Bifurcation Of Common Iliac Artery Research Articles

Right Ectopic Pelvic Kidney and Bilateral Vascular Aberrations a Female Donor: A Case Report

During an abdominopelvic cavity dissection in an undergraduate gross anatomy course, a right ectopic pelvic kidney was identified in the lesser pelvis and was concomitant with bilateral vascular aberrations.  The right kidney was located anterior to the sacrum and medial to the right common iliac artery bifurcation with aberrant vasculature.  The left kidney was located near the traditional T12-L3 level; however, multiple aberrant arteries supplied this kidney as well.  Such renal anatomy anomalies have immediate implications in anatomy and embryology education, medical imaging, abdominopelvic surgical approaches, and the field of nephrology regarding renal form, function, and pathophysiology.

Morphometric measurements for potential dangers of anterior intra-pelvic approach in women: A cadaveric study.

This study aimed to improve the surgical anatomical knowledge of pelvic/acetabular trauma surgeons by providing detailed morphometric data on some of the most vulnerable arteries and nerves due to constant bony landmarks during anterior intra-pelvic approach fixation of acetabular fractures in women. Ten hemipelvis were dissected from 5 female cadavers. The following measurements relative to the symphysis were performed: (1) the distance of the corona mortis anastomosis and (2) the bisection of the external iliac vein with the pubic ramus. In addition, dis- tance to the pelvic brim at the level of pectineal convexity of the following structures was measured: (3) depth of obturatory neurovascu- lar bundle, (4) superior vesical artery, and (5) vaginal artery. Also, the clock position of the (6) gluteal superior and inferior vessels due to sciatic notch in the supine position. Due to antero-superior corner of sacroiliac joint (7) location of the common iliac artery bifurcation, (8) location of the bifurcation of internal iliac vessels to truncuses, (9) bifurcation of superior gluteal artery and lateral sacral artery, and (10) L5 nerve were measured. The descriptive statistics were given as medians and ranges as this is a descriptive anatomical study without comparisons. The median distance of corona mortis to symphysis pubis was 59.5 mm (range = 58-61). The external iliac vein bisected the pubic arm 68.5 mm (range=65-70) lateral to the symphysis pubis. At the level of pectineal convexity (about the middle of the pelvic brim), obturatory neurovascular bundle, superior vesical artery, and vaginal artery were 15 mm (range=13-16), 24 mm (range=23-25), and 36 mm (range=34-38) inferior to the pelvic brim, respectively. The superior gluteal vessels leave the sciatic notch at 12 o'clock position in supine position. Inferior gluteal vessels leave the sciatic notch at 31⁄2 o'clock position (given for left side). Common iliac artery bifurcation bisects the SI joint 5 mm (4-7) superior to antero-superior corner of the Sacro-iliac (SI) joint. The internal iliac artery gives its posterior trunk 18 mm (range=15-20) straightly anterior to antero-superior corner of the SI joint. Bifurcation of superior gluteal artery and lateral sacral artery was 11 mm (range = 10-12) away from the beginning of the posterior truncus. L5 root's medial margin was 9 mm (range = 7-10) medial to this landmark, where its lateral margin was on the SI joint (2 mm medial to 2 mm lateral). The majority of the bleeding complications of the major branches of the internal and external iliac arteries and neurologic palsies due to obturatory nerve and L5 nerve root damage within the operative field of the anterior intra-pelvic approach can be avoided or managed by utilizing morphometric data provided from this study. N/A.

Upper limit of radiation treatment portals in rectal cancer: is it wise to keep using bony landmarks in the present era of 3D conformal treatment?

This study aimed to compare the levels of L5-S1 interspace and the bifurcation of common iliac vessels on simulation images of rectal cancer patients to evaluate the adequacy of superior borders in conventional 2D planning for covering internal iliac vessels. Simulation images of 236 rectal cancer patients who received neoadjuvant chemoradiation and surgery were analyzed. The images were retrieved from the radiation treatment database and included delineations of L5-S1 interspace and common iliac vessel bifurcation. Distances between these landmarks were measured. Among the 236 patients, the majority had the common iliac artery bifurcation positioned above the L5-S1 interspace. Specifically, 78.3% of patients had the right common iliac bifurcation above L5-S1 interspace, with an average distance of 2.02 cm. For the left common iliac artery, 77.11% of patients had the bifurcation above L5-S1 interspace, with an average distance of 1.99 cm. Notably, there were cases where the bifurcations were not at the same level. Using the L5-S1 junction as the upper border of the treatment portal may result in missing proximal nodes at risk of metastases. However, further research is needed to determine the significance of failures above the L5-S1 interspace for justifying the inclusion of the common iliac artery bifurcation in the treatment portal.

MitraClip single-leaflet detachment and consequent migration in atrial functional mitral regurgitation.

An 84-year-old woman with symptomatic severe functional mitral regurgitation (MR) due to long standing atrial fibrillation underwent percutaneous edge-to-edge repair using the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) (see Supplementary data online, Video S1). Following deployment of an XTR clip in the A2-P2 segment, a second MitraClip XT device was deployed laterally to prevent recurrence of MR caused by stretching of left atrium and mitral leaflets. However, single leaflet detachment of the anterior leaflet occurred immediately (Panel A, Supplementary data online, Video S2). Since only mild MR was observed after the procedure, additional clipping was not performed, and her symptoms were relieved. However, at 2 weeks after discharge, she presented with right inguinal pain and aggravated dyspnea. The lateral clip was not observed on chest x-ray (Panels B and C). Computed tomography revealed the migrated MitraClip at the right common iliac artery bifurcation (yellow arrows in Panel D). Transesophageal echocardiogram showed recurrence of severe MR with newly developed small chordae rupture (Panel E, Supplementary data online, Video S3). The embolized MitraClip was successfully retrieved using 10- and 15-mm Amplatz GooseNeck® snares (Ev3, Plymouth, MN, USA) through a 16-French Check-Flo® Introducer sheath (Cook Medical, Bloomington, IN, USA) (Panels F, G, and H, Supplementary data online, Video S4), and another NTW clip was deployed. Post-procedure transesophageal echocardiogram confirmed residual mild to moderate MR (Panel I, Supplementary data online, Video S5). Images from this case show the complications of MitraClip single leaflet detachment and distal migration, and how this problem was solved.

Computed tomography findings of intersigmoid hernia.

To evaluate the computed tomography findings of intersigmoid hernias. Between April 2010 and March 2018, 7 patients who were surgically diagnosed with intersigmoid hernia in 3 institutions were enrolled in this study. Two radiologists evaluated imaging findings for the herniated small bowel, the distance between the occlusion point and bifurcation of the left common iliac artery, and the anatomic relationship with adjacent organs. All patients were male, and their mean age (standard deviation, range) was 61.0 (13.5, 36-85) years. The mean size of the bowel loops was 5.2 (1.3, 4.0-8.3) cm in the caudal direction, 3.6 (0.8, 2.5-5.1) cm in the lateral, and 3.4 (0.6, 2.5-4.7) cm in the anterior-posterior direction. The volume was 37.9 (27.8, 15.6-103.0) cm3 approximated by an ellipse, and 24.0 (17.7, 9.9-65.6) cm3 approximated by a truncated cone. The obstruction point was located 3.6 (0.6, 2.8-4.7) cm inferior to the bifurcation of the left common iliac artery. In all cases, the small bowel ran under the point at which the inferior mesenteric vessels bifurcated to the superior rectal vessels and the sigmoid vessels and formed a sac-like appearance between the left psoas muscle and the sigmoid colon. The ureter ran dorsal to the point of the bowel stenosis, and the left gonadal vein ran outside the small bowel loops. All cases showed common imaging findings, which may be characteristic of men's intersigmoid hernia. In addition, the fossa's position was lower, and the size was larger than in the previous study, which may be a risk factor.

Abdominal aortic calcification volume (AACV) is a predictive factor for postoperative complications associated with biliary tract cancer.

Curative surgical treatment of biliary tract cancer is highly invasive and involves postoperative complications. Abdominal aortic calcification is a parameter that is reportedly linked to systemic arteriosclerosis. We measured the abdominal aortic calcification volume (AACV), assessed the correlation between AACV and postoperative complications, and evaluated the clinical utility of AACV. We retrospectively evaluated 97 patients (ampullary carcinoma, n = 21; distal bile duct cancer, n = 43; hilar bile duct cancer, n = 33). We assessed the calcification volume of the abdominal aorta from the renal artery ramification to the common iliac artery bifurcation. The correlation between AACV, clinical factors, and postoperative complications was evaluated. The average AACV was 5.02cm3, and the median AACV was 3.74 (range 0-27.4)cm3. The AACV was significantly related to age (P = 0.009), Brinkman index (P = 0.007), and history of cardiovascular disease (P = 0.015). The AACV was strongly correlated with postoperative complications (P < 0.001) and Clavien-Dindo grade > III postoperative complications (P < 0.001). The AACV was also correlated with pancreatic fistula in pancreatectomy cases (P < 0.001). A multivariate analysis revealed that the AACV was an independent predictor of postoperative complications. The AACV was significantly associated with postoperative complications. The AACV could be used for the preoperative assessment of surgical risk.

Intravascular lithotripsy to facilitate transfemoral TAVI: a single-center experience

Abstract Introduction Transfemoral is considered the approach of choice for transcatheter aortic valve implantation (TAVI) and improves clinical outcomes such as death or stroke compared to transaortic or transapical access. Intravascular lithotripsy (IVL) has enabled modification of calcified intimal and medial lesions to increase vascular wall compliance which might facilitate the transfemoral TAVI approach. Purpose To present a single-center experience with intravascular lithotripsy facilitating transfemoral TAVI approach. Methods A peripheral IVL catheter was used to perform lithotripsy of calcified iliofemoral stenosis. A 0.014" guidewire was used to guide the lithotripsy catheter with a balloon diameter of 5.0 or 6.0 mm. Inflating the balloon with 4–6 atm of pressure enabled apposition with the arterial wall and several cycles of 30 pulses have been performed at various locations of the iliofemoral arteries. IVL was planned in advance as primary strategy in case of ring or as baillout strategy in case of ring or excentric calcified periferial artery stenosis, respectively. The IVL was immediately followed by transfemoral TAVI. Retrograde data were collected for the purpose of this abstract. Results From December 2019 to December 2021 433 TAVI procedures were performed in the University Medical Centre Ljubljana. In 13 of the procedures (3%) IVL was used to facilitate the transfemoral approach. The mean minimal diameter of iliofemoral arteries was 5,2 mm with calcifications affecting at least three-quarters of arterial circumference in 92% and circular calcifications in 62% of cases. In all cases, IVL was performed in a common iliac artery or aortic bifurcation, while external iliac (15%) or femoral (8%) arteries were treated less often. A 5 mm IVL balloon was used in 2 (15%), and a 6 mm balloon in 9 (69%) cases, while a combination of 5 and 6 mm balloons was used in 2 (15%) cases. IVL and subsequent TAVI were successful in all the cases. No hospital mortality or major bleeding was observed. One patient needed one unit of blood transfusion due to loss during planned surgical preparation and closure of the puncture site. The puncture site was closed using a 2 Proglide technique and no conversion from percutaneous to surgical puncture site closure was needed. A self-expanding aortic prosthesis (Evolut R, Medtronic) was used in 11 (85%) and a balloon-expandable (Sapien 3, Edwards Lifesciences) in 2 (15%) cases. Conclusion In our experience IVL of iliofemoral arteries is a safe and effective method to facilitate transfemoral approach in TAVI, especially in cases of circular calcifications affecting the majority of arterial wall circumference. Funding Acknowledgement Type of funding sources: None.

Occluded Thoracoabdominal Aorta: Blood Finds a Way

A 35-year-old, nonsmoker, nondiabetic woman presented with severe left ventricular dysfunction and uncontrolled hypertension. The computed tomography angiography scan revealed chronic total occlusion of the aorta distal to the left subclavian artery origin, including the entire descending thoracic and abdominal aorta with distal reconstitution at the bilateral common iliac artery bifurcation (Fig 1).

Application of a Novel Common-Iliac-Artery Skirt Technology (CST) in Treating Challenge Aorto-Iliac or Isolated Iliac Artery Aneurysms.

Purpose: To report a novel common-iliac-artery skirt technology (CST) in treating challenge iliac artery aneurysms.Methods: When required healthy landing zone of common iliac artery (CIA) is not available, CST is a strategy to exclude the internal iliac artery (IIA) and prevent IIA reflux without need of embolization. Patients who received endovascular aneurysm repair (EVAR) in our center from 2014 to 2020 were retrospectively screened, and patients treated with CST or with IIA embolization (IIAE) were enrolled.Results: After retrospective screen of 524 EVAR patients, 39 CST patients, 26 IIAE patients, and 7 CST + IIAE patients were enrolled in this study. CST group suggested to have more aged, hyperlipemia, and smoking patients than IIAE group. Two groups had comparable maximal diameter of abdominal aorta (AA), CIA, EIA, but larger diameter of IIA (CST 19.82 ± 2.281 vs. IIAE 27.82 ± 3.401, p = 0.048), and CIA bifurcation (CST 25.01 ± 1.316 vs. IIAE 29.76 ± 2.775, p = 0.087) was found in IIAE group. Anatomy of 79.5% of CST patients and 92.3% of IIAE patients (p = 0.293) was not suitable for potential use of iliac branch device. CST group had significant shorter surgery time (CST 97.42 ± 3.891 vs. IIAE 141.0 ± 8.010, p < 0.001), shorter hospital stay (CST 15.35 ± 0.873 vs. IIAE 19.32 ± 1.067, p = 0.009), lower in-hospital [CST 0% (0/39) vs. IIAE 11.5% (3/26), p = 0.059] and 1-year follow-up stent related MAEs [CST 6.7% (2/30) vs. IIAE 28.6% (6/21), p = 0.052], but comparable mortality and stent related MAEs for all-cohort follow-up analysis comparing to IIAE group. In our study, a lower in-hospital buttock claudication (BC) rate for CST (CST 20.5% vs. IIAE 46.2%, p = 0.053) and a comparable erectile dysfunction (ED) rate (CST 10.3% vs. IIAE 23.1%, p = 0.352) were found between CST and IIAE groups. After 1 year, both groups had about one third relief of BC symptoms [CST 33.3% (4/12) vs. IIAE 30.7% (4/13), p = 1.000]. Subgroup analysis of 14 patents concomitant with IIA aneurysm in CST group and the 7 CST + IIAE patients were carried out, and no difference was found in mortality, stent MAEs, sac dilation, or reintervention rate. Last, illustration of seven typical CST cases was presented.Conclusion: In selected cases, the CST is a safe, feasible-and-effective choose in treating challenge iliac artery aneurysms and preventing IIA endoleak.

Custom-Made Bifurcated Prosthetic Graft for Aortoiliac Aneurysm Repair.

Revascularization of the internal iliac artery during open repair of aortoiliac aneurysms can be challenging, especially if there is a significant distance between the orifices of the internal and external iliac arteries owing to common iliac aneurysmal dilatation. We describe a technique involving insertion of an 18-mm tube graft between the proximal aortic neck and aneurysmal common iliac artery bifurcation. Revascularization of the contralateral external iliac artery is accomplished through an 8-mm side arm graft.

Aberrant Origin of Obturator Artery- A Case Report

The medial compartment of thigh is nourished by a branch from anterior division of internal iliac artery called Obturator Artery (OA). However, many studies have documented variation in the origin of the artery from other neighboring vessels. Hence, any deviation from the normal pattern should be acknowledged to prevent any injuries during herniorrhaphy or other pelvic procedures. The study was conducted on a pelvis of female cadaver of age 55 years. Length of the artery and its distance from the bifurcation of common iliac artery using the measuring tape were noted. OA was seen to be originating from the inferior epigastric artery bilaterally along with several unusual but significant branches budding from it. The case report shows variant of OA which is of academics interest to students, anatomists, radiologist, general and orthopedic surgeons. Further dissection of more number of pelvic specimens might help to assess the frequency or prevalence of the variation.

Aortic dissection during transoesophageal echocardiography: a case report.

BackgroundTransoesophageal echocardiography (TOE) is a safe and useful tool. In our case, we are presenting a rare case of a patient with aortic dissection during TOE procedure.Case summaryA 79-year-old woman was referred to our hospital for recurrent paroxysmal atrial fibrillation (AF) with palpitation. Pre-procedural cardiac computed tomography (CT) showed slight dilated ascending aorta (maximum diameter: 40 mm). We decided to perform catheter ablation (CA) for AF, and recommended TOE before the CA because she had a CHADS2 score of 4. On the day before the CA, TOE was performed. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, there was no abnormal finding of the ascending aorta. At 5 min after the insertion, TOE showed ascending aortic dissection without pericardial effusion. After waking, she had severe back pain and underwent a contrast-enhanced CT. Computed tomography demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm). The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery.DiscussionTransoesophageal echocardiography would have to be performed under sufficient sedation with continuous blood pressure monitoring in patients who have risk factors of aortic dissection. The risk–benefit of TOE must be considered before a decision is made. Depending on the situation, another modality instead of TOE might be required.

Sentinel lymph node mapping and intraoperative assessment in a prospective, international, multicentre, observational trial of patients with cervical cancer: The SENTIX trial

BackgroundSENTIX (ENGOT-CX2/CEEGOG-CX1) is an international, multicentre, prospective observational trial evaluating sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. We report the final preplanned analysis of the secondary end-points: SLN mapping and outcomes of intraoperative SLN pathology. MethodsForty-seven sites (18 countries) with experience of SLN biopsy participated in SENTIX. We preregistered patients with stage IA1/lymphovascular space invasion-positive to IB2 (4 cm or smaller or 2 cm or smaller for fertility-sparing treatment) cervical cancer without suspicious lymph nodes on imaging before surgery. SLN frozen section assessment and pathological ultrastaging were mandatory. Patients were registered postoperatively if SLN were bilaterally detected in the pelvis, and frozen sections were negative. Trial registration: ClinicalTrials.gov (NCT02494063). ResultsWe analysed data for 395 preregistered patients. Bilateral detection was achieved in 91% (355/395), and it was unaffected by tumour size, tumour stage or body mass index, but it was lower in older patients, in patients who underwent open surgery, and in sites with fewer cases. No SLN were found outside the seven anatomical pelvic regions. Most SLN and positive SLN were localised below the common iliac artery bifurcation. Single positive SLN above the iliac bifurcation were found in 2% of cases. Frozen sections failed to detect 54% of positive lymph nodes (pN1), including 28% of cases with macrometastases and 90% with micrometastases. InterpretationSLN biopsy can achieve high bilateral SLN detection in patients with tumours of 4 cm or smaller. At experienced centres, all SLN were found in the pelvis, and most were located below the iliac vessel bifurcation. SLN frozen section assessment is an unreliable tool for intraoperative triage because it only detects about half of N1 cases.

Comparison of efficacy between extended pelvic lymph node dissection and standard pelvic lymph node dissection in open radical cystectomy

Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND) and standard pelvic lymph node dissection (sPLND) in open radical cystectomy. Methods We retrospectively analyzed the clinical data of 139 patients with bladder cancer cases in our hospital from January 2007 to January 2017, who underwent open radical cystectomy and pelvic lymph node dissection performed by the same group of surgeons. There were 117 males and 22 females, aged from 20 to 84 years old, with an average of (64.6±11.7) years, 91 patients were underwent ePLND group and 48 patients were underwent sPLND group. The preoperative anemia-free patients was compared between the ePLND group and the sPLND group [24 (50.0%)] vs. 58 (54.9%), respectively], the patients with anemia were [24 (50.0%) vs. 41 (45.1%)]. The range of ePLND is: sway to the common iliac artery and the lower aortic (unreaching the inferior mesenteric artery); the lateral boundary to the reproductive femoral nerve; the distal end of the iliac artery at the groin level, the posterior border to the iliac vessels and closure, which contains the anterior tibial lymph nodes between the two sides. The range of sPLND is below the level of the common iliac artery bifurcation, and the rest of the range is the same as ePLND. The average operative time, average intraoperative blood loss, intraoperative blood transfusion, intraoperative and postoperative complications, postoperative eating time, postoperative activity time, postoperative exhaust time, postoperative hospital stay, mean gastric tube indwelling time, average pelvic drainage tube indwelling time, lymph nodes positive rate, lymph node density, and cancer-free survival were evaluated. Results All 139 patients underwent surgery successfully. The average operative time in the ePLND group and the sPLND group were [(351.2±79.5) min vs.(342.5±69.3) min], average intraoperative blood loss [(314.6±120.6) ml vs.(298.3±126.3) ml], intraoperative blood transfusion [(702.9±645.7) ml vs.(936.9±818.1) ml], no intraoperative complications, postoperative complications [29 cases (31.9%)vs.18 cases (37.5%)], postoperative eating time [(5.4±1.9)d vs.(4.8±2.1)d], postoperative activity time[(2.1±0.9)d vs.(1.9±0.8)d], postoperative exhaust time [(3.8±0.9)d vs.(3.6±1.0)d], postoperative hospital stay [(14.9±7.8) d vs.(15.5 ± 6.9) d], average gastric tube indwelling time [(4.8 ± 2.6) d vs.(4.53± 1.9) d], average pelvic drainage tube indwelling time [( 11.1±4.9)d vs.(10.9±4.9)d], the difference was not statistically significant (P>0.05). A total of 2 359 lymph nodes were dissected from the two groups. The number of lymph nodes dissected in each of the ePLND group and the sPLND group was [(20.3±3.8) vs. (10.6±3.1), P<0.01], and the average number of positive lymph nodes was [(0.6±1.3) vs.(0.3±1.0), P=0.034], the ratio of lymph node positive patients was [33 (36.3%) vs. 9 (18.8%), P=0.026], and the lymph node density was [7.9% (146/1848) vs. 4.1% (21/511)], the difference was statistically significant (P<0.05). In regard to prognosis, the disease-free survival rate (DFS) of ePLND group was 94.5%, 91.0%, 84.4%, 81.1%, 75.3% at 1, 2, 3, 4 and 5 years follow-up respectively. The other group was 70.5%, 63.5%, 57.8%, 51.4%, 41.1% respectively. DFS of ePLND group tended to be higher than that of sPLND group in lymph node positive subgroups. The difference between the two groups was statistically significant (P<0.001). Conclusions In open radical cystectomy, ePLND and sPLND have similar surgical safety, but expanded lymph node dissection can improve disease-free survival in patients and improve the prognosis by increasing the detection range of positive lymph nodes. Key words: Bladder cancer; Radical cystectomy; Lymph node dissection; Cancer-free survival; Prognosis

Reconstruction of three-dimensional vascular models for lymphadenectomy before surgery

Introduction: A three-dimensional (3D) model of the pelvic vessels was reconstructed before surgery to aid in the understanding of the individual anatomy and help guide lymphadenectomy performance.Material and methods: Thirty patients with early-stage cervical cancer who were scheduled for lymphadenectomy at Nanfang Hospital, Southern Medical University from January 2017 to June 2017 were included. Three-dimensional models of the pelvic vessels were obtained.Results: All 3D models of the 30 patients were reconstructed successfully and were consistent with the operative findings.The most common structural types posterior to the common iliac artery (CIA) and CIA bifurcation (CIAB) were non-vessel structures (23/30 patients) and the common iliac vein (CIV) (27/30); these were observed separately on the left pelvic vein. The confluence of common iliac vein (CCIV) (29/30) and CIV (20/30) were most commonly observed posterior to the CIA and CIAB; these were observed separately on the right pelvic vein. Venous abnormalities were identified in 15 patients. There were variants in venous confluence shown to be homolateral to the CIV (2/15) and contralateral to the CIV (2/15) and CCIV (4/15).Conclusions: Three-dimensional models of the pelvic vessels can provide information on individual anatomy features that can help guide lymphadenectomy performance.

Fluorescence sentinel lymph node mapping in patients with cervical cancer

Objective:to assess the efficacy of fluorescence sentinel lymph node (SLN) detection with indocyanine green (ICG) in patients with cervical cancer.Materials and methods.We analyzed the results of examination and treatment in 80 patients with morphologically verified stage IA1–IIA1 cervical cancer. All patients underwent laparoscopic surgery with fluorescence SLN detection with ICG using a high-resolution infrared camera.Results.SLNs were detected in 78 out of 80 patients (97.5 %); the rate of bilateral SLN detection was 80.0 % (64 out of 80). SLNs were not identified in 2 patients only (2.5 %). The majority of SLNs (99 out of 176; 56.28 %) were located in the internal group of lymph nodes, near to the common iliac artery bifurcation. Eleven out of 80 patients (13.75 %) were found to have pelvic lymph node metastasis. SLN metastatic lesions were observed in 10 out of 80 patients (12.5 %), whereas only one participant had non-SLN metastasis. Therefore, the sensitivity of the fluorescence method with ICG was 98.75 %.Conclusion.Fluorescence SLN mapping with ICG in patients with stage IA1–IIA1 cervical cancer is an effective diagnostic method allowing SLN topical diagnosis, intraoperative restaging, and correction of the treatment strategy. 

Abstract 17198: Asymmetric Bifurcation Angle of Common Iliac Artery is Associated With Unilateral Calcified Nodule Lesion of Common Iliac Artery

Background and aim: It has been known that bifurcation angles of common iliac artery (CIA) are not always bilateral symmetry. Previous study reported that mechanical stress initiate calcification in aortic valve. The aim of this study was to investigate the impact of CIA anatomical features on lesion characteristic of CIA. Methods and results: This study enrolled 72 patients with intermittent claudication who had undergone endovascular-therapy (EVT) for de novo CIA atherosclerotic lesions in our hospital during April 2012 to March 2017. Anatomical analysis of CIA bifurcation was assessed by frontal view of initial angiography at EVT. We calculated the bilateral CIA angles between axis of terminal aorta and axis of proximal CIA, and bilateral symmetry was expressed as absolute value of the difference between both CIA angles (Δangle). The patients were divided into 2 groups: symmetry group (Δangle≦10 degrees, n=40) and asymmetry group (Δangle&gt;10 degrees, n=32), according to the mean of Δangle. Distribution characteristics were classified into 2 patterns: bilateral lesions pattern and unilateral lesion pattern, furthermore we assessed calcified nodule of CIA lesion using intravascular ultrasound. There was no difference between 2 groups about patient characteristics. Unilateral lesion was observed in asymmetry group much more than symmetry group (63% vs 22%, P&lt;0.05). Calcified nodule lesion was observed in asymmetry group much more than symmetry group (28% vs 5%, P&lt;0.05). Conclusions: These findings suggested that asymmetric bifurcation angle of CIA was associated with unilateral lesion and calcified nodule lesion. Asymmetry of CIA bifurcation might be predictor of unilateral calcified nodule lesion of CIA.

Morphometric analysis of significant vascular structures in posterior disc surgery with computed tomography angiography.

Vascular injuries, which are rarely seen in all spinal area procedures, especially lumbar disc surgery, are vitally important. The relationship between the course of the iliac artery and vein and intervertebral disc distance was studied morphometrically in patients who had undergone computed tomography angiography for abdominal aorta. This study was carried out retrospectively. A total of 100 patients who had undergone computed tomography angiography participated in the study. The aorta bifurcation, right and left common iliac artery (R/LCIA) and vein (R/LCIV), and the location of the common iliac artery bifurcation were investigated. The location of these vascular structures at the level of the spinal vertebral body and at the intervertebral disc level, determination of a fat plane between them, and the anterior longitudinal ligament (ALL) were analyzed. At the L4-5 intertransversarius dorsalis (IDL), the RCIV was determined to be at the 12 o'clock position RCIA in 51% of cases and between the ratio of 67% ALL. The LCIA was at the 1 o'clock position in 72% and adjacent to the ALL in 47%. The RCIV was located in the 11 o'clock position and there was no fat plane between the RCIV and the ALL in 92%. In 80%, the LCIV was located at the 11-12 o'clock position and in 18% transversely along the 12-1-2 o'clock region. There was no fat plane between the LCIV and the ALL in any patient. At the L5-S1 IDL, the RCIA was observed at the 10 o'clock position in 63%, and there was no fat plane between the RCIA and the ALL. The LCIA was at the 2 o'clock position in 72% and the LCIV was between the ALL and the LCIA in 92%. The RCIV was located at the 9-10 o'clock position in 95% and no fat plane was found between the ALL and the RCIV in 60%. The LCIV was located at the 1-2 o'clock position in 96% and there was no fat plane between the LCIV and the ALL in 92%; it was located close to the ALL. The L4-5 IDL RCIA was located at the midline and at a 30° angle position. The LCIV was located between them. The L5-S1 IDL located at LCIA left at 60° position was quite close to ALL with LCIV. When the distance from the ALL was compared and the frequency of fat planes between the ALL and the CIAs are considered, it can be noted that the RCIA in the L4-L5 IDL (p<0.001) and the LCIA in the L5-S1 IDL (p<0.001) were located remotely and in a more protected position. It should be kept in mind that the LCIV can progress along the L4-5 ID level, adjacent to the ALL, as well as transversely.

What Is the Optimal Abdominal Aortic Aneurysm Sac Measurement on CT Images during Follow-up after Endovascular Repair?

Purpose To develop a computed tomographic (CT) angiographic postprocessing protocol with two- and three-dimensional measurements for follow-up of patients who underwent endovascular aortic repair. Materials and Methods This HIPAA-compliant institutional review board-approved retrospective study included 159 patients (129 men, 30 women; mean age ± standard deviation, 74.9 years ± 8.2) who underwent 824 CT examinations (median of five examinations per patient; range, two to 14) with unenhanced and arterial -phase imaging performed between September 2004 and March 2015. The largest diameter on the axial plane; coronal, sagittal, and maximal diameter perpendicular to the reconstructed centerline; volume of the abdominal aortic aneurysm sac; and volume from the lowest renal artery to the aortic bifurcation and to the common iliac artery bifurcation were measured. Endoleaks on contrast material-enhanced images were considered the reference standard, and the predictive value of diameter and volume changes was analyzed. Intraclass correlation was used to compare diameters and volumes. Results All diameters and volumes showed excellent correlation (intraclass coefficient, 0.95 and 0.94, respectively). Average interobserver difference for diameters and volumes was 2%-3% and 4%-12%, respectively. Endoleaks were observed in 80 (50%) of 159 patients (59 [74%] at initial and 21 [26%] at later CT angiography). New endo-leaks were associated with increased aneurysm size measured as the largest diameter on the axial plane (P = .04) and perpendicular to the centerline (P = .01), and volume was measured from the lowest renal artery to the aortic bifurcation (P = .03) and to the common iliac artery bifurcation (P = .01). With a 5% size threshold, sensitivity and specificity for detection of endoleaks was optimal for centerline diameter (64.3% and 81.7%, respectively) and volume from the lowest renal artery to the common iliac artery bifurcation (57.1% and 63.5%). Conclusion The maximal diameter and volume of an abdominal aortic aneurysm sac can be used for temporal monitoring after endovascular aortic repair, with excellent correlation and interobserver agreement. An increase in the centerline diameter and volume from the lowest renal artery to the iliac bifurcation were the most sensitive criteria for detecting endoleaks. © RSNA, 2017 Online supplemental material is available for this article.

Comparison of efficacy between extended pelvic lymph node dissection and standard pelvic lymph node dissection in laparoscopic radical cystectomy

Objective To investigate the difference of surgical efficacy between extended lymph node dissection and standard lymph node dissection in laparoscopic radical cystectomy. Methods We retrospectively analyzed 62 bladder cancer cases, icluding 52 males and 10 females patients in our hospital from January 2011 to October 2016, who underwent laparoscopic radical cystectomy and pelvic lymph node dissection. Their mean age was (62.5±9.6)years, ranged from 42 to 83 years.27 cases were underwent extended lymph node dissection and 35 cases were underwent standard lymph node dissection respectively. The basic characters, operative time, intraoperative blood loss, intraoperative and postoperative complications, postoperative eating time, postoperative activity time, postoperative hospital stay, lymph nodes positive rate, lymph node density, and cancer-free survival were evaluated. Results All patients were underwent successful operation. There was no significant difference in operation time[(326.2±77.5)min vs. (345.5±66.8)min, P=0.297], blood loss[ (198.2±77.5)ml vs. (213.7±160.0)ml, P= 0.590], intraoperative complications(0/27 vs. 5/35, F=0.063), postoperative complications(8/27 and 9/35, P=0.732), postoperative eating time[ (4.8±2.2)d vs.(4.6±1.9)d, P=0.817], postoperative activity time[ (1.9±0.8)d vs. (1.9±0.9)d, P=0.838]and postoperative hospital stay[ (15.6±7.5)d vs. (16.0±5.9)d, P=0.483]. In this study, 994 lymph nodes and 100 positive lymph nodes were dissected. There were significant differences in the number of lymph nodes dissected in the two groups (23.2±6.6 vs. 10.5±3.6, P 0.05), DFS of ePLND group tended to be higher than that of sPLND group in lymph node positive subgroups. Conclusions Extended lymph node dissection and standard lymph node dissection have similar surgical safety and prognosis, and appropriate surgical procedures should be selected according to the patient′s condition. Key words: Laparoscopic radical cystectomy; Lymph node dissection; Safety; Prognosis