Iliolumbar Artery Research Articles

The complete anatomy of the iliolumbar artery: a meta-analysis with clinical implications.

The arterial anatomy of the pelvic region is highly variable, and variations in the anatomy of the ILA may often be observed in its point of origin. The main objective of the present meta-analysis was to provide the most up-to-date and evidence-based data regarding the complete anatomy of the iliolumbar artery (ILA. It is hoped that our results may aid in reducing possible complications associated with various procedures performed in the pelvis. To perform this meta-analysis, major online medical databases - PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar - were searched through to find all studies considering the anatomy of the ILA. The pooled prevalence of the ILA originating from the Internal Iliac Artery, in the overall analysis, was found to be 93.62% (95% CI: 82.96-99.63%). Mean diameter of the ILA was found to be 2.67 mm (Standard Error = 0.19 ; Lower Limit = 2.29 ; Upper Limit = 3.05). Mean length of the ILA was established at 12.50 mm (Standard Error = 1.64 ; Lower Limit = 9.28 ; Upper limit = 15.73). The anatomy of the ILA was found to be quite constant, in contrast to what has been discussed in the literature. The said artery originated most frequently from the internal iliac artery (93.62%). Most frequently, this artery originated from the internal iliac artery (observed in approximately 93.62% of cases). Notably, the results of our current meta-analysis indicate that the average distance between the ILA's point of origin, the lower margin of the L5 vertebra, and the bifurcation site of the common iliac artery were 43.20 mm and 28.58 mm, respectively.

Gross anatomy of vascular supply and drainage of mammary fat pads in mice models.

This work extensively studied the vasculature of mice mammary fat pads (BALB/c and C57BL/6) with special reference to haematogenous drainage routes. Mammary fat pads were five pairs (first cervical, second and third thoracic, fourth abdominal and fifth inguinal), bilaterally symmetrical, extending laterally and continuously with the subcutaneous fascia. The superficial cervical artery and vein primarily accomplished the blood vasculature of the first mammary fat pad, while the lateral thoracic and external thoracic arteries and veins supplied the second and third mammary fat pads. The superficial cervical vein (found parallel to the superficial cervical artery) drained into the external jugular vein. The lateral thoracic artery and external thoracic artery branched almost at the same level as the axillary artery (branch of subclavian artery), the latter being more medial in position. However, in some specimens, the branching of both arteries appeared to be at the same level, and their origins were indistinguishable. The lateral thoracic vein that was parallel to the lateral thoracic artery drained to the axillary vein close to the drainage of the external thoracic vein. The lateral thoracic, superficial caudal epigastric, iliolumbar and external thoracic arteries and veins vascularized the fourth mammary fat pad and displayed anastomosis among themselves. The iliolumbar vein (found parallel to the iliolumbar artery) drained into the inferior vena cava. The superficial caudal epigastric vein (found parallel to the superficial caudal epigastric artery (SCaEA)) drained into the femoral vein. Unlike humans, the internal thoracic artery and vein did not participate in the vasculature of mammary fat pads. The SCaEA and vein supplied blood and drained the fifth mammary fat pad. The anatomical continuity of the fourth and fifth mammary fat pads provided common drainage for both mammary fat pads. The BALB/c and C57BL/6 mice strains studied did not differ in topography and size of mammary fat pads. The vascular supply and drainage of the mammary fat pads also did not differ in the strains studied. Only minor variations could be noted in the small veins draining into the lateral thoracic vein. Lateral tributaries seen in the terminal end of the lateral thoracic vein were absent in the C57BL/6 mice.

Patent iliolumbar artery increase no risk of type II endoleaks after endovascular abdominal aortic aneurysm: a case-control study.

The aims of the present study were to explore the risk factors for type 2 endoleaks (T2ELs) after endovascular aneurysm repair (EVAR) and the association between T2ELs and the iliolumbar artery. A single-center, retrospective case-control study in West China Hospital was conducted among patients with infrarenal abdominal aortic aneurysm (AAA) who underwent EVAR between June 2010 and June 2019. The associations of patient characteristics, anatomical factors, internal iliac artery embolization, and ILA with the primary outcome were analyzed. The secondary objective was to analyze survival and reintervention between the T2EL group and the non-T2EL group. Kaplan-Meier survival, propensity matching analysis and multivariate logistic regression analysis were used. A total of 603 patients were included. The median follow-up was 51 months (range 5.0-106.0). There was a significant difference in the diameter of the lumbar artery (LA), middle sacral artery (MSA) and inferior mesentery artery (IMA), proportion of thrombus and LA numbers. The univariate analysis showed that T2ELs were more likely to develop more thrombus in aneurysm cavity (OR = 0.294, p = 0.012), larger MSA (OR = 1.284, p = 0.04), LA (OR = 1.520, p = 0.015), IMA (OR = 1.056, p < 0.001) and more LAs (OR = 1.390, p = 0.019). The multivariate analysis showed that the number of LAs (HR: 1.349, 95% CI: 1.140-1.595, p < .001) and the diameter of the IMA (HR: 1.328, 95% CI: 1.078-1.636, p = 0.008) were significantly associated with T2ELs. There were no new findings from the propensity score matching. The reintervention-free survival rates were significantly different between the two groups (p = 0.048). Overall survival and AAA-related death rates were not different between the two group. This was consistent with the PSM analysis. The iliolumbar artery and the different internal iliac artery interventions may not increase the incidence of T2ELs. But the numbers of LAs and IMA diameter were independent risk factors for T2Els. T2ELs was associated with the reintervention but did not affect long-term survival or increase aneurysm-related mortality after EVAR.

Improvement in Quality of Life Following Celiprolol Hydrochloride Administration in a Patient with Vascular Ehlers–Danlos Syndrome: A Case Report

A 40-year-old female, who underwent transcatheter arterial embolization due to acute bleeding from an iliolumbar artery, was subsequently genetically diagnosed with vascular Ehlers–Danlos syndrome. She experienced chronic anemia for many years due to the easy bruising of her whole body. The bruising improved with oral administration of celiprolol hydrochloride. There were no cardiac or vascular events during the 7 years following the transcatheter arterial embolization. Vascular Ehlers–Danlos syndrome requires specialized treatment that is scientifically proven to prevent a major vascular event. Proactive genetic diagnosis is recommended in patients suspected of having vascular Ehlers–Danlos syndrome after careful patient interview.

Accessory iliolumbar artery- A case report

The variant anatomy of pelvic vasculature is reported in fewer studies, especially the internal iliac artery branching pattern. Branches of the internal iliac artery are more critical when considering procedures such as iliac bone grafting, surgical approach to fix pelvic fractures or iatrogenic vascular haemorrhages in the pelvis. The present case shows the variation in the right ileal system, i.e. the accessory Iliolumbar artery (ILA), in addition to the principal ILA on the right side, which supplies the iliac and lumbar region.

Iatrogenic Injury to the Iliolumbar Artery during Bone Marrow Biopsy Successfully Treated with Direct Embolisation through the Biopsy Needle: a Case Report

Iatrogenic Injury to the Iliolumbar Artery during Bone Marrow Biopsy Successfully Treated with Direct Embolisation through the Biopsy Needle: a Case Report

Insight into Vietnamese women’s internal iliac artery anatomy

This study aims to assess the characteristics of the internal iliac artery and to examine correlations between the internal iliac artery and other anatomic structures in the pelvis. A cross-sectional study was conducted in the period between October 2019 and May 2020. Eighteen samples of the left and right internal iliac arteries were taken from formaldehyde-embalmed female cadavers at the Ho Chi Minh City University of Medicine and Pharmacy Department of Anatomy. The study showed that the origins of most internal iliac arteries were located by the lumbar vertebrae 4-5. The mean distance from the origin of the internal iliac artery origin to the sacral promontory was 33.95 ± 3.35 mm (on the left), and 31.70 ± 4.64 mm (on the right). The internal iliac artery always had two big branches – anterior and posterior. A third branch was an ilio-lumbar artery, often seen by 43.33%. The diameters of those internal iliac artery branches were comparable on both sides, and the branches of similar name had a little larger diameter on the left than on the right. The internal iliac artery always has two large anterior and posterior branches; in some cases, it has a third branch called ilio-lumbar artery. The internal iliac artery’s length from its origin to the initial branch division is comparable for both right and left sides. The distance from the internal iliac artery’s origin to the sacral promontory is suggestive for surgeons to find the internal iliac artery after determining the sacral promontory.

The Role Of The Lumbar Arteries In Aneurysm Sac Growth And Secondary Interventions Following Endovascular Aneurysm Repair (EVAR) For Infrarenal Abdominal Aortic Aneurysms (AAA)

Type II endoleak (EL-2) is the most common complication of endovascular aneurysm repair (EVAR), leading to continued sac growth with potential risk of rupture. The contribution of lumbar arteries (LAs) to continued sac growth from EL-2 is unclear. We tested the hypothesis that the lower LAs (L3 and L4) play a greater role than the upper LAs (L1 and L2) in continued sac growth due to their rich collateral network with the iliolumbar and deep circumflex iliac arteries.

Variations in the origin of iliolumbar artery with its clinical significance

Introduction: The Iliolumbar artery mainly arises from the posterior division of the internal iliac artery. It extends oblique superiorly and laterally in front of the sacroiliac joint and lumbosacral trunk. It crosses the obturator nerve and external iliac vessels &amp; reaches the medial edge of the psoas major. The aim of our study was to know the origin variability of the Iliolumbar artery. This helps to prevent any iatrogenic injury during various surgeries. Materials and Methods: 50 formalin-fixed adult human pelvic halves with known sex were procured from the Department of Anatomy, Medical College, Baroda. Site of origin of the Iliolumbar Artery was identified. Results: In the current study, we observed that the origin of the Iliolumbar Artery was from the posterior division of IIA in 52%, 38% from the trunk of the internal iliac artery, 4% from the single trunk with obturator artery from posterior division, and 6% absent. Conclusion: The variable origins of the ILA from different branches of the internal iliac artery should be taken into account during the surgical procedures involving the lower abdominal &amp; pelvic region so as to modify the surgical tactics to prevent undesired hemorrhagic complications.

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

Ginsenoside Rb3 attenuates skin flap ischemia-reperfusion damage by inhibiting STING-IRF3 signaling.

We investigate the protective effect of ginsenoside Rb3 on skin flap microvasculature following ischemia-reperfusion (I/R) injury and its regulatory mechanism. We used a rat model of I/R injury with the right iliolumbar artery and oxidative stress model of human dermal microvascular endothelial cells. The effects of Rb3 on skin flap tissue and endothelial cell survival, STING-IRF3 pathway activation, and endothelial cell adhesion were measured. Following reperfusion, the survival rate of rat perforator flaps in the Rb3-treated group gradually increased with increasing Rb3 concentration. The treatment also reduced the amount of STING protein, phosphorylated IRF3, and P-selectin in skin flap tissue, with this change being most obvious in microvascular endothelial cells. In vitro, activated IRF3 binds to the P-selectin promoter and induces P-selectin expression. Our results suggest that Rb3 plays a role in reducing I/R flap damage through negatively regulating STING-IRF3 activation to limit leukocyte-endothelial cell adhesion.

Effects of transient receptor potential vanilloid type 4-specific activator on human vascular endothelial cell functions and blood supply of rat perforator flap and its mechanism

Effects of transient receptor potential vanilloid type 4-specific activator on human vascular endothelial cell functions and blood supply of rat perforator flap and its mechanism

Dual efficacy of Fasudil at improvement of survival and reinnervation of flap through RhoA/ROCK/PI3K/Akt pathway.

Fasudil is reported to be effective at protecting against ischaemic diseases, and at augmenting axon growth. In this study, we aim to evaluate its efficacy in promoting flap survival and reinnervation. Ninety-two Institute of Cancer Research (ICR) mice were used and divided into the control, Fasudil, LY294002, Fasudil+LY294002 groups, receiving a daily intraperitoneal injection of normal saline, Fasudil (10mg/kg), LY294002 (5mg/kg), and Fasudil (10mg/kg) + LY294002 (5mg/kg), respectively. On days 0 and 5, the blood perfusion and diameter of the iliolumbar artery in the pedicle of the flaps in the four groups were evaluated using laser speckling contrast imaging (LSCI). On day 5, the flaps were photographed and the necrosis rate of the flaps was calculated using Photoshop CS6. In addition, tissues were harvested from the flaps and divided into two parts. One part underwent routine cryosection and immunofluorescent staining using the antibody against CD31 for evaluation of the microvascular density in the four groups. In the other part, the expression of RhoA, ROCK1+2, p-CPI-17, p-MYPT, p-PTEN, p-PI3K, p-Akt, and vascular endothelial growth factor (VEGF) within the flaps were determined using western blotting. Moreover, at days 0, 7, 15, and 30 after flap surgery, the axons within the flaps were evaluated using immunofluorescent staining with the antibody against Neurofilament-200. It turned out that the necrosis rate was (24.4 ± 7.7)%, (5.2 ± 1.6)%, (29.8 ± 4.2)%, and (30.9 ± 7.1)%, respectively, in the control, Fasudil, LY294002, LY294002+Fasudil groups. There was a significant reduction in the necrosis rate of the flaps in the Fasudil group (P < .001). The LSCI and immunofluorescent staining demonstrated that Fasudil could significantly expand the diameter of the iliolumbar artery in the pedicle, boost the overall blood perfusion, and increase the microvascular density of the flaps in the Fasudil group (P < .05), which could all be abolished by PI3K inhibitor LY294002. On day 5, the expression of p-CPI-17, p-MYPT, and p-PTEN were downregulated, whereas pPI3K, p-Akt, and VEGF were upregulated in the Fasudil group (P < .001). As for reinnervation, Neurofilament-200 fluorescent staining revealed that at days 15 and 30 after flap harvest, only in the Fasudil group could new axons be observed. It can be concluded that Fasudil could simultaneously improve the survival and axon growth after flap harvest, a dual efficacy achieved by inhibition of the RhoA/ROCK pathway, which in turn activates /PI3K/AKT pathway.

Which one is better for multi-territory perforator flap survival, central perforator artery or central perforator vein?

The survival of multi-territory perforator flap is associated with the position of the perforators. This study aimed to explore whether use of the central perforator artery or vein was better for flap survival. 75 male Sprague-Dawley rats were randomly divided into three groups (n=25 per group). The flap contained the right and left iliolumbar, left posterior intercostal, and left thoracodorsal angiosomes, termed angiosomes Ⅰ to Ⅳ, respectively. The anastomosis between angiosomes Ⅱ and Ⅲ was termed choke 2. In experimental group 2, only the right iliolumbar vein and the left iliolumbar artery were preserved; in experimental group 1, only the right iliolumbar artery and the left iliolumbar vein were preserved; and in the control group, only the right iliolumbar artery and vein were preserved. On day-7 after the operation, the flap arteriography, intraluminal diameter, average microvascular density, vascular endothelial growth factor (VEGF) expression and flap survival were compared among groups. Moreover, the percentages of the angiosomes were measured. The dilation of the choke 2 artery was most pronounced in experimental group 2, followed by experimental group 1, and, finally, the control group (p<0.05). Similar results regarding average microvascular density, VEGF expression, and survival rate were found among the three groups. The percentages of angiosomes Ⅰ to Ⅳ were 23.1%, 23.0±3.1%, 23.0±1.9%, and 31.0±3.1%, respectively. Compared with the central perforator vein, the central perforator artery was more beneficial in enhancing flap survival. A multi-territory perforator flap with the central perforator artery could capture 3 angiosomes safely.

An animal experiment study on the application of indocyanine green angiography in the harvest of multi-angiosome perforator flap.

BackgroundThis study sought to explore the application value of indocyanine green angiography (ICGA) in the harvest of multi-angiosome perforator flap and the effect of low molecular weight heparin (LMWH) on the survival of postoperative flap.MethodsTwenty-four SD male rats were selected to construct a three-angiosome perforator flap model with the unilateral iliolumbar artery perforator. They were randomly divided into two groups: the control group was injected with indocyanine green (ICG) into the femoral vein during the operation, and the fluorescence signal was collected and quantitatively analyzed using Real-Time Image Guided System to determine the intraoperative fluorescence imaging length. The experimental group was injected subcutaneously with LMWH (400 U/kg) after 0.5 h postoperatively, and the control group was injected with the same amount of normal saline. The injection was repeated at the same time each day from 0 to 7 days postoperatively. After the flap was sutured in situ, ICGA was performed at 0, 1, 3, 5, and 7 days postoperatively to observe the vascular structure of the two groups of flaps. The flap survival length of the control group was counted at 7 days postoperatively, and the correlation between the intraoperative fluorescence imaging length and the survival length at 7 days postoperatively was calculated. The proportion of distal necrosis of the flaps between the two groups was compared at 7 days postoperatively.ResultsThe average length of intraoperative fluorescence imaging in the control group was 6.29±0.50 cm, and the survival length of the flap at 7 days postoperatively was 8.24±0.52 cm. The actual survival length was higher than the intraoperative fluorescence imaging length, with a ratio of 1.31±0.08. The difference was statistically significant (P<0.05). At 7 days postoperatively, the flap necrosis ratio of experimental group and control group were 10.92%±1.30% and 19.11%±1.19%, and the flap necrosis ratio of experimental group was lower than that of control group (P<0.001).ConclusionsICGA can locate the position of perforator, and can be used to predict and observe the length of distal survival of multi-angiosome perforator flap postoperatively. LMWH can promote the distal survival of flap and reduce flap necrosis.

Fiber Optic RealShape (FORS) Technology for Endovascular Navigation in Severe Tortuous Vessels

Purpose: The purpose of this study was to describe the use of a wire and catheters embedded with optical fiber (Fiber Optic RealShape [FORS]) to catheterize tortuous target vessels avoiding radiation. Technique: A virtual biplane vies was simulated coupling traditional x-ray system, preoperative CT scan, and FORS system to treat an isolated hypogastric aneurysm. Despite the complex anatomy, catheterization of all target vessels was possible in 12 minutes with 19 seconds of fluoroscopy time (Radiation Exposure 3.8 mGy×cm2). A minimal invasive endovascular exclusion of the aneurysm was achieved through selective coil-embolization of the iliolumbar artery and implantation of balloon expandable covered stents, thus preserving the perfusion of the superior gluteal artery. Conclusion: FORS guidance allowed catheterization of a target vessel with challenging anatomy with a low radiation exposure.

Anatomical Variants of the Obturator Artery and Their Clinical Importance

Context: The obturator artery (OA) originates from the internal iliac artery (IIA), and it runs on the lateral pelvic wall to leave through the obturator canal. It can have a varied source of origin. A small pelvic space makes it susceptible to injury during repair of femoral and inguinal hernias and pelvic surgeries. Unexpected injury of an aberrant OA can be avoided only with a thorough knowledge of its anatomy. Aim: This study aims to estimate the prevalence and describe the course of aberrant obturator arteries. Settings and Design: A descriptive, cross-sectional, cadaveric study was conducted in the Department of Anatomy, Government Medical College, Thiruvananthapuram, India. Materials and Methods: Sixty-four hemipelvices were dissected. Variations in the origin, course, and relations of the OA were observed and noted. Statistical Analysis Used: The results were tabulated, and the prevalence of each variation was calculated. Results: Variations were seen in 40.6% cases. OA originated from inferior epigastric artery (23.4%), external iliac artery (3.1%), posterior division of IIA and iliolumbar artery (1.5%), superior gluteal artery (6.2%), internal pudendal artery (1.5%), and inferior gluteal artery (3.1%) cases. Arterial corona mortis, a tortuous anastomotic channel connecting OA (originating from IIA) and inferior epigastric artery was seen along with venous connections in one specimen. Conclusions: Aberrant origins of OA pose a high risk for significant hemorrhage in trauma and various surgeries. Hence, a sound anatomical knowledge of its origin and course is vital while repairing fractures and hernias in this region.

A Unique Case of an Expanded Polytetrafluoroethylene Graft Rupture 14 Years after Abdominal Aortic Aneurysm Open Repair Managed with Placement of a Thoracic Endograft.

We report a unique case of expanded polytetrafluoroethylene (ePTFE) tube graft rupture that occurred 14 years after abdominal aortic aneurysm (AAA) repair. Endovascular repair with a thoracic endograft was performed. Postoperatively, an increase in the size of the existing hematoma with active extravasation occurred and was managed with iliolumbar artery embolization. Τo the best of our knowledge, rupture of ePTFE graft used for AAA repair has not been reported in the literature.

Effect of Taxifolin on Ischemia/Reperfusion-Induced Oxidative Injury of Sciatic Nerve in Rats

Ischemia is a condition in which blood flow to tissues is decreased or entirely stopped for various reasons. The reperfusion process exacerbates damage caused by ischemia in the organs and tissues. Reactive oxygen species (ROS) are mainly responsible for ischemia-reperfusion (IR) damage. ROS increase results in lipid peroxidation (LPO) and oxidative stress. In the literature, taxifolin reportedly suppresses ROS production. This study aimed to determine the effect of taxifolin, which is a flavonoid, on IR injury of the sciatic nerve in rats. This study divided 30 albino Wistar rats into 3 groups: IR without medication (IR) group, taxifolin applied IR (TAX+IR) group, and only dissection made to the sciatic nerve sham group (SHAM). Sciatic nerve injury was induced by applying 2 hours of ischemia and 3 hours of reperfusion to the abdominal aorta and iliolumbar arteries. Biochemical and histopathologic investigations then were performed on sciatic nerve tissues. Malondialdehyde, total glutathione, glutathione reductase, and glutathione peroxidase were analyzed as oxidative stress markers, and tumor necrosis factor-α and interleukin-1β levels were evaluated as inflammatory stress markers in biochemical tests. The IR group has statistically significantly high oxidant and cytokine levels and low antioxidant levels compared with the TAX+IR group. Taxifolin treatment was also shown to cause significant histopathologic improvement. We suggest that taxifolin may be effective in preventing IR injury of the sciatic nerve.

Surgical anatomy of the anastomoses of the iliolumbar artery

Objective: to determine the variants of topography and quantity of the anastomoses of the iliolumbar artery.Materials and methods. The material of the research was 206 dead bodies of men (aged 22–82 at the time of death) and 113 dead bodies of women (aged 32–93 at the time of death) who had died of accidental causes not related to pelvic pathology. The vascular injection method, preparation method were used to achieve the objective of the study. The statistical processing of the obtained data was performed.Results. It has been found that the formation of the anastomoses of the iliolumbar artery is most often found in its proximal and middle thirds, significantly rarely — in its distal third. We have revealed no statistically significant differences between the average diameters of the iliolumbar artery and the average diameters of its anastomoses in men.Conclusion. The performed research has demonstrated that the anastomoses of the iliolumbar artery in men and women have a definite pattern of origination.