Iliac Artery Research Articles

The anatomy of the anterior division of the internal iliac artery: a computed tomography angiography analysis with implications for surgical and endovascular procedures.

The anterior division of the internal iliac artery (ADIIA) is a crucial vascular structure that supplies blood to the pelvic organs, perineum, and gluteal region. The present study demonstrates practical data concerning the anatomy of the ADIIA and its branches. It is hoped that the results of the current study may aid in localizing the pelvic arteries effectively. The present study is a retrospective analysis that was carried out to determine the anatomical variations, prevalence, and morphometric data of the ADIIA and its branches. Ultimately, 148 ADIIAs from 73 patients met the necessary criteria and were evaluated in 45 categories. The most prevalent branch of the ADIIA was found to be the internal pudendal artery, as it was present in 134 of the studied cases (90.5%). The most common first branch of the ADIIA was found to be the umbilical artery (48.5%), whereas the most common last branch of the ADIIA was found to be the inferior gluteal artery (68.4%). The median distance between the origin of the ADIIA and the origin of the uterine artery was found to be 12.00mm (LQ = 7.49; HQ = 18.63). The median diameter of the ADIIA at its origin was found to be 5.76mm (LQ = 4.80; HQ = 6.45), whereas the median cross-sectional area at the same point was set to be 24.77 mm2 (LQ = 17.65; HQ = 31.95). It is hoped that the results of the present study will assist in the localization of the branches of the ADIIA in cases of pelvic hemorrhage and during various pelvic surgeries, including laparoscopic hysterectomies.

HC-A solution limb perfusion alleviates liver damage induced by limb ischemia-reperfusion injury in pigs.

The aim of the study was to explore a feasible method for alleviating limb ischemia-reperfusion injury (LI/RI) through the use of a high-concentration citrate solution (HC-A solution) for limb perfusion (LP). Eighteen pigs were divided into three groups: the Sham group, LI/RI group, and HCA group. The Sham group underwent exposure of the iliac artery and vein. The LI/RI group underwent tourniquet placement and clamping of the iliac artery and vein to simulate LI/RI. The HCA group received HC-A solution LP for 30 min through the left iliac artery below the level of blood flow occlusion based on the LI/RI group. Oxidative stress markers and inflammatory response markers were compared among the three groups. Compared to the LI/RI group, the HCA group showed significantly lower levels of serum creatine kinase (CK), lactate dehydrogenase (LDH), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), aspartate aminotransferase (AST), and alanine aminotransferase (ALT), and significantly greater activities of serum superoxide dismutase (SOD) (p < 0.05). There were no significant differences in serum interleukin-6 (IL-6) or in muscle MDA, SOD, TNF-α, and IL-6 between the HCA group and the LI/RI group (p > 0.05). Compared to the LI/RI group, MDA, TNF-α, and IL-6 levels in the liver were significantly lower in the HCA group (p < 0.05), while SOD activities were not significantly different (p > 0.05). Histopathological examination revealed reduced skeletal muscle and liver damage in the HCA group compared to the LI/RI group. HC-A solution LP can alleviate liver damage caused by LI/RI in pigs.

Advances in Diagnosis, Treatment and Prognostic in Aortoiliac Occlusive Disease - A Narrative Review.

Aortoiliac disease (AID) is a variant of peripheral artery disease involving the infrarenal aorta and iliac arteries. Similar to other arterial diseases, aortoiliac disease obstructs blood flow through narrowed lumens or by embolization of plaques. AID, when symptomatic, may present with a triad of claudication, impotence, and absence of femoral pulses, a triad also referred as Leriche Syndrome (LS). The authors aim to review the available evidence on the management of the aortoiliac occlusive disease and describe its clinical characteristics, diagnosis and treatment management. A comprehensive review of the literature was carried out to collect data from relevant studies concerning patients with moderate to severe symptomatic aortic occlusive disease. The data was identified by a search using PubMed and Google Scholar with the keywords / MESH terms "aortoiliac occlusive disease". For this study, the authors included papers published in the past two decades, written in English. The diagnosis and evaluation of extensive aortoiliac disease involves several important considerations: vascular imaging plays a fundamental role in confirming the diagnosis of peripheral artery disease (PAD), evaluating the severity and extent of the disease and directing the planning of revascularization procedures. It provides essential information to select the most appropriate treatment modality. Despite successful revascularization, patients are at high risk of mortality and numerous life-threatening complications. Clinical and imagiologic factors may be used for risk stratification in order to select appropriate patients for revascularization and to better counsel patients about expected postoperative outcomes.

Deep circumflex iliac artery aneurysm-related retroperitoneal hemorrhage mimicking a ruptured abdominal aortic aneurysm

Introduction: Deep circumflex iliac artery (DCIA) aneurysm is a rare cardiovascular condition whose clinical characteristics are largely unknown. Herein, we report a case of retroperitoneal hematoma caused by a ruptured DCIA aneurysm that mimicked a ruptured abdominal aortic aneurysm (AAA). Case Report: An 87-year-old woman presented to our hospital with sudden onset of severe abdominal pain. Computed tomography (CT) showed a 58-mm AAA and a marked retroperitoneal hematoma. The patient was diagnosed with ruptured AAA and underwent emergency graft replacement. Owing to the persistent hemorrhage, repeat CT evaluation was performed, which revealed a hemorrhage from an aneurysm in the DCIA. Consequently, coil embolization was performed to achieve hemostasis. Conclusion: Although DCIA aneurysms are uncommon, the possibility should be considered when diagnosing cases of retroperitoneal hemorrhage, as DCIA yields CT findings and symptoms similar to those of a ruptured AAA.

Reversed anatomy in transanal lateral lymph node dissection: landmarks and pitfalls.

Lateral lymph node dissection (LLND) is getting global attention as an asurgical option to reduce local recurrence inlocally advanced rectal cancer. As the transanal total mesorectal excision (TaTME) is gaining popularity worldwide, a novel LLND approach was established adoptinga two-teamapproach that combines the transabdominal and transanal approaches using the TaTME technique. Thisnarrative review describes the advantages, anatomical landmarks, surgical techniques, and pitfalls of transanal LLND (TaLLND). The advantages of TaLLND include a magnified view and enhanced maneuverability of the laparoscopic instruments in the deep pelvis. TaLLND is also beneficial for LLND in patients with a history of pelvic surgery because surgeons can have access to theareas unaffected by previous surgery. To master the TaLLND technique, the procedure should be understood according to the following steps: S4 nerve identification, lateral space entry, lateral dissection, obturator vein, artery, and nerve identification, dissection along the external iliac vein, medial dissection, median and bottom dissection, dissection along the internal iliac artery, and dissection along the obturator nerve. TaLLND can be applied to highly advanced diseasethat requires combined resection of themajor internal iliacvessels, pelvic nerves, or adjacentorgans. In such cases, simultaneous transanal and transabdomiinalLLND utilizing a two team approachhas advantages as theseapproachescan providemutualcomplementary roles. TaLLND is expected to overcome the difficulty of transabdominal LLND and improve the quality of LLND.

The benefit of additional embolization after perioperative balloon occlusion of pelvic artery during cesarean hysterectomy in placenta accreta spectrum.

Cesarean hysterectomy in the placenta accreta spectrum (PAS) remains challenging due to difficulty in controlling perioperative bleeding. To compare the effectiveness and safety of perioperative balloon occlusion with versus without pelvic artery embolization in PAS women who underwent a cesarean hysterectomy. A total of 26 pathological confirmed cases of PAS were retrospectively reviewed and categorized into two groups: perioperative balloon occlusion at either the anterior division of the internal iliac artery or uterine artery followed by gelfoam embolization (n = 12, study group) and perioperative balloon occlusion alone (n = 14, control group). Intraoperative estimated blood loss (EBL), a unit of packed red blood cell (pRBC) transfusion, surgical time, transfer to the intensive care unit (ICU), postoperative hospitalization days, postoperative complications, and Apgar scores were compared between the two groups. The median and interquartile range (IQR) intraoperative EBL in the study group (1200 mL [700-2100 mLl]) was significantly lower compared to those in the control group (1900 mL [1300-3200 mL]) (P = 0.044). There was no significant difference between the study and control groups in units of pRBC blood transfusion, surgical time, transfer to the ICU, postoperative length of stay, postoperative complications, and mean Apgar score at 1 min and 5 min. The perioperative combination of balloon occlusion followed by embolization of the pelvic artery before cesarean hysterectomy is more effective in reducing blood loss than perioperative balloon occlusion alone in PAS with no difference in postoperative complications or neonatal outcomes.

The Role of Interventional Radiology in Managing Placenta Accreta Spectrum Disorder.

Interventional Radiology (IR) can be a crucial player in managing placenta accrete spectrum disorder (PAS), offering minimally invasive angiographic techniques that can prevent or control hemorrhage and preserve fertility. These include prophylactic balloon occlusion of the aorta or iliac arteries, preoperative catheter placement in the iliac or uterine arteries for subsequent embolization, or pre-emptive arterial embolization preceding hysterotomy and delivery. This review provides obstetricians with an overview of IR's role in the management of PAS by describing specific endovascular techniques; existing outcomes data; and considerations for protocol development, preoperative planning, and intraoperative dynamics for when IR assists with PAS cases.

Magnetic resonance imaging and pathological findings of aortoiliac thromboembolism with a thoracic aortic mural thrombus in a Japanese Black calf.

A 24-day-old female Japanese Black calf presented a sudden paraplegia after a history of watery diarrhea. Antemortem magnetic resonance imaging confirmed the suspicion of thrombotic component in the abdominal aorta, without any spinal cord abnormality at the lumbar region. On necropsy, a massive thrombus occupied the lumen from the distal abdominal aorta to the bifurcation of the external iliac arteries. In the thoracic aorta, another mural thrombus developed from the caudal side of the incompletely closed ductus arteriosus orifice, with aortic wall erosion. Both thrombi were mainly composed of platelets. Any microbes were undetected during organ and thrombus incubations. A saddle embolism in the abdominal aorta occurred by an abacterial white thrombus suspiciously originated from the thoracic aortic mural thrombus.

Impact of open femoral endarterectomy on treating multilevel iliac and common femoral artery occlusive disease

Impact of open femoral endarterectomy on treating multilevel iliac and common femoral artery occlusive disease

Deep Circumflex Iliac Artery (DCIA) Free-Flap Mandibular Reconstruction Using Patient-Specific Surgical Guides and Customized Plates: A Preliminary Study

Background: Mandibular reconstruction remains challenging in oral and maxillofacial surgery due to its complex anatomy and functional requirements. While Deep Circumflex Iliac Artery (DCIA) flaps offer advantages in bone height and natural contour, their application with computer-aided surgical planning remains limited. Aim: This preliminary study aimed to evaluate the accuracy and clinical outcomes of mandibular reconstruction using DCIA free flaps with patient-specific surgical guides and customized plates. Materials and Methods: A pilot study of five patients who underwent mandibular reconstruction using DCIA free flaps was conducted. Virtual surgical planning was performed using Cone-Beam Computed Tomography (CBCT) and pelvic Computed Tomography (CT) data to design patient-specific cutting guides and reconstruction plates. All surgeries were performed by a single experienced surgeon using standardized techniques. Results: The mean deviation between the virtual planning and actual surgical outcomes was 0.73 ± 0.23 mm, with maximum deviations ranging from 3.87 to 7.83 mm. All flaps achieved 100% survival, with one case (20%) experiencing screw loosening that required plate removal. This complication led to the modification of the plate design to include six or more holes in subsequent cases. Conclusions: Despite limitations including the small sample size and short follow-up period, our preliminary results demonstrate that computer-aided surgical planning with patient-specific devices can significantly improve the accuracy and predictability of DCIA flap mandibular reconstruction, even in challenging revision cases. Further studies with larger patient cohorts are needed to validate these findings.

Aortoiliac Morphology in a Thai Cohort: Implications for Endovascular Aneurysm Repair

Objective: To comprehensively characterize the aortoiliac segment in Thai patients with abdominal aortic aneurysms (AAAs) and to assess the suitability of employing endovascular aneurysm repair (EVAR) across different stent-graft devices. Materials and Methods: Electronic medical records of AAA patients eligible for treatment between January 2014 and August 2020, drawn from the Songklanakarin Hospital database, were systematically analyzed. Preoperative assessments of whole aorta CT angiograms were conducted using ‘Endosize’ software, scrutinizing various anatomical parameters. The suitability of eight FDA-approved stent devices for EVAR was determined based on stringent criteria. Results: Distinct variations in aortoiliac morphology were identified in the Thai population, deviating from characteristics observed in Western populations. Notably, these variances included smaller dimensions overall, juxtaposed with a marginally larger maximum aneurysm diameter. Key measurements encompassed suprarenal and infrarenal angles of 28 and 45.6 degrees, neck diameter and length of 21.1 and 25.3 mm, maximum aneurysm diameter of 62.8 mm, and aortic bifurcation at 29.7 mm. Common iliac artery dimensions featured diameters of 12.7 and 13 mm, coupled with lengths of 52.8 and 54.4 mm. Femoral artery diameters were recorded at 7.1 and 7.2 mm. Stent-graft compatibility exhibited variability, ranging from 24.9% to 67%, with Ovation® demonstrating the highest compatibility and AFX® the lowest. Common iliac length demonstrated greater compatibility, in contrast to diminished compatibility associated with larger neck and common iliac diameter requirements. Conclusion: The present investigation uncovered distinctive morphological features within the aortoiliac segment of the Thai population, thereby contributing to the observed variations in EVAR compatibility across different stent-graft manufacturers. The results underscore the pivotal role of ethnicity as a crucial determinant in vessel morphology, with implications that hold particular relevance for the ongoing design and development of stent-grafts. The unique insights derived from the present study enhance understanding of population-specific anatomical considerations, thereby enriching the field of vascular surgery.

Effectiveness of single-energy metal artifact reduction algorithm in CT: application to contrast-enhanced CT with EVAR and coil embolization.

This study aimed to evaluate the efficacy of the single-energy metal artifact reduction (SEMAR) algorithm in reducing metal artifacts and enhancing image quality in contrast-enhanced computed tomography (CT) for patients undergoing endovascular aneurysm repair (EVAR) with coil embolization. Thirty-eight patients (mean age 81.0 ± 6 years; 31 men, 7 women) who underwent contrast-enhanced CT following EVAR and internal iliac artery coil embolization between September 2022 and May 2023 were retrospectively analyzed. The Artifact Index (AI) quantified metallic artifacts from internal iliac artery aneurysm coils in CT images, calculated from the standard deviation of the artifact-containing region relative to a reference region. CT values of the external iliac artery at the same slice were also evaluated and compared. Two radiologists independently performed qualitative assessments of SEMAR and non-SEMAR images. SEMAR significantly reduced metal artifacts, decreasing the AI from 171.9 ± 74.5 HU to 35.8 ± 16.9 HU (p < 0.001). The mean CT values of the external iliac artery were similar for SEMAR (259.4 ± 63.7 HU) and non-SEMAR (257.1 ± 63.6 HU, indicating no significant difference. Qualitative assessment scores improved significantly with SEMAR (from 1.0 ± 0.0 to 2.5 ± 0.5; p < 0.001), enhancing visualization of internal iliac artery aneurysms. Interobserver agreement was high (κ = 0.83). The SEMAR algorithm effectively reduces metal artifacts in contrast-enhanced CT, significantly enhancing image quality without altering adjacent artery CT values. These improvements enhance the image quality of post-operative assessments in patients undergoing EVAR with coil embolization.

Biomechanical and clinically controlled study of different fenestration positions in vascularized iliac bone flaps for treating femoral head necrosis

BackgroundNo appropriate studies have been conducted that compare the biomechanical properties of different fenestration positions in deep circumflex iliac artery (DCIA)-vascularized iliac bone grafts for femoral head necrosis (ONFH) treatment. In this study, we aimed to explore the fenestration locations of DCIA-vascularized iliac grafting in ONFH treatment using FEA and clinical retrospective analysis.MethodsWe simulated an iliac bone flap transplantation with a vascularized tip by finite element analysis (FEA). Patients were divided into four groups using different femur fenestration positions as follows: center-window group (C-group), superior-window group (S-group), medial-window group (M-group), and inferior-window group (I-group). In this study, we primarily observed the maximum femoral stress at different healing degrees (0, 25, 50, 75, and 100%). We retrospectively analyzed the changes in the postoperative Harris scores (HHS) and the imaging of 16 patients with iliac flaps for ONFH (11 and 5 cases in the center and other-positioned groups, respectively) at the final follow-up visit.ResultsThe FEA results showed that the peak von Mises stresses in the four groups at the time of complete healing were in the following order: group C (20.28 MPa) < group I (20.33 MPa) < group M (20.92 MPa) < group S (22.00 MPa). A clinical retrospective study following a comparison of the two groups found that the mean improvement in HHS was 18.00 ± 12.38 in the center-window group and 13.60 ± 25.55 in the other groups. However, no significant difference was observed in the rate of collapse (36.37 vs. 40.00%) or changes in the HHS between the two groups.ConclusionA fenestration at the center of the femoral neck resulted in improved biomechanical gain and clinical outcomes.Trial registrationapproval was granted by the Ethics Committee (II202418102).

A Bleed From the Distal Anastomosis Site of a Bypass Graft From the Left Common Iliac Artery to the Celiac Trunk Treated With a Surgeon-Modified Fenestrated Endograft.

The use of surgeon-modified fenestrated endograft to treat a bleeding complication in the common iliac artery. An Endurant limb graft was modified on back table in theater after planning the fenestration using a semi-automated centerline. The Endurant stent was planned to land flush at the aortic bifurcation. The Endurant limb was partially deployed until the fenestration opened facing the anastomosis to enable rotation and axial movement of the stent graft, if needed. By obtaining access from the contralateral common femoral artery, the fenestration was cannulated using up-and-over technique and bypass graft cannulated. The Endurant stent graft was then fully deployed. Through a separate puncture in the ipsilateral sheath, the fenestration was re-cannulated using a hydrophilic wire, and a balloon-expandable covered stent was introduced through a 7F sheath and then flared in a kissing fashion along with the Endurant stent. The distal part of the Endurant limb was extended with a bare metal stent into the external iliac artery. Control angiography was satisfactory, and bleeding was controlled. Surgeon-modified stent graft in the iliac arteries can be used even in the context of non-aneurysmal disease to treat patients in high-risk emergency situations and could be part of the armamentarium of the vascular surgeon. Physician-modified endografts are increasingly being used by vascular surgeons and interventional radiologists to treat patients with complex aorto-iliac aneurysms in whom custom-made endograft provided by the manufacturer is too expensive to produce and/or patient requires urgent surgery. Data on the use of physician-modified endografts to treat non-aneurysmal disease is lacking. This technical note highlights the use of physician-modified endograft to treat a patient with bleeding complication from the distal anastomosis of an iliac artery to coeliac trunk bypass graft in whom open surgery posed unacceptable high morbidity and mortality risks. This technical note continues to add more information and knowledge to the vascular surgery / interventional radiology communities on the use of physician-modified endografts and also adds another tool in the armamentarium of teams involved.

Cullen Sign Associated with External Iliac Artery Aneurysm Rupture: A Case Report

Introduction: Cullen sign is an area of periumbilical ecchymosis that results from blood tracking along the round ligament. Any source of retroperitoneal or abdominal hemorrhage can cause Cullen sign, but it is often described in association with acute pancreatitis. Case Report: Here we report a case of a chronically ill male who presented with a bulging sensation in his lower abdomen and lower abdominal pain. On physical examination this patient was noted to have a large area of periumbilical ecchymosis predominantly on the left aspect of the umbilicus, consistent with Cullen sign. Computed tomography abdomen and pelvis were remarkable for an enlarging left external iliac artery aneurysm with adjacent hematoma and multifocal intraperitoneal hematoma tracking into the right side of the abdomen, concerning for aneurysmal rupture. The patient was taken to the operating room for a left iliac artery arteriogram and stent placement. Conclusion: Isolated iliac artery aneurysms are rare and represent less than 2% of all abdominal aneurysmal disease; furthermore, external iliac artery aneurysms are exceedingly rare and account for the least common abdominal aneurysmal pathology. This case demonstrates the importance of considering other etiologies of Cullen sign beyond pancreatitis, including aneurysmal ruptures.

Successful Bailout of Intraoperative External Iliac Artery Rupture by Aorto-Uni-Iliac Stent Grafting and Femoral-Femoral Crossover Bypass in a Patient With a Giant Common Iliac Artery Aneurysm

Successful Bailout of Intraoperative External Iliac Artery Rupture by Aorto-Uni-Iliac Stent Grafting and Femoral-Femoral Crossover Bypass in a Patient With a Giant Common Iliac Artery Aneurysm

Enhancing Mandibular Reconstruction with Surgeon–Bioengineer Collaboration: A Protocol for Virtual Surgical Planning

Background/Objectives: Computer-assisted mandibular reconstruction requires sophisticated technical expertise alongside surgical knowledge. This study aims to establish and validate an efficient collaborative protocol between oral and maxillofacial surgeons and bioengineers for virtual surgical planning in mandibular reconstruction. Methods: We developed a structured protocol with four sequential phases: (1) generation of 3D models from CT data, (2) virtual resection planning, (3) reconstruction design, and (4) surgical guide fabrication. Protocol efficiency was assessed through seven simulation trials measuring planning duration and required revisions. Clinical validation was performed in four mandibular reconstruction cases. Accuracy was evaluated by comparing virtual surgical plans to postoperative outcomes using 3-matic 13.0 software analysis. Results: Protocol implementation showed consistent efficiency across simulations with a mean planning duration of 2.86 working days (SD = 1.35). Only two of seven simulations required design revisions. Clinical application in four cases (three ameloblastomas, one odontogenic myxoma) demonstrated high precision with a mean virtual-to-actual discrepancy of 0.90 mm (SD = 0.34). Successful reconstructions were achieved across varying defect spans (29–53 mm) using both bicortical deep circumflex iliac artery (DCIA) flaps and monocortical iliac block bone grafts. The collaborative workflow resulted in optimized surgical guide design, reduced planning iterations, and improved surgical precision. Conclusions: The established surgeon–bioengineer collaborative protocol enhances the efficiency and accuracy of computer-assisted mandibular reconstruction while making advanced surgical planning techniques more accessible. While initial results are promising, future studies with larger patient cohorts and extended follow-up periods are needed to fully validate the protocol’s long-term benefits and broader applicability.

Total Pelvic Exenteration with Presacral Fascia and Pelvic Musculature Excision for Pelvic Recurrence of Rectal Cancer.

Local relapse has not been eradicated even in the era of total mesorectum excision.1,2 Although various approaches have been attempted, R0 resection remains the only potentially curative treatment.3,4 PATIENT AND METHODS: A 45-year-old woman with a history of laparoscopic abdominoperineal resection was diagnosed with pelvic recurrence 7 months ago. Then, she received chemoradiotherapy. Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) showed pelvic recurrences at the surface of the right piriformis and obturator internus, posterior vaginal wall, and presacral fascia. The patient also had bilateral hydronephrosis. No distant metastasis was found. First, the lateral pelvic lymph nodes were removed. Then, the internal iliac arteries and veins were transected. Next, the fibrotic ureters were isolated and cut. Then, presacral fascia at the S4 and S5 levels was excised. Anteriorly, the urethra and vagina were transected. Lastly, the suspected pelvic recurrent lesions were resected en bloc with partial right piriformis, obturator internus, and gluteus maximus through a combined abdominal and perineal approach. Greater omental pedicle flap was transplanted into the pelvic cavity and pelvic floor was reconstructed. The operative time was 600min, and blood loss was 400ml. Postoperative course was uneventful, and the patient was discharged 14days after surgery. Pathology report showed a moderately differentiated rectal adenocarcinoma invading the vagina, presacral fascia, and pelvic musculature. All margins were negative. As demonstrated by this case, image-guided total pelvic exenteration with presacral fascia and sidewall musculature excision provides an opportunity to cure pelvic recurrence of rectal cancer.5.

Deep Learning Models for Automatic Classification of Anatomic Location in Abdominopelvic Digital Subtraction Angiography.

To explore the information in routine digital subtraction angiography (DSA) and evaluate deep learning algorithms for automated identification of anatomic location in DSA sequences. DSA of the abdominal aorta, celiac, superior mesenteric, inferior mesenteric, and bilateral external iliac arteries was labeled with the anatomic location from retrospectively collected endovascular procedures performed between 2010 and 2020 at a tertiary care medical center. "Key" images within each sequence demonstrating the parent vessel and the first bifurcation were additionally labeled. Mode models aggregating single image predictions, trained with the full or "key" datasets, and a multiple instance learning (MIL) model were developed for location classification of the DSA sequences. Model performance was evaluated with a primary endpoint of multiclass classification accuracy and compared by McNemar's test. A total of 819 unique angiographic sequences from 205 patients and 276 procedures were included in the training, validation, and testing data and split into partitions at the patient level to preclude data leakage. The data demonstrate substantial information sparsity as a minority of the images were designated as "key" with sufficient information for localization by a domain expert. A Mode model, trained and tested with "key" images, demonstrated an overall multiclass classification accuracy of 0.975 (95% CI 0.941-1). A MIL model, trained and tested with all data, demonstrated an overall multiclass classification accuracy of 0.966 (95% CI 0.932-0.992). Both the Mode model with "key" images (p < 0.001) and MIL model (p < 0.001) significantly outperformed a Mode model trained and tested with the full dataset. The MIL model additionally automatically identified a set of top-5 images with an average overlap of 92.5% to manually labelled "key" images. Deep learning algorithms can identify anatomic locations in abdominopelvic DSA with high fidelity using manual or automatic methods to manage information sparsity.

Pre-distance assessment from radial artery to lower extremity arterial lesion.

Endovascular treatment (EVT) for patients with lower extremity artery disease is widely used as a less invasive alternative to surgical bypass. Recently, transradial artery intervention has gained popularity owing to its minimally invasive nature. The distance from the radial artery to the target vessel is critical for success; however, effective pre-assessment methods have not yet been established. This study aimed to evaluate the usefulness of predistance measurements from the left radial artery using simple computed tomography (CT) images. In this study, distance measurements were performed from the left radial artery to the left and right iliac artery bifurcations and from the left radial artery to the common femoral artery at the upper femoral border. These distances, measured using CT images before and after the lower-extremity contrast study, were compared with the distances identified during the lower-extremity contrast study. Distances measured using simple CT images showed a high correlation with the distances identified during the lower-extremity contrast examination (r = 0.9317, p < 0.0001; from the left radial artery to the left and right iliac artery bifurcation; r = 0.9402, p < 0.0001; and from the left radial artery to the right common femoral artery at the upper femoral border). Our results suggest that pre-distance measurement using simple CT images can be a useful tool for EVT using the left radial artery approach. Although future large-scale studies are required, this technique merits consideration owing to its widespread adoption in clinical practice.