Common Iliac Research Articles

Abstract 4138449: High Output Heart Failure from an Aortocaval Fistula

Introduction: High output heart failure (HOHF) due to a post-traumatic aortocaval fistula is a rare entity. This case seeks to explore the presentation as well as complexities of management of these patients. Case Presentation: A 50-year-old male with a prior right abdominal stab wound requiring exploratory laparotomy 20 years ago presented with worsening dyspnea on exertion and palpitations. Physical examination was remarkable for jugular venous distention, lower extremity edema, and a pulsatile mass in the right abdomen with an audible bruit. A 12-lead ECG showed rapid atrial flutter. A transthoracic echocardiogram (TTE) showed a reduced left ventricular ejection fraction (LVEF) of 30-35%, severely dilated atria and inferior vena cava (IVC) with high velocity flow. Abdominal computed tomography venogram showed dilation of the IVC up to 8cm and an aortocaval fistula at the level of the right renal vessels, resulting in an atrophic right kidney. Cardiac catheterization was notable for a cardiac output (CO) of 12L/min, cardiac index (CI) of 7L/min/m2 and reduced systemic vascular resistance (SVR). He was managed with beta blockers and diuretics, followed by TEE-guided cardioversion for atrial flutter to restore sinus rhythm. Vascular surgery performed a successful, first of its kind endovascular repair of the abdominal aorta with stenting of the right common iliac artery and placement of a 20mm Amplatzer Septal Occluder device in the right renal artery. He tolerated the procedure well, and post-operative TTE showed a recovered LVEF of 55-60% and CO of 6L/min. Discussion: HOHF is defined by a CO more than 8L/min or CI more than 4L/min/m2 along with clinical symptoms. Decreased SVR leads to sympathetic activation and stimulation of the renin-angiotensin-aldosterone system, leading to fluid retention, cardiac remodeling, and exacerbation of symptoms. Challenges present in the management of HOHF and the use of vasodilatory agents should be avoided, as they can exacerbate the problem. In our case, limitations were also faced in the use of many traditional HF therapies due to renal dysfunction as a result of the fistula. Therefore, repair was the only viable long-term solution. Conclusion: This case displays an uncommon etiology of HOHF, emphasizing the need for meticulous evaluation to ensure proper management. Early detection of aortocaval fistulas is crucial to prevent worsening cardiac dysfunction, with symptoms resolving rapidly post-repair.

The anatomy of the common iliac artery: a meta-analysis based on 5785 cases.

The common iliac arteries (CIA) are the main finals branches of the abdominal aorta. The aim of the present meta-analysis was to demonstrate the most up-to-date and evidence-based data regarding the general anatomy of the CIAs, including their length, take-off angles, and diameters. PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to find all studies considering the anatomy of the CIA. Eligibility assessment and data extraction stages were performed. The results of the measurements in a total of 5785 patients were evaluated and included in the statistical analysis. The prevalence of the origin variations of the CIA has been evaluated. CIA was found to most commonly originate at the level of L4 vertebrae with a pooled prevalence of 59.49% (95% CI 48.00-70.50%). The overall mean length of the CIA was 5.59mm (SE: 0.13), and the mean diameter of the CIA was 10.52mm (SE: 0.85). The knowledge of the anatomy and variations of the CIA is crucial in lumbar spine surgery, especially when performing the anterolateral approach to L4 and L5 vertebrae. Furthermore, the level of the aortic bifurcation has significant implications related to vascular surgery in this region. We performed the present meta-analysis to standardize the extensive information on the anatomy of the CIAs.

“Bead to death,” Fibromuscular Dysplasia Presenting as A Rapidly Enlarging Right Anterior Axillary Mass

Fibromuscular dysplasia (FMD) is a rare non-inflammatory, non-atherosclerotic arterial disease characterized by abnormal cellular proliferation and distorted architecture. It commonly affects the renal and extracranial carotid and vertebral arteries, but nearly all arterial beds may be affected, and multivessel involvement is common. We report a rare case of a 31-year-old Filipino female who presented with a rapidly enlarging right anterior axillary mass. Initial consideration was a bleeding soft tissue sarcoma as seen on chest CT scan, while whole abdominal CT scan with IV contrast revealed incidental findings of multiple aneurysms in the superior mesenteric artery, both renal arteries and right common iliac artery, suggestive of fibromuscular dysplasia. Further vascular imaging studies showed a looped left internal carotid, and a tortuous left brachial artery with beading pattern.

NCMP-18. A CASE OF METASTATIC GLIOBLASTOMA MULTIFORME

Abstract Glioblastoma multiforme (GBM) is the most common primary brain tumor and rarely causes metastasis. We present a case of a 43-year-old female who developed tingling and heaviness in her right lower extremity in March 2023. This sensation progressed to involve her entire right hemi-body over the next two months. She presented to the emergency department where an MRI show a large left frontal parietal mass measuring 5.2x3.7x3.7cm with significant mass effect. She underwent surgical resection and surgical pathology showed IDH1-mutant R132H, retained ATRX, MGMT promoter mutation, and ki-67 of 80%. She received 6 weeks chemoradiation and then started maintenance temozolomide at 150mg/m2. Temozolomide was increased to 200mg/m2 for cycle 3 maintenance. In March 2024, she presented to the hospital with pain radiating down her legs and saddle anesthesia. MRI lumbar spine showed infiltrating osseous mass at S1 and S2 and bilateral sacral ala with anterior and posterior extraosseous invasion, invading the spinal canal resulting in moderate to severe spinal canal narrowing and compression of the sacral nerve roots. She underwent biopsy of the lesion which showed IDH wildtype metastatic GBM. She also underwent lumbar puncture and cerebrospinal fluid cytology was negative. She experienced pancytopenia limiting chemotherapy options. In April 2024, she underwent PET scan which showed hypermetabolic epidural soft tissue in spinal canal at L5-S1 level, widespread hypermetabolic skeletal lesions, tiny left cervical level 4 lymph node, small hypermetabolic right hilar, aortocaval, left retroperitoneal nodes and a tiny left common iliac node. The incidence of extracranial metastasis is 0.4-2.0% with less than 25 reported cases of bone marrow spread. This is thought to be rare due to the absence of lymphatics within the brain and the limited survival associated with GBM. This metastasis may occur through vascular invasion, perineural spread, lymphatics, direct invasion, or iatrogenic spread into soft tissues.

A new domestic self-expanding nitinol stent: in vivo preclinical study

Objective. To evaluate the results of implantation of a new domestic self-expanding nitinol stent in experimental animals. Materials and methods. Experimental implantations of a self-expanding nitinol stent were performed in the common iliac artery of three Vietnamese Pot-bellied pigs. In the postoperative period, all animals received dual antiplatelet therapy for 3 months. Vital signs were also assessed throughout the observation period. After 3 months, the animals underwent control angiography and ultrasound examination of the iliofemoral segment, followed by withdrawal from the experiment by euthanasia. The next step was a macroscopic and histological analysis of the stented areas of the vessels. Results. The observation period of the animals was 3 months. Throughout the entire observation period, vital signs in all animals remained within normal values. The results of control angiography and ultrasound examination after 3 months demonstrated patency, as well as the absence of significant in-stent stenoses in two pigs. One animal showed signs of in-stent restenosis. The results of macroscopic and histological analysis showed signs of damage to the subendothelial layer, as well as myointimal hyperplasia. These changes were especially pronounced in the animal with restenosis. Our analysis showed that the presented results were due to excessive oversizing of the implanted stents (20–30 %). Conclusion. Our proposed self-expanding nitinol stent, in general, showed satisfactory results in the in vivo experiment. Nevertheless, it should be borne in mind that severe stent oversizing can cause excessive neointimal proliferation, which, in turn, will lead to the development of restenosis in the long-term postoperative period. In this regard, it is necessary to carry out an additional series of implantation of the presented stent to the experimental animals with less oversizing in order to determine its optimal values for this particular stent model.

The Effect of Arterial Elongation on Isolated Common Iliac Artery Pathologies

The Effect of Arterial Elongation on Isolated Common Iliac Artery Pathologies

Ballooning and Bursting of Barrels and Pipes: A Rare Case of Suspected Vascular Ehlers–Danlos Disease

Vascular Ehler–Danlos disease (vEDS), a rare subtype of a rare disease, is a life-threatening disease, with an increased risk for spontaneous vascular or visceral rupture. These patients have fatal complications ranging from vascular aneurysms, dissection, and rupture of systemic vessels to frequent thromboembolic events, the common causes of death in these individuals with a shortened life span. In the present case, a 28-year-old male with history of shoulder dislocations and spontaneous colon perforation presented to the primary care clinic with right lower extremity swelling and pain. His history includes presentation to the emergency department with left lower leg swelling with compartment syndrome one year prior. A CT angiogram of lower extremities and abdomen revealed acute arterial extravasation of the left posterior tibial artery, indicating a ruptured aneurysm along with aneurysms of the splenic artery and left common iliac artery. He was treated with a saphenous vein graft, but was associated with post-operative complications that necessitated below-knee amputation. CT angiogram of his right leg revealed occlusion of the anterior tibial and peroneal arteries with aneurysms, and, ultimately, he was referred to a tertiary care center for aneurysm embolization. This case report emphasizes the frequent vascular complications encountered in vascular EDS patients, and thus advocates for close and regular monitoring for early referral and surgical management of their vascular anomalies. Finally, genetic counseling and screening of asymptomatic family members should be routinely implemented in these patients.

Comparison of patients with occlusive or hemorrhagic access site complications requiring reintervention after percutaneous transfemoral transcatheter aortic valve implantation.

Background: Transcatheter aortic valve implantation (TAVI) via transfemoral (TF) access is increasingly integral to aortic valve disease treatment, expanding beyond high-risk patients. Despite technical advancements, access-related vascular complications, occurring in approximately 10% of TAVI procedures, remain a substantial challenge. Objective: This study investigated the clinical and morphological characteristics of percutaneous TF-TAVI patients experiencing occlusive (OC) and hemorrhagic (HC) complications managed with surgical or endovascular reintervention. Methods: The cohort included patients from a Dutch and a German tertiary referral hospital, managed with TF-TAVI procedures between 2017 and 2021 that required reintervention for OC or HC. Demographics, comorbidities, procedural details, and preoperative imaging data were collected and compared between groups. Results: Among 109 TF-TAVI patients, 32 with OC and 77 with HC required reintervention. The OC group presented significantly smaller access arterial diameters (common femoral artery: OC 6.7 mm vs. HC 8.9 mm, p<.001; external iliac artery: OC 7.2 mm vs. HC 8.3 mm, p<.001; common iliac artery: OC 9.4 mm vs. HC 10.5 mm, p=.012) while the HC group presented higher tortuosity index (TI) (OC 1.24 vs. HC 1.30; p=.017). No differences were observed regarding baseline characteristics, vessel calcification or vascular closure device use. Conclusions: In patients requiring reintervention following TF-TAVI, smaller arterial diameters were associated with OC, while higher TI was linked to HC. These findings emphasize the importance of preoperative imaging in developing individualized prevention strategies.

Evaluation of complications and biochemical recurrence rates after (super) extended lymph node dissection during radical prostatectomy

ObjectiveTo evaluate the effectiveness of extended (e-PLND) and super-extended pelvic lymph node dissection (se-PLND) during robot-assisted radical prostatectomy (RARP) by examining lymph node (LN) yield, complications, LN metastasis, and biochemical recurrence (BCR) incidence.MethodsBetween January 2016 and January 2020, 354 consecutive patients with > 5% risk of lymph node involvement (LNI), as predicted by the Memorial Sloan Kettering Cancer Center nomogram, underwent RARP with (s)e-PLND at a high-volume center. The e-PLND involved removing fibrofatty lymphatic tissue around the obturator fossa, internal iliac region, and external iliac vessels. The se-PLND, performed at the discretion of the surgeons, also included lymph nodes from the pre-sacral and common iliac regions. Outcomes included histopathological findings by anatomical region; complications; and BCR incidence during follow-up.ResultsThe median LNI risk was 18% (IQR 9–31%). A median of 22 LN (IQR 16–28) were removed, with se-PLND yielding a higher number: 25 (IQR 20–32) compared to e-PLND: 17 (IQR 13–24) (p < 0.001). pN1 disease was detected in 22% of patients overall, higher in se-PLND (29%) than e-PLND (14%) (p < 0.001). Of metastatic LNs, 14% were situated outside the e-PLND template. Operation time was longer for se-PLND, but perioperative complications were similar between both groups. After a median follow-up of 24 months (IQR 7–33), BCR incidence was comparable between the two groups.ConclusionCompared to standard extended pelvic lymph node dissection (PLND), super extended PLND increases lymph node yield and removal of metastatic deposits but does not contribute to progression free survival at mid-term.

A cadaveric study showing the OLIF corridor dimensions after retraction of the abdominal great arteries and psoas major.

The aim of this study is to assess the oblique lateral interbody fusion (OLIF) corridor dimensions when the abdominal great arteries (the abdominal aorta or common iliac arteries) and psoas major are retracted. Twenty embalmed cadaveric specimens were dissected. The widths of the OLIF operative corridor at L1-2, L2-3, L3-4, and L4-5 were measured with the psoas major and abdominal great arteries in static state, with psoas retraction, and with mild retraction of the abdominal great arteries. The retractable distances of the psoas major and the abdominal great arteries at each lumbar segment were compared. In the static state, the operative corridor gradually narrowed from L1-2 to L4-5, but there was no significant difference in its width between segments (p > 0.05). There was no significant difference in the corridor width between segments after retraction of the psoas major or the abdominal great arteries (p > 0.05). However, retraction of either the psoas major or the abdominal great arteries made the corridor at the L1-5 segments significantly wider than those in the static state (p < 0.05), particularly at L4-5, and the retractable distance of the psoas major was significantly greater (p < 0.05). The cadaveric model demonstrated the use of abdominal great arteries retraction in principle. The OLIF operative corridor could be widened to some extent by retracting the abdominal great arteries, and widened further by retracting the psoas major.

Comparison and Significance of Contrast-Enhanced Computed Tomographic Findings of Large-Vessel Vasculitis Before and After Treatment: Differences Between Takayasu Arteritis and Giant Cell Arteritis.

Imaging is essential for diagnosing large-vessel vasculitis (LVV). During diagnostic imaging, assessing disease activity and vascular damage separately is important. Acute-phase findings represent disease activity, while chronic-phase findings represent vascular damage; however, whether the imaging findings are acute or chronic may be unclear. We investigated how vascular lesions change before and after treatment and whether they were acute- or chronic-phase findings. Fifty-one patients with LVV who had undergone contrast-enhanced computed tomography (CT) scans from the neck to the pelvis before treatment and 1-4 months after treatment were recruited. Wall thickening, wall contrast enhancement, stenosis, occlusion, dilation, aneurysm, and calcification were semi-quantitatively assessed in 21 vessels from the common carotid to the common iliac artery. Twenty-four patients were diagnosed with Takayasu arteritis (TAK), and 27 with giant cell arteritis (GCA). Wall thickening and wall contrast enhancement improved after the treatment, which was especially significant in the GCA group. No significant differences in stenosis, occlusion, dilation, aneurysm, or calcification were observed before and after treatment. Stenosis and occlusion were more common with TAK, while calcification was more common with GCA. Wall thickening and wall contrast enhancement are acute-phase findings (activity), while stenosis, occlusion, dilation, aneurysm, and calcification are chronic-phase findings (damage). The frequencies of these findings differ between TAK and GCA.

Ruptured Complex Aortoiliac Aneurysm in an Elderly Patient With a Kidney Transplant Presenting With Sciatica.

Background: Common iliac artery aneurysms are uncommon, with an estimated incidence of less than 0.01% in adults and accounting for only 1% of all intra-abdominal aneurysms. While the risk of rupture is approximately 5%, it increases significantly to 29% once the aneurysm reaches 4 cm. Similarly to abdominal aortic aneurysms, common iliac artery aneurysms often develop silently, remaining asymptomatic in about 70% of cases. This report describes the treatment of a patient with a kidney transplant who underwent endovascular repair of a ruptured left common iliac artery aneurysm with a concomitant abdominal aortic aneurysm and a focal aneurysm of the right renal artery origin. Case Description: A 78-year-old male patient with a kidney transplant presented with left sciatica symptoms and was found to have a contained rupture of a 10 x 7 cm left common iliac artery aneurysm with a concomitant 8 cm abdominal aortic aneurysm and a focal 1.8 cm aneurysm of the right renal artery origin. He underwent an endovascular aneurysm repair with an Aorto-Uni-iliac stent graft and a concomitant right-to-left femoral-femoral bypass using 8 mm ringed PTFE graft and ligation of left external iliac artery to prevent retrograde flow into the left common iliac artery aneurysm. At 3-year follow-up, patient remains stable with a functioning kidney transplant and excluded aneurysms with no evidence of endoleak. Conclusion: This report describes the endovascular repair of a ruptured left common iliac artery aneurysm conducted under local anesthesia in a patient with a renal transplant and complex aneurysm anatomy. The calcification pattern observed on a non-contrast CT scan was effectively used for surgical planning, leading to a successful aneurysm repair while preserving kidney transplant function.

Impact of Pelvic Calcification Severity on Renal Transplant Outcomes: A Prospective Single-Center Study.

Background: Vascular calcifications (VC) are increasingly prevalent in patients with chronic kidney disease. This study aimed to assess the incidence of iliac artery calcifications in kidney transplant (KT) patients and explore the relationship between iliac VC burden measured by pelvic calcification score (PCS) and renal transplant outcomes. Methods: This prospective study involved 79 KT recipients. VC quantification, using a pre-transplant computed tomography (CT) scan, was performed by assessing calcifications in the common and external iliac arteries bilaterally, resulting in an overall PCS ranging from 0 (no calcifications) to 44 (extensive calcifications). Based on PCS values, patients were divided into three equal-sized groups: PCS Group 1 (PCS 0-4), PCS Group 2 (PCS 5-19), and PCS Group 3 (PCS > 19). Post-transplant outcomes tracked for at least 1 year were patient and graft survival, graft function (urea, creatinine, MAG-3 clearance), and incidence of MACE during the first post-transplant year. Results: Calcifications were present in at least one arterial segment in 61 patients (77.2%). One-year patient survival was 95%, and one-year graft survival was 92.4%. Patients in PCS Group 3 had significantly lower one-year patient and graft survival compared to those in PCS Group 1 and 2 (p = 0.006 and p = 0.008, respectively). MACE and renal function indicators 1-year post-transplant were similar across all PCS groups. Conclusions: Our study demonstrated that a significant majority of KT recipients exhibited iliac VC during pre-transplant CT assessments. Patients in PCS Group 3 exhibited significantly lower one-year patient and graft survival rates compared to those in PCS Groups 1 and 2, indicating that this subgroup may require more intensive post-transplant monitoring and management.

Intravascular Nodular Fasciitis Mimicking Thrombotic Complications in a 16-year-old male with May-Thurner Syndrome

Abstract Introduction/Objective Nodular fasciitis is a rare benign myofibroblastic proliferation commonly mistaken for malignant tumors due to its rapid growth and clinical presentation. May-Thurner Syndrome (MTS), characterized by compression of the left common iliac vein by the right common iliac artery, predisposes individuals to deep vein thrombosis (DVT). However, here we present a unique case of intravascular nodular fasciitis presenting as thrombotic complications in the context of MTS in a 16-year-old male. Methods/Case Report A 16-year-old male presented with progressive left hip and leg pain accompanied by recent swelling. Ultrasound revealed occlusive thrombi within the left side external iliac, common superficial femoral, and great saphenous veins, along with nonocclusive thrombi in left deep femoral vein. Magnetic resonance venography confirmed MTS and extensive thrombosis. Thrombectomy was done with fragments sent to pathology. Microscopic examination showed cellular areas with loose myxoid composition, proliferating spindle, myofibroblastic/fibroblastic, and stellate cells arranged in irregular bundles. Additional microscopic findings included mild cellular atypia, mitoses, focal macrophage aggregates, occasional multinucleate forms, foci of hemorrhage, fibrin exudate, ingrowing fibroblasts, and increased vascularization. Immunohistochemical stains demonstrated positivity for SMA, CD31, ERG, and CD34, highlighting prominent vascularization, while desmin, myogenin, myoglobin, STAT6, beta-catenin, S100, and AE1/AE3 were negative. Differential diagnosis included intravascular fasciitis, and possibly organizing thrombus with myxoid stroma. USP6 gene rearrangement (FISH) study was positive, confirming the diagnosis of nodular fasciitis. Results (if a Case Study enter NA) N/A Conclusion This case emphasizes the significance of maintaining a broad differential diagnosis when assessing specimens sent as thrombectomies. Recognizing intravascular nodular fasciitis as a potential presentation mimicking thrombosis is essential for accurate diagnosis and management.

Risk factors of thromboembolic events in patients with scrub typhus.

Thromboembolic events are a well-recognized cause of in-hospital deaths of patients with infectious diseases. However, thromboembolic events in patients with scrub typhus, caused by Orientia tsutsugamushi have rarely been reported. This study aimed to assess risk factors associated with thromboembolic events in patients with scrub typhus. All 93 scrub typhus patients' diagnoses were confirmed serologically or by positive nested polymerase chain reaction (PCR). The clinical and laboratory findings from 12 scrub typhus patients with thromboembolic events and 81 scrub typhus patients with nonthromboembolic events were retrospectively studied. To determine the factors implicated in thromboembolic events, we performed multivariate logistic regression analysis using the six independent factors identified by the univariate analysis. The mean age of the patients in the thromboembolic group was 76.4 years (median, 76 years), and in nonthromboembolic group it was 64.6 years (median, 65 years) (P<0·001). Thromboembolic events were observed in 12 patients. These events included acute coronary syndrome (n = 5), acute limb ischemia (n = 4), ischemic stroke (n = 1), deep vein thrombosis combined with pulmonary thromboembolism (n = 1), and left common iliac artery aneurysm with a thrombus (n = 1). According to multivariate analysis, the following four factors were significantly associated with the thromboembolic events: 1) treatment with rifampin (OR = 57.6; CI 1.2-2700.3), 2) Taguchi genotype (OR = 41.5, P = 0.028; CI 1.5-1154.6), 3) atrial fibrillation (OR = 9.4, P = 0.034; CI 1.2-74.0), and 4) age (OR = 1.1, P = 0.046; CI 1.0-1.3). Our study suggests that clinicians should be cautious when managing patients with scrub typhus to avoid the development of thromboembolic events, especially in patients with risk factors such as treatment with rifampin, Taguchi genotype, atrial fibrillation, and advanced age.

Correlation and predictive value analysis of iliac artery calcification score and restenosis of lower extremity arteries after drug-coated balloon combined with stent implantation in patients with lower extremity atherosclerotic occlusive disease

Objective: To analyze the correlation between iliac artery calcification score and restenosis of lower extremity arteries in patients with lower extremity atherosclerotic occlusive disease (LEASO) who underwent drug-coated balloon (DCB) combined with stenting, and to assess the predictive value. Methods: A total of 105 patients with LEASO at Nanjing Drum Tower Hospital, Nanjing University Medicine School, from January 2018 to June 2023 were retrospectively included, and the patients were divided into 2 groups according to whether restenosis of the original lower limb arteries had occurred during follow-up after DCB combined stent implantation: the restenosis group (n=64) and the patency group (n=41). The clinical information of the study subjects was collected through the electronic case system, and all patients underwent CTA examination of both lower limb arteries before the operation, and the calcification scores of common iliac arteries and external iliac arteries of patients' bilateral and stenotic sides were calculated according to the results of the CTA examination. The follow-up time [M (Q1, Q3)] was 9.15 (5.67, 15.60) months in the patency group and 9.20 (6.85, 19.65) months in the restenosis group. Univariate and multivariate logistic regression models were used to analyze the factors associated with restenosis after DCB combined with stent implantation in LEASO patients. The predictive value of iliac artery calcification score for postoperative restenosis was assessed using the receiver operating characteristic (ROC) curves. Results: There were 44 males and 20 females in the restenosis group, aged (73±9) years; 31 males and 10 females in the patency group, aged (73±10) years. Compared with the patency group, the restenosis group had higher neutrophil counts, platelet counts, lymphocyte counts, neutrophil-to-lymphocyte ratios (NLR), platelet-to-lymphocyte ratios (PLR), C-reactive protein, fibrinogen, stent lengths, stent numbers, common iliac artery calcification scores (bilateral and stenotic side), and external iliac artery calcification scores (bilateral and stenotic side) (all P<0.05). Multifactorial logistic regression analysis showed that higher external iliac artery calcification score on the stenotic side (OR=1.480, 95%CI: 1.130-1.939, P=0.004) was an associated factor for restenosis of the lower extremity arteries after DCB combined with stenting.ROC curve analysis showed that the cut-off value of the external iliac artery calcification score on the stenotic side was 5.5 score, the area under the curve (AUC) for predicting restenosis of lower extremity arteries after DCB combined stent implantation in LEASO patients was 0.818 (95%CI: 0.731-0.904, P<0.001), with a sensitivity of 85.4% and a specificity of 68.8%. Conclusions: An elevated calcification score of the external iliac artery on the stenotic side is a correlate of restenosis of the lower extremity arteries after DCB combined stenting in patients with LEASO. With a cut-off value of 5.5 points, its sensitivity for predicting restenosis of the lower extremity arteries after DCB combined stenting is 85.4%, and its specificity is 68.8%.

Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancer

BackgroundWhether extended lymphadenectomy is associated with improved disease-free and overall survival, as compared with standard lymphadenectomy, among patients with localized muscle-invasive bladder cancer undergoing radical cystectomy is unclear.MethodsWe randomly assigned, in a 1:1 ratio, patients with localized muscle-invasive bladder cancer of clinical stage T2 (confined to muscle) to T4a (invading adjacent organs) with two or fewer positive nodes (N0, N1, or N2) to undergo bilateral standard lymphadenectomy (dissection of lymph nodes on both sides of the pelvis) or extended lymphadenectomy involving removal of common iliac, presciatic, and presacral nodes. Randomization was performed during surgery and stratified according to the receipt and type of neoadjuvant chemotherapy, tumor stage (T2 vs. T3 or T4a), and a Zubrod’s performance-status score (0 or 1 vs. 2; assessed on a 5-point scale, with higher scores indicating greater disability). The primary outcome was disease-free survival. Overall survival and safety were also assessed.ResultsOf 658 patients who were enrolled, 592 eligible patients were randomly assigned to undergo extended lymphadenectomy (292 patients) or standard lymphadenectomy (300). Surgery was performed by 36 surgeons at 27 sites in the United States and Canada. Neoadjuvant chemotherapy had been received by 57% of the patients. At a median follow-up of 6.1 years, recurrence or death had occurred in 130 patients (45%) in the extended-lymphadenectomy group and in 127 (42%) in the standard-lymphadenectomy group, and the estimated 5-year disease-free survival was 56% and 60%, respectively (hazard ratio for recurrence or death, 1.10; 95% confidence interval [CI], 0.86 to 1.40; P=0.45). Overall survival at 5 years was 59% in the extended-lymphadenectomy group and 63% in the standard-lymphadenectomy group (hazard ratio for death, 1.13; 95% CI, 0.88 to 1.45). Adverse events of grade 3 to 5 occurred in 157 patients (54%) in the extended-lymphadenectomy group and in 132 (44%) in the standard-lymphadenectomy group; death within 90 days after surgery occurred in 19 patients (7%) and 7 patients (2%), respectively.ConclusionsAs compared with standard lymphadenectomy, extended lymphadenectomy did not result in improved disease-free or overall survival among patients with muscle-invasive bladder cancer undergoing radical cystectomy and was associated with higher perioperative morbidity and mortality. (Funded by the National Cancer Institute and the Canadian Cancer Society; SWOG S1011 ClinicalTrials.gov number, NCT01224665.)

Results of endovascular interventions for peripheral arterial diseases on the targeted arterial segments.

Endovascular interventions (EVIs) are an effective and minimally invasive therapeutic option for peripheral arterial diseases (PADs). This study aimed to evaluate the results of EVIs for PADs on the targeted arterial segments (TASs). One hundred and sixteen (116) participants with PADs were included in this cohort study. The diagnosis of PAD in this study was based on the ankle-brachial index (ABI) and Rutherford classification, confirmed by Duplex ultrasound and computed tomography angiography (CTA). The targeted arterial segments (TASs) were treated using either balloon angioplasty or endovascular stenting. At the end of each EVI, a post-procedure angiography was performed to evaluate the EVIs' results (i.e., balloon angioplasty and endovascular stenting) for PADs on the TASs. The results of EVIs were classified as either satisfactory or unsatisfactory. Satisfactory if the TASs were recanalized or had <30% stenosis after the EVIs. Unsatisfactory if the TASs were still occluded or had >30% stenosis after the EVIs. The mean participants' age was 54.42±7.74 years; 35.3% of them were diabetic, 36.2% were hypertensive, and 28.5% had multiple medical disorders. Based on Rutherford classification, 44.83% of the participants had grade I, category 2 chronic ischemia, 23.28% had grade I, category 3 chronic ischemia, 12.93% had grade II, category 4 chronic ischemia, and 18.96% had grade III, category 5 chronic ischemia. About 87.1% of the participants' PADs were managed using balloon angioplasty. The affected arteries were the superficial femoral arteries in 47.5%, popliteal arteries in 18.8%, posterior tibial arteries in 18.8%, and anterior tibial arteries in 14.9%. About 12.9% of the participants' PADs were managed using endovascular stenting and the affected arteries were the common iliac arteries in 60%, and external iliac arteries in 40%. The results of EVIs were satisfactory in 98.28% of the participants, while it was unsatisfactory in 1.72% of them. Endovascular interventions in this study were an effective and minimally invasive therapeutic option for PADs, with satisfactory results in 98.28%. Further studies, including the long-term and clinical outcomes after EVIs for PADs, are required.

137 - WSS and velocity changes of common iliac arteries in patients with abdominal aortic aneurysm: assessment using 4D flow MRI

137 - WSS and velocity changes of common iliac arteries in patients with abdominal aortic aneurysm: assessment using 4D flow MRI

A clinical assessment of preperitoneal packing adequacy for pelvic fracture bleeding control

BackgroundThis study aimed to objectively assess the laparotomy pads to potential hemorrhage sites proximity in pelvic fracture patients who underwent post-pre peritoneal packing (PPP) CT scans with packs in situ. MethodsThe CT scans of 19 patients were assessed to measure the distance between laparotomy pads and predetermined pelvic anatomical landmarks. ResultsA total of 38 measurements showed that the median pack-to-point distance for the sacroiliac joint was 2.7 cm (IQR, 2.1–4.0), for the common iliac artery 4.1 cm (IQR, 3.2–5.0), for the external iliac artery 0 cm (IQR, 0.0–0.2), for the internal iliac artery 0.1 cm (IQR, 0–0.7), and for the iliac bifurcation 2.0 cm (IQR, 1.7–3.9). There were 60 % direct contact measurements for the iliac arteries. ConclusionThis study shows that with adequately executed PPP a reasonable proximity of laparotomy packs to the potential bleeding sites to provide tamponade for arresting hemorrhage may be achieved.