External Iliac Vein Research Articles

Spine Stabilization Is a Risk Factor for the Development of Pelvic Iliac Vein Lesions

Open lumbar spine stabilization surgery often requires mobilization of the left and right common iliac veins (CIVs) and the placement of plates and screws that can impinge on iliac veins. We reviewed our venography experience during the past 3 years to determine whether there is an association between spine stabilization surgery and the development of iliac vein lesions and symptomatic iliac vein outflow obstruction. A retrospective chart review was performed to identify patients who underwent venography with or without venous stenting and who had a history of previous lumbar spine stabilization. From January 2014 to April 2018, venography were performed in 1713 limbs in 1245 patients at the Center for Vascular Medicine. Of the 1245 patients, 17 patients had a history of lumbar spine stabilization procedures (4 anterior-posterior and 13 posterior). Nine had single-level and eight had two- or three-level fusions. All 17 patients demonstrated pelvic lesions, which included the following: one left CIV aneurysm, five left CIV stenoses, three bilateral CIV stenoses, two left CIV and inferior vena cava occlusions, and two external iliac vein stenoses. The aneurysm patient was treated with anticoagulation. Eight patients underwent stenting, and one patient refused stenting because of relocation to another country. One inferior vena cava-CIV occlusion could not be crossed. Fear of dislodging a thrombus and the proximity to a protruding posteriorly placed screw prevented stenting in two patients. Four patients had a venoplasty alone because of undersizing of a stenosis or missed lesions with intravascular ultrasound after review by a blinded reviewer. Lesions in anterior-posterior patients were extremely stenotic, required predilation, and resulted in a residual stenosis requiring venoplasty at a second setting in one patient. Lumbar spine stabilization surgery may be a risk factor for development of symptomatic venous outflow obstruction lesions. During venography and stenting in patients with anterior-posterior approaches, significant scarring may be encountered, resulting in a residual stenosis after stent placement. Predilation venoplasty, before stent deployment, is recommended to prevent stent migration. Furthermore, a history of spine stabilization surgery in patients presenting with pelvic or lower extremity pain or swelling should prompt consideration of a pelvic venous duplex ultrasound examination to assess for the presence of an iliac venous outflow lesion.

The auto-transplantation of uterus in swine: surgical techniques and long-term graft survival

Objective: Uterus transplantation (UTx) provides a available treatment for women with absolute uterus-related infertility. The aim of this study was to develop surgical techniques for UTx and to observe the long-term graft survival in the swines. Materials and Methods: Ten female swines received uterus auto-transplantation surgery after general anesthesia. The operative time, ischemic time, and vascular injury in each swine were recorded. The bicornual uterus with vaginal canal and main vessel were removed, bake-table preparation was performed with cooled at 4°C, and perfused with heparin saline with continuous flushing. The uterus was placed in original pelvic position. The uterus arteries and veins were end-side anastomosed with external iliac arteries and veins in the host swines. Results: One case was randomly selected as the preliminary experiment. The remaining nine cases showed that the uterine arteries and veins were anastomosed successfully and only eight cases attained long-term survival. The host in another case died four days after surgery from suspicious embolism postoperation. The blood flow of uterus arteries was observed by Doppler ultrasonography at four days after the operation and no congestion was found. The second-look laparotomy at six months after surgical was subsequently performed and the uterus showed a normal morphology and size. However, the pregnancy was unsuccessful due to the shorter observation time, and the severe adhesion and tubal obstruction after surgery may have affected pregnancy of those swines. Conclusion: These preliminary experiences suggest that the uterine auto-transplantation using the end-side vascular anastomosed method is feasible. The accumulation of basic data and experiences from swine experiments can provide important guidance for establishment of UTx in humans.

External iliac vein injury during total hip arthroplasty: a case report

External iliac vein injury during total hip arthroplasty: a case report

In Situ Gonadal Vein Valvulotomy and Side-to-side Gonado-iliac Bypass for the Management of Nutcracker Syndrome in an Adolescent With a Solitary Kidney and Absence of Pelvic Congestion

Herein we present the first case report of laparoscopic exploration, endovascular valvulotomy, and open side-to-side bypass of a gonadal vein into the ipsilateral external iliac vein for Nutcracker syndrome in an adolescent patient with solitary kidney without pelvic congestion. Though prior management has included various large open surgeries or endovascular or extravascular approaches with the use of stents and shields, this case offers an expanded novel approach to weigh the unique challenges of the patient's age and solitary renal status. If reproducible, this technique may gain value in the management of patients with this rare, incapacitating condition.

Pelvic cardiovascular magnetic resonance venography: venous changes with patient position and hydration status

BackgroundTo determine the effect of hydration as well as prone versus supine positioning on the pelvic veins during cardiovascular magnetic resonance (CMR) venography.MethodsUnder institutional review board approval, 8 healthy subjects were imaged with balanced steady state free precession, non-contrast CMR venography to measure common and external iliac vein volumes and common femoral vein cross-sectional area in the supine, prone and decubitus positions after dehydration and again following re-hydration. CMR venography from 23 patients imaged both supine and prone were retrospectively reviewed and measurements of common femoral and iliac veins areas were compared using Wilcoxon test.ResultsCommon femoral vein area on CMR venography increased with prone positioning (83 ± 35 mm2) compared to supine positioning (59 ± 21 mm2) (p = 0.02) and further increased with hydration to 123 ± 44 mm2 (p < 0.01). With right and left side down decubitus positioning, the common femoral vein area on dehydration increased from 29 ± 17 mm2 in the ante-dependent position to 134 ± 36 mm2 in the dependent position (p < 0. 001). Similarly, common and external iliac veins increased in volume with prone, 5.4 ± 1.9 cm3 and 5.8 ± 1.9 cm3 compared to supine positioning 4.6 ± 1.8 cm3 and 4.5 ± 1.9 cm3 (p = 0.01) and further increase with hydration to 6.7 ± 2.1 cm3 and 6.3 ± 1.9 cm3 (p = 0.01). CMR venography on patients also demonstrated an increase in mean common femoral vein luminal area from 103 ± 44 mm2 in supine position to 151 ± 52 mm2 with prone positioning (p < 0.001) as well as increases in common and external iliac vein volumes from 6.5 ± 2.6 cm3 and 8.0 ± 3.4 cm3 in the supine position to 7.5 ± 2.5 cm3 and 9.3 ± 3.6 cm3 with prone positioning (p < 0.01).ConclusionsCommon femoral and common/external iliac vein size on CMR venography may be affected by position and hydration status. Routine clinical CMR venography of the pelvis could include prone positioning and avoiding dehydration to maximize pelvic vein distension.

Deep vein thrombosis occurring early postrenal transplant

In kidney transplant recipients (KTRs), there can be an increased risk of thrombotic diseases. Here, we report a case of KTR, who developed ipsilateral acute iliofemoral deep vein thrombosis (DVT). A 38-year-old male with end-stage renal disease underwent deceased donor renal transplantation. He received antithymocyte globulin induction (2 mg/kg) and was maintained on tacrolimus, mycophenolate mofetil, and steroids. He had delayed graft function. One month posttransplant, the patient presented with right lower limb edema, with Doppler showing DVT of the right external iliac, common femoral, and proximal superficial femoral veins. He was treated with unfractionated heparin and underwent placement of retrieval filter in the infrarenal inferior vena cava (IVC) through the right internal jugular vein approach. Heparin was overlapped and switched to oral acenocoumarol. At 3 months postoperative, the patient is stable with no limb edema and serum creatinine of 0.8 mg/dl. A follow-up venous Doppler demonstrated the resolution of the thrombus. In conclusion, our patient developed DVT within 30-day postoperative period with no apparent risk factor and was successfully treated with anticoagulation and placement of IVC filter. Venography, thrombolysis, and thrombectomy pose challenges in the KTRs because of increased risk of adverse effects such as bleeding, contrast-induced nephropathy, and pulmonary embolism.

Iliac vein aneurysms: a comprehensive review.

Introduction: Iliac vein aneurysm is a rare clinical entity. Iliac venous tract is the least commonlocation for venous aneurysms. There are a few cases of common, external and internal iliac veinaneurysms in the literature. However, undiagnosed and ruptured iliac venous aneurysms couldhave hazardous consequences. Herein, we reviewed all literature cases of iliac vein aneurysms.Their potential diagnostic and therapeutic challenges are discussed. Literature Review: Following a systematic search, 50 cases of iliac venous aneurysms wereidentified. We used MEDLINE [1900-March 2018] and EMBASE [until March 2018]. MeSHterms of iliac vein/veins/venous, hypogastric, inferior vena cava and aneurysm/aneurysms wereused. Fifty patients with venous aneurysms located in common, external or internal iliac veinswere found in our systematic search. Seventeen patients were female (35.4%) and 31 patients weremale (64.6%). The age range was 13 to 70 years of age. The aneurysm was located in right side in17 patients (34%). It was located in left side in 29 patients (58%) and it was bilateral in 4 patients(8%). The aneurysm was located in common, external and internal iliac veins in 15 (30%), 31(62%) and 4 (8%) patients respectively. The aneurysm was due to a previous arteriovenousfistula (AVF) in 19 patients (38%) and of them, 16 patients (32%) had a history of AVF resultingfrom a previous trauma. 29 patients (59.2%) underwent open surgical treatment. Five patients(10.2%) underwent endovascular treatment. One patient (2.0%) underwent hybrid treatment.Conservative treatment was used in 14 patients (28.6%). Conclusion: Iliac vein aneurysms are extremely rare. Its diagnosis necessitates precise clinicalsuspicion and the treatment is based on patients’ clinical scenario and radiological features. Bothopen and endovascular techniques could be feasible. Iliac vein aneurysms are more commonin men. Left sided aneurysms are more common. The most common anatomic location isexternal iliac vein. The most common cause of iliac aneurysms is dilatation of vein secondary toa traumatic AVF.

Domino compensation of the external iliac vein using an ePTFE graft after its procurement for portal vein reconstruction in pancreatic surgery

Domino compensation of the external iliac vein using an ePTFE graft after its procurement for portal vein reconstruction in pancreatic surgery

Domino compensation of the external iliac vein using an ePTFE graft after its procurement for portal vein reconstruction in pancreatic surgery

Domino compensation of the external iliac vein using an ePTFE graft after its procurement for portal vein reconstruction in pancreatic surgery

Vessel Disposition Technique in Kidney Transplantation: Long-term Follow-up at Cho Ray Hospital, Vietnam

In this clinical serial, we would like to introduce a surgical technique for kidney transplantation (KTx) from living donor (LD); we call the vessel disposition technique (VDT), with long-term follow-up results. A prospective study at Cho Ray Hospital. The patients underwent the KTx from 1998-2011 and following-up until 2016. There were 201pts., 130 males (64.7%) and 71 females (35.3%). Average age is 33.56 ± 8.62 year old (yo), [15 to 61yo]. We divided it into two groups (at the back table and recipient surgical table): Group A: The Kidney graft (KG) with short vein (≤20 mm) was transplanted on right iliac fossa: 63/201pts. (31.34%), 13/63 from the left (20.63%) and 50/63 from the right (79.37%): the renal vein was dissected, liberated and prolonged; for the right KG, a renal VDT would be done. On the pts., right Gibson incision, made an iliac VDT: dissection of the right iliac vessels (RIV), moved the external iliac vein (IV) to the right side of the external iliac artery; and a termino-lateral venous anastomosis. The renal artery anastomosis would be done as usual. Group B: The KG with the long vein enough (>20 mm) was also transplanted on RIF: 138/201pts (68.66%). Usually, the KG is the left, the KTx was performing as usual, vascular postoperative follow-up by Doppler ultrasound. There wasn’t any surgical vascular complication during the average FU of: 8.0±3.44 years (group A) and 8.79±4.07 years (group B). During the long time follow-up on the serial, the VDT was satisfactory. The KTx from LD was safety for the short KG vein and we could perform on the right side of the pts for the left and the right KG. We could avoid other risky venous reconstructive techniques.

Novel Anastomotic Technique for Uterine Transplant Using Utero-ovarian Veins for Venous Drainage and Internal Iliac Arteries for Perfusion in Two Laparoscopically Harvested Uteri

Study ObjectiveTo evaluate 2 cases of uterine transplant surgery that used utero-ovarian veins as outflow channels, internal iliac arteries for perfusion, and the organ harvest surgery performed laparoscopically. DesignCase study (Canadian Task Force Classification III). SettingAn urban, private, tertiary care hospital. PatientsTwo patients, ages 30 and 24years, diagnosed with absolute uterine factor infertility secondary to Mayer-Rokitansky-Küster-Hauser syndrome underwent related living donor uterine transplants; donors were their mothers with normal menses. InterventionsRetrieval of organs through minilaparotomy and laparoscopic harvest of donor internal iliac arteries and ovarian veins. Measurements and Main ResultsAnastomosis was completed with bilateral donor internal iliac arteries to recipient internal iliac arteries in an end-to-end manner and with bilateral donor ovarian veins to recipient external iliac veins in an end-to-side manner. The lengths of utero-ovarian veins of both donors were 11 and 11cm on both sides; the lengths of the internal iliac arteries of both donors were 10 and 7.5cm on the left side and 10 and 6cm on the right side. The operative times for harvest surgery, bench surgery and transplant surgery were 2:40 and 3:20 hours, 34:32 and 33:30 min and 4:00 and 4:30 hours respectively for recipients 1 and 2. Daily postoperative uterine Doppler was completed through day 8 and then every other day and showed good intrauterine blood flow (i.e., low resistance arcuate vessel flow; resistance index < .5). Cervical biopsies on postoperative days 7 and 14 showed no evidence of rejection in either recipient. Both recipients started menstruating within 2 months of surgery. ConclusionBy using ovarian veins as outflow channels, the challenges involved in dissection along the internal iliac vein are avoided, and harvesting the donor internal iliac artery reduces the tension on vascular anastomosis. The selection of vessels to be harvested could make the technique reproducible, although larger studies are warranted to confirm results.

A cadaveric study of variations of external iliac artery and its implication in trauma and radiology

A severe and potentially lethal complication in pelvic injuries is arterial bleeding commonly involving the iliac arteries. Hence, the objective of our study was to systematically document the morphology and variations of the external iliac artery in human cadaveric pelvises. Study was conducted on 48 pelvic halves which were obtained by making mid-line saw cuts through formalin embalmed adult human male cadaveric pelvises. The external iliac artery was cleaned, its length and diameter were measured using a scale. Following parameters were noted: variations of the external iliac artery in terms of its location, course, termination, relations with other vessels and variations in its branching pattern. Variations related to the morphology and branching pattern of the external iliac artery was observed in 20 hemipelvises (42%). Nine (19%) hemipelvises showed morphological variations of the artery (looped, tortuous, curved, twisted or 'S' shaped). Variations in the branching pattern of the artery were seen in 6 (13%) hemipelvises and the artery was superficial or medial to the external iliac vein in 5 (10%) hemipelvises. Mean length of the artery was 10cm on the right and 9.9cm on the left side of the pelvis. Its mean diameter was 0.94mm on the right and 0.99mm on left side. Diagnostic and interventional radiologic procedures on the pelvic arteries are becoming more frequent, and hence in here, we have performed the morphological study of the external iliac artery is necessary to guide interventional procedures.

Treatment results for acetabulum fractures using the modified Stoppa approach

ObjectivesThe aim of this study was to evaluate the clinical and radiological results of the surgical treatment of acetabular fractures using modified Stoppa approach. MethodsA total of 57 patients (mean age 37.8 years; range 15–84) who underwent surgical treatment for acetabular fracture with modified Stoppa approach from February 2013 to June 2016 were included into the study. The mean follow-up time was 28.1 months (range 24–35). The records were reviewed for fracture patterns, time to surgery, operative time, blood loss, reduction quality, and perioperative complications. Reduction quality was graded as anatomic, imperfect, or poor. The Harris Hip Score (HHS) and Merle d'Aubigné score were used for functional evaluation. ResultsAmong the 63 acetabulum fractures of the 57 patients, 27 were associated with both columns, 12 were T-type fractures, 10 were transverse, 7 were anterior column/posterior hemitransverse, 5 were anterior column, and 2 were anterior wall fracture. A single surgeon performed all operations. Pfannenstiel incision was used in the first 19 cases while vertical midline incision in the remaining 38 cases. Average time to operation was 5.5 days, and supplemental lateral windows were used in 17 (29.8%) patients. Average blood loss and operation times were 660 mL and 152 min, respectively. Radiological outcomes were anatomic, imperfect, and poor in 52 (82.5%), 9 (14.2%), and 2 (3.2%) of the acetabulum fractures, respectively. Clinical outcomes at 2 years with HHS and Merle d’Aubigné scores were mean 86.6 (range 66–96) (Excellent in 27, good in 23, fair in 4, poor in 3 patient) and 16.7 (range 10–18) (Excellent in 25, very good in 18, good in 6, fair in 5, poor in 3 patient), respectively. There was a significant relation between the reduction quality and clinical outcome (p < 0.001), while there was no significant relation between the clinical outcome and the fracture type (p > 0.05). Iatrogenic external iliac vein damage was noted in 2 patients. Obturator nerve palsy was noted in 3 patients, who recovered spontaneously at mean time of 3.7 months (range 3–5). Rectus abdominus paralysis was noted in 2 of the 19 (10.5%) Pfannenstiel-incision patients but not in the vertical-incision patients. ConclusionOur experience in 57 patients shows that satisfactory results can be obtained, even in bilateral fractures with vertical midline incision. Level of evidenceLevel IV Therapeutic Study

Impact of degree of stenosis in May-Thurner syndrome on iliac vein stenting

ObjectiveMay-Thurner syndrome (MTS) patients with lifestyle-limiting symptoms undergo stenting of the iliac vein for relief of compressive disease. The impact of degree of stenosis on clinical symptoms and outcomes after stenting is unknown and examined in our study. MethodsRetrospective review of contemporaneously entered data of 202 patients who underwent stenting for MTS between 2005 and 2011 was performed. Classification into three groups based on luminal area obtained by intraoperative intravascular ultrasound interrogation of the involved femoroiliocaval segments was carried out. Normal luminal diameters and areas were defined as 12 mm and 125 mm2, 14 mm and 150 mm2, and 16 mm and 200 mm2 in the common femoral, external iliac, and common iliac veins, respectively. Mild (<60%), moderate (60%-89%), and severe (>90%) compression groups were defined using the normal values noted previously and observed after stenting to evaluate outcomes. Kaplan-Meier analysis was done to assess primary, primary assisted, and secondary patencies. Visual analog scale for pain scores, grade of swelling, and Venous Clinical Severity Score (VCSS) before and after stenting at 6, 24, and 48 months were analyzed using paired t-test and Tukey test. Logistic regression was used to gauge the impact of multiple variables including degree of stenosis on stent reintervention. ResultsThere were 55 patients who had mild, 87 patients who had moderate, and 60 patients who had severe iliac vein compression. Baseline demographic characteristics and comorbidities were similar across all groups. In addition, there was no statistically significant difference in median baseline visual analog scale score, grade of swelling, and VCSS among the groups. Compression was treated with angioplasty and stenting encompassing all areas of disease as determined by intravascular ultrasound. Stent technique involved use of Wallstent (Boston Scientific, Marlborough, Mass) only in 183 patients and Wallstent-Z stent (Cook Medical, Bloomington, Ind) combination in the remainder. No difference in median stent patency was noted on follow-up. Clinically, at 48 months, a statistically significant recurrence of pain, swelling, and worsening of VCSS were noted in the severe stenosis group but not in the other two groups. No variable was noted to have an impact on stent reintervention. ConclusionsSeverity of MTS stenosis is not a predictor of initial clinical symptoms. Long term, patients with ≥90% initial MTS stenosis experience recurrence of symptoms. The degree of iliac venous stenosis does not appear to affect stent patency. Such information will help counsel patients before intervention.

Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney

BackgroundIn this case report, we describe a novel application of the technique of ‘dual-balloon assisted’ cannulation and embolisation of a high flow arterial venous fistula (AVF) in transplant kidney, where attempts at standard and previously described embolisation techniques were proving difficult to achieve.Case presentationSeventy year old gentleman with renal transplant presenting with high output cardiac failure and deteriorating renal function. Angiography demonstrated high flow traumatic AV fistula within transplanted kidney, secondary to multiple biopsies. Attempts at guidewire and guiding sheath placement and stability for occlusion plug deployment were failing due to combination of very high back-flow pressures within the AVF and challenging vascular anatomy; with an aneurysmal, tortuous iliac artery as well as intra renal transplanted vessels. A combination of angioplasty and remodeling aortic balloons in the transplant artery and the host external iliac vein respectively, facilitated stabilization of guiding sheath and hence controlled delivery of an occlusion plug from the venous side of the fistula. The fistula was successfully embolised, leading to complete resolution of patient symptoms and improvement of renal function beyond his previous baseline.ConclusionsPercutaneous embolisation is an established technique to treat iatrogenic AVF in transplant kidneys. High flow pressure through an AVF, as demonstrated in this case, can cause difficulty and raise safety issues in accessing and embolising the AVF using previously described techniques. This case report describes an effective and novel application of the technique of using a second balloon in the host common iliac vein to; lower flow pressure, stabilise the guidewires during plug deployment and prevent displacement of wires and/or plug into the common iliac vein.

Rare case of a kidney and inferior vena cava abnormalities with extensive lower extremity deep vein thrombosis in a young healthy male.

Kidney and inferior vena cava (IVC) abnormalities with extensive deep vein thrombosis (DVT) is a very rare cause of DVT and has a diverse clinical presentation. Computed tomography (CT) angiography is the gold standard for diagnosis and treatment including thrombectomy, thrombolysis and systemic anticoagulation. We present a rare case of active young healthy male admitted with acute onset of right lower extremity pain and swelling who was found to have extensive DVT on doppler ultrasound. CT abdomen showed extensive clot burden involving right common femoral vein extending into internal and external iliac veins associated with IVC hypoplasia and hypoplastic left kidney. Patient underwent urgent thrombectomy, catheter directed thrombolysis and was discharged home in stable condition on oral anticoagulation.

Lateral Node Dissection in Rectal Cancer in the Era of Minimally Invasive Surgery: A Step-by-Step Description for the Surgeon Unacquainted with This Complex Procedure with the Use of the Laparoscopic Approach.

Lateral node dissection in rectal cancer has been routinely performed in Eastern countries. Technical and anatomical challenges and potential significant postoperative morbidity associated with the procedure have prevented its implementation into clinical practice in Western countries. However, the minimally invasive approach may offer the opportunity of performing this complex procedure with precise anatomical dissection and minimal intraoperative blood loss. In this setting, proper training and standardization of technical steps is highly warranted for surgeons not fully acquainted with the procedure. Access to the lateral nodes along the obturator and internal iliac vessels is described by using specific anatomical landmarks. Opening of the peritoneum along the ureter provides access to the region of interest. Dissection of the medial limit is performed preserving the neurovascular bundle and ureter. The lateral dissection is performed along the external iliac vein to provide access to the obturator muscle. Identification of the obturator nerve with blunt dissection of the fat is a critical part of the procedure. Once the lymphatic connections between the inguinal and iliac nodes are transected, dissection is performed along the internal iliac vessels, and branches are separated from the lymphadenectomy specimen. Evidence supports that lateral node dissection performed for highly selected patients with minimally invasive access leads to less intraoperative blood loss and similar oncological outcomes. Technical steps illustrated in the present video may aid surgeons in performing this procedure with precise anatomical landmarks and minimal risk for intraoperative complications. Lateral node dissection for rectal cancer is a procedure that may follow standardized technical steps by using precise anatomical landmarks with the use of minimally invasive approach.

Neurofibromatosis type 1-associated multiple rectal neuroendocrine tumors: A case report and review of the literature.

Neurofibromatosis type 1 (NF-1) is commonly associated with benign or malignant tumors in both the central and peripheral nervous systems. However, rare cases of NF-1-associated multiple rectal neuroendocrine tumors have been reported. This report describes a case of a 39 year old female with NF-1 and intermittent hematochezia as a primary symptom. Physical examination showed multiple subcutaneous nodules and café au lait spots with obvious scoliosis of the back. Imaging examinations and colonoscopy found malformation of the left external iliac vein and multiple gray-yellow nodules with varying sizes and shapes in the rectal submucosal layer. Histological and immunohistochemical results suggested multiple rectal neuroendocrine tumors, a rare disease with few appreciable symptoms and a particularly poor prognosis. The patient with NF-1 presented here had not only multiple rectal neuroendocrine neoplasms but also vascular malformations, scoliosis and other multiple system lesions. This case therefore contributes to improving clinical understanding, diagnosis and treatment of related complications for patients with NF-1 who present with associated medical conditions.

Radiological characteristics and predisposing factors of venous tumor thrombus in pelvic osteosarcoma: A mono-institutional retrospective study of 115 cases.

BackgroundVenous tumor thrombus (VTT) in pelvic osteosarcoma has been regarded as a rare oncological condition and few literatures investigated this issue.MethodsWe retrospectively reviewed 115 cases of pelvic osteosarcoma treated in our center from 2006 to 2016. Diagnosis of VTTs was made based on histo‐pathological findings. We summarized the radiological manifestations of VTTs on CT, MRI, and PET/CT. We also compared the demographical, oncological, and radiological data between cases with or without VTTs to identify its predisposing factors.ResultsSeventeen cases (14.8%) were diagnosed with VTT. Manifestations of VTTs on CT included increased caliber (64.7%), calcification (47.1%), low density on plain scan (100%), filling defect (100%), and streak‐like enhancement (35.7%) on contrast enhancement. On MRI, the VTTs could be hypo‐ or iso‐intense on T1WI (100%), hyperintense on T2WI (100%), and filling defect on contrast enhancement (100%). PET/CT showed high metabolic activity of the VTTs. The ranges of the VTTs included unilateral external iliac vein (EIV) (two cases), unilateral internal iliac vein (IIV) (one case), unilateral common iliac vein (CIV) and IIV (five cases), unilateral CIV + EIV (two cases), inferior vena cava (IVC) and unilateral CIV + EIV (one case), IVC and unilateral CIV + IIV (four cases), IVC and bilateral CIVs + IIVs (two cases). Multivariate analysis indicated that chondroblastic subtype and involvement of L5/S1 intervertebral foramen might predispose to VTTs.ConclusionThe incidence of VTTs in pelvic osteosarcoma was 14.8%. Comprehensive radiological studies help preoperative diagnosis of VTTs. Predisposing factors included chondroblasic subtype and involvement of L5/S1 intervertebral foramen.

Treatment of large renal allograft arterial pseudoaneurysm with in situ cold perfusion, ex vivo vascular reconstruction and reimplantation

Background: Pseudoaneurysm after renal transplantation is a rare but serious complication. Case Presentation: We report a case of a 76-year-old man who presented six weeks after kidney transplant with a large pseudoaneurysm arising from the renal artery anastomosis, causing renal vein compression and renal allograft dysfunction. Prior to the removal of the transplanted kidney, an in situ cold perfusion of the allograft was performed. The pseudoaneurysm was repaired ex vivo and the renal artery was reconstructed. External iliac vein was reconstructed with deceased donor interposition allograft, and the kidney was then re-implanted. The patient recovered with immediate allograft function. Conclusions: Successful surgical management of a large renal allograft arterial pseudoaneurysm involves avoidance of dissection of the pseudoaneurysm, utilization of in situ cold perfusion and en-bloc removal of the kidney together with pseudoaneurysm, and pseudoaneurysm incision and vascular bypass reconstruction ex vivo