect has been published in 1979 but has gained very little popularity in the fields of the reconstructive surgery of the extremities. The usual approach to harvest vascularized iliac crest goes through the inguinal ligament. Up to 10% of inguinal hernia and above 20% of sensory loss have been reported as complication with this approach. On the other hand, the iliac crest offers larger amount of rapidly integrated cancellous bone as compared to vascularized fibula. The pararectus approach has been initially used for internal fixation of acetabular fractures. This approach gives direct access to the branches of the external iliac artery without interruption of the inguinal ligament. In this anatomical study, 5 human specimens preserved with the Thiel-Method and injected with colored latex were harvested on both side with the pararectus approach. The goal of the study was to assess if this approach gives easily access to the deep circumflex iliac artery (DCIA) vascularizing the anterior iliac crest. The approach consisted into an incision of the rectus sheath at the lateral border of the rectus abdominis and then to a retrograde dissection the deep inferior epigastric vessels up to the external iliac artery and veins in the retroperitoneal space. In all specimens, the level of the origin of the deep circumflex iliac vessels coincided with the origin of the deep inferior epigastric vessels on the external and internal border of the external iliac vessels, respectively. To harvest large scale vascularized iliac crest the pararectus approach was extended to the supraumbilical level with incision of the anterior and posterior sheath of the rectus abdominis. With this approach, the maximum size of harvested bone was 8 × 5 cm, preserving the first 2 cm of the anterosuperior iliac spine. In all harvested sides, the anterograde dissection of the lateral femoral cutaneous nerve and of the genitofemoral nerve was easy and allowed a safe harvest of the deep cicumflex iliac vessels. In conclusion, the pararectus approach extended to the supraumbilical space give an easy access to the deep circumflex iliac vessels and very large size of vascularized iliac crest. This approach respects the inguinal ligament and is easy to close. We are now using this approach in a preliminary clinical study to harvest vascularized iliac crest of large scale.

Massive hemothorax due to inferior phrenic artery injury after blunt trauma.

Injury to the inferior phrenic artery after blunt trauma is an extremely rare event, and it may occur under unanticipated conditions. This case report describes an injury to the left inferior phrenic artery caused by blunt trauma, which was complicated by massive hemothorax, and treated with transcatheter arterial embolization (TAE).An 81 year-old female hit by a car while walking at the traffic intersection was transferred to the emergency department, computed tomography scanning revealed active extravasations of the contrast medium within the retrocrural space and from branches of the internal iliac artery. The patient underwent repeated angiography, and active extravasation of contrast medium was observed between the retrocrural space and the right pleural space originating from the left inferior phrenic artery. The injured left inferior phrenic artery was successfully embolized with N-butyl cyanoacrylate, resulting in stabilization of the patient’s clinical condition.Inferior phrenic artery injury should be recognized as a rare phenomenon and causative factor for hemothorax. TAE represents a safe and effective treatment for this complication and obviates the need for a thoracotomy.

Is Embolization an Effective Treatment for Recurrent Hemorrhage After Hip or Knee Arthroplasty?

Spontaneous recurrent hemorrhage after arthroplasty of the hip or knee is a rare condition. In patients who do not have coagulopathy, the likeliest etiology for hemarthrosis is hypertrophic vascular synovium. Treatments include arthroscopic or open synovectomy, or angiography with embolization; however, because the condition is rare, seldom reported, and debilitating, small case series characterizing the efficacy of any approach are important to allow a collective experience with this condition to emerge. We attempted to (1) determine whether angiography with embolization can prevent recurrent hemarthrosis after hip or knee arthroplasty in a small series of patients with or without coagulopathy, and (2) evaluate complications associated with this intervention. Between 2005 and 2014, seven patients presented with spontaneous, recurrent hemarthroses. One patient had polycythemia vera and factor XIII deficiency as underlying illnesses. All patients were treated with selective transarterial embolization, and all had followup at a minimum of 12 months (range, 12-102 months; median, 74 months). Other treatments during this time included hematoma removals and flap operations in one patient, and indications for transarterial embolization included recurrent hemarthrosis. The patients included six men and one woman with a median age of 72 years (range, 61-78 years). Five patients underwent one or more reoperations before transarterial embolization. A diagnostic workup for coagulopathy was performed in all patients; one patient was identified to have polycythemia ruba vera and factor XIII deficiency, however the patient still was treated with transarterial embolization because it was perceived to be the least invasive of available options. No other patients had a diagnosis of coagulopathy. Angiography showed hypervascularity in all patients and a contrast agent showed extravasation in two. Selective transarterial embolization of branches of the internal iliac artery, common femoral artery, deep femoral artery, or the popliteal artery was performed with polyvinyl alcohol particles, microspheres, and/or coils. Patients were followed clinically during 12 to 102 months (median, 74 months) to determine whether the hemorrhages recurred. Technical success was achieved in all patients. No procedure-related complications were reported. On followup, recurrent hemorrhage was reported in one patient who had a diagnosis of coagulopathy before the procedure. He underwent three reinterventions and five reoperations. Three months after initial embolization, a flap procedure was performed. In a small series of patients with a minimum followup of 1 year, we found selective transarterial embolization to be effective in patients without underlying coagulopathy in preventing recurrences of spontaneous recurrent hematoma or hemarthrosis of the hip and the knee. This condition is rare, therefore comparative trials are unlikely to be done. Because transarterial embolization is relatively low risk and generally well tolerated, we consider it to be a reasonable approach for consideration with other options such as arthroscopic or open synovectomy and revision arthroplasty. Level IV, therapeutic study.

Abstract No. 397 - Internal iliac artery branches: “how much do I remember?” Angiographic identification and intervention under various circumstances

Abstract No. 397 - Internal iliac artery branches: “how much do I remember?” Angiographic identification and intervention under various circumstances