Iliolumbar Artery Research Articles

Far Lateral Disc Excision at L5–S1 Complicated by Iliolumbar Artery Incursion: Case Report

NEUROSURGERY PUBLICATIONS NEUROSURGERY OPERATIVE NEUROSURGERY NEUROSURGERY PRACTICE CNS.ORG NEUROSURGERY PUBLICATIONS NEUROSURGERY OPERATIVE NEUROSURGERY NEUROSURGERY PRACTICE CNS.ORG

Far Lateral Disc Excision at L5–S1 Complicated by Iliolumbar Artery Incursion: Case Report

Far Lateral Disc Excision at L5–S1 Complicated by Iliolumbar Artery Incursion: Case Report

Retrograde Catheterization of the Inferior Mesenteric Artery to Treat Endoleaks: Anatomic and Technical Considerations

Abbreviations: IMA inferior mesenteric artery, SMA superior mesenteric artery ENDOVASCULAR stent-graft placement is a promising new therapy for the treatment of infrarenal abdominal aortic aneurysm (1,2). The procedure can be successfully accomplished with low procedural morbidity in most cases. However, persistent aneurysm perfusion after stent-graft placement is an important complication of this new innovative therapy that is observed in 5%–40% of patients (3,4). The best method for managing patients with postimplantation perigraft perfusion (endoleak) is not yet known and, consequently, many approaches to the management of this problem are being explored (5–7). Some endoleaks are due to backbleeding from infrarenal aortic sidebranches (4). These sidebranches receive inflow from arterial collaterals. Blood typically flows in through one sidebranch, such as the inferior mesenteric artery (IMA), traverses the perigraft space, and then flows out through another sidebranch, such as a lumbar artery. Endoleaks of this type can be prevented by occluding the involved aortic sidebranches. Sidebranch vessels can be accessed for embolization in two ways: (i) via a systemic collateral (superior mesenteric artery [SMA] or iliolumbar arteries)—in this way, the sidebranch vessel and perigraft space are catheterized from an “outside-in” approach, or (ii) via the perigraft space, which can be entered directly, around the proximal or distal end of the stent-graft—in this way, the sidebranch vessel is catheterized from an “inside-out” approach. In the past few years, we have gained experience with retrograde catheterization of infrarenal aortic sidebranches for this purpose. The purpose of this article is to highlight the anatomic and technical considerations relevant to retrograde IMA catheterization used to treat endovascular stent-graft leaks.

External oblique abdominal muscle: A new look on its blood supply and innervation

Numerous reports have discussed the use of the external oblique abdominal muscle as a pedicled or a free flap for defect coverage. A detailed description of the supplying vessels and nerves is a prerequisite for successful tissue transfer but so far is not available in the literature. A study of the arteries and nerves supplying the external oblique abdominal muscle was carried out in 42 cadavers after injection of a mixture of latex and bariumsulfate. In seven fresh cadavers the motor branches were identified with the Karnovsky technique. Three different groups of arteries were identified as the nuturing vessels. The cranial part of the muscle is supplied by two branches of the intercostal arteries. While the lateral branches run on the outer surface of the muscle together with the nerves, the anterior branches enter the muscle from its inner surface. The caudal part of the muscle derives its main blood supply from one or two branches of the deep circumflex iliac artery (94.7%) or the iliolumbar artery (5.3%). The external oblique abdominal muscle is innervated by motor branches of the lateral cutaneous branches of the anterior spinal nerves in a segmental pattern. With the exception of the subcostal nerve the motor branches enter the outer surface of the muscle digitation arising from the rib above. The results show that the cranial half of the external oblique abdominal muscle has a strictly segmental blood and nerve supply while the caudal half of the muscle derives its main blood supply from one artery but still shows a segmental innervation. Anat Rec 255:388–395, 1999. © 1999 Wiley-Liss, Inc.

External oblique abdominal muscle: a new look on its blood supply and innervation.

Numerous reports have discussed the use of the external oblique abdominal muscle as a pedicled or a free flap for defect coverage. A detailed description of the supplying vessels and nerves is a prerequisite for successful tissue transfer but so far is not available in the literature. A study of the arteries and nerves supplying the external oblique abdominal muscle was carried out in 42 cadavers after injection of a mixture of latex and bariumsulfate. In seven fresh cadavers the motor branches were identified with the Karnovsky technique. Three different groups of arteries were identified as the nurturing vessels. The cranial part of the muscle is supplied by two branches of the intercostal arteries. While the lateral branches run on the outer surface of the muscle together with the nerves, the anterior branches enter the muscle from its inner surface. The caudal part of the muscle derives its main blood supply from one or two branches of the deep circumflex iliac artery (94.7%) or the iliolumbar artery (5.3%). The external oblique abdominal muscle is innervated by motor branches of the lateral cutaneous branches of the anterior spinal nerves in a segmental pattern. With the exception of the subcostal nerve the motor branches enter the outer surface of the muscle digitation arising from the rib above. The results show that the cranial half of the external oblique abdominal muscle has a strictly segmental blood and nerve supply while the caudal half of the muscle derives its main blood supply from one artery but still shows a segmental innervation.

Transcatheter arterial embolization for malignant osseous and soft-tissue sarcomas. I. A rabbit experimental model.

To evaluate the effect of transcatheter arterial embolization (TAE) on metastatic bone tumors in an experimental study. Fifteen Japanese white rabbits were transplanted with VX2 sarcoma cells into the iliac crest. In 10 rabbits, the arterial supply to the iliac bone tumors, internal iliac artery and iliolumbar artery were then embolized with particles of gelatin sponge. The therapeutic effect was evaluated by comparison with the natural course of control tumors in the other five rabbits. After TAE, extensive necrosis, fibrosis, and vacuolization within the tumors were confirmed histologically. In the control rabbits, 19% +/- 7% of the entire tumor was found to be spontaneous tumor necrosis; in contrast, the tumors of the TAE group showed necrosis as 62% +/- 22% of the entire tumor. In one TAE group rabbit, no active tumor cell could be detected in the residual tumor. TAE was found to be an effective treatment for bone tumors in an experimental model.

Transcatheter arterial embolization for malignant osseous and soft tissue sarcomas. II. Clinical results.

To evaluate the clinical effects of transcatheter arterial embolization (TAE) on malignant bone and soft tissue tumors. TAE was performed in 10 patients with primary bone and soft tissue sarcomas and in 31 patients with metastatic bone tumors. The embolized arteries were the internal iliac artery in 30 cases, the intercostal artery in six cases, the lumbar artery in five cases, the suprascapular artery in three cases, and the iliolumbar artery, the internal pudendal artery, and the lateral sacral artery in one case each. The embolized material was gelatin sponge particles. The chemotherapeutic drugs were usually 20-40 mg of doxorubicin for primary and metastatic tumors and 50-100 mg of cisplatin only for primary tumors. In addition, 50-60 Gy of 10-MV radiotherapy with or without radiofrequency (RF)-capacitive hyperthermia in four sessions was administered before TAE for primary tumors only. Even though the pain score increased immediately after TAE, 30 of 38 (79%) patients with pain (8 of 9 with primary tumors, and 22 of 29 with metastases) achieved pain control after TAE. A necrotic low-density area shown by computed tomography (CT) after TAE was found in 31 of 41 (76%) tumors [8 of 10 (80%) with primary tumors, and 23 of 31 (74%) with metastatic tumors]. The tumor size decreased in 14 of 25 (56%) primary and metastatic tumors after 3 months. Osteosclerotic changes appeared in two cases of metastatic tumors after 6 months. In five tumors resected after TAE, large areas of necrosis within the tumor were confirmed histologically. Transient local pain and numbness appeared after TAE, but were relieved by drug treatment within 1 week. No severe complications except a case of gluteal muscle necrosis were encountered after TAE. The 1-year survival rate of the patients with primary tumors was 38.1%, and the median survival was 18 months. The longest survival was 84 months. The 1-year survival rate of the patients with metastatic bone tumors was 38.9%; the median survival was 12 months. The longest survival was 24 months. TAE could be an effective treatment for pain control and local control of malignant bone and soft-tissue tumors.

Blood Supply of the Lower Thoracic and Lumbosacral Regions

Postmortem aortography was performed in 38 adults, aged 17 to 29 years, to elucidate the normal anatomy of the arteries supplying the lower thoracic and lumbosacral regions. The lowest 3 thoracic segmental arteries, examined in 32 cases, ran symmetrically in 27 cases. In 5 cases (16%) their course was asymmetric; on one side every segment was fed by an artery of its own, whereas on the other side a segmental artery fed 2 or more segments. The course, distribution and size of the 1st to 4th lumbar arteries were constant in every case except one, while the middle sacral artery and its branches, the 5th lumbar arteries, varied in size, being frequently compensated for, partly or wholly, by the iliolumbar arteries derived from the internal iliac arteries. In their course around the vertebral bodies, lumbar arteries frequently passed between and beneath fibrous attachments of the crura of the diaphragm and the psoas muscle.

Blood Supply of the Lower Thoracic and Lumbosacral Regions

Postmortem aortography was performed in 38 adults, aged 17 to 29 years, to elucidate the normal anatomy of the arteries supplying the lower thoracic and lumbosacral regions. The lowest 3 thoracic segmental arteries, examined in 32 cases, ran symmetrically in 27 cases. In 5 cases (16%) their course was asymmetric; on one side every segment was fed by an artery of its own, whereas on the other side a segmental artery fed 2 or more segments. The course, distribution and size of the 1st to 4th lumbar arteries were constant in every case except one, while the middle sacral artery and its branches, the 5th lumbar arteries, varied in size, being frequently compensated for, partly or wholly, by the iliolumbar arteries derived from the internal iliac arteries. In their course around the vertebral bodies, lumbar arteries frequently passed between and beneath fibrous attachments of the crura of the diaphragm and the psoas muscle.

Reduced vascular responsiveness after a single bout of dynamic exercise in the conscious rabbit.

We measured agonist-induced changes in the iliac artery blood flow velocity (IFV) independent of baroreflex-mediated compensatory mechanisms in chronically instrumented New Zealand White rabbits (n = 8). Animals were instrumented with a Doppler flow probe around the right common iliac artery. A Teflon catheter was inserted into the right iliolumbar artery for local infusion of the vasoactive agonists. Another Teflon catheter was inserted in the left femoral artery for the measurement of pulsatile and mean arterial (MAP) blood pressures and heart rate (HR). The alpha-adrenergic receptor agonist phenylephrine (PE, 1.32-10.0 micrograms), the beta 1- and beta 2-adrenergic receptor agonist isoproterenol (IP, 0.022-0.11 micrograms), and the purinergic receptor agonist adenosine (AD, 10.0-100.0 micrograms) were injected into the functionally isolated hindlimb, and dose-response curves were generated. Changes in IFV were obtained without changes in MAP or HR. Exercise increased HR, MAP, and IFV (65.3 +/- 7.1 beats/min, 11.1 +/- 2.2 mmHg, and 2.2 +/- 0.3 kHz, respectively). The maximum responses to PE, AD, and IP were reduced 29.0 +/- 6.7, 50.7 +/- 8.5, and 61.0 +/- 8.1%, respectively, after exercise. In conclusion, exercise attenuated adrenergic and purinergic receptor-mediated vascular responses in the intact conscious rabbit.

Arrangement of the branches of the aorta abdominalis in the wood mouse (Apodemus sylvaticus).

Data on the distribution and variation of the abdominal arteries in the wood mouse, Apodemus sylvaticus, are given. Seventy specimens (44 males and 26 females) caught in the field were analyzed by injection of green latex solution and dissection. The general branching pattern of the aorta abdominalis is similar to those described in other rodents. There are certain differences, however, especially in the branching of the coeliac trunk, the origin of the genital arteries and the arrangement of the caudal mesenteric artery. Significant variability was detected in the distribution of the iliolumbar arteries about the testicular and ovaric arteries. Based on the observations and measurements carried out, some branching patterns of the aorta abdominalis are presented.

A new experimental model: the vascular pedicle cutaneous flap over the dorsal aspect (flank and hip) of the rat

Cutaneous vascular anatomy of the flank and the hip was studied in the rat. Investigation was done by anatomical dissection, ink injection to the axial artery and flap harvesting in living rats. Anatomical dissection and India ink injection revealed that the rat's flank and hip skin derives its blood supply from the iliac branch of the iliolumbar artery, which originates from the lateral aspect of the abdominal aorta. The vascular territory of the iliac branch of the iliolumbar artery was defined as follows: the medial border—along the midline of the back from the 12th rib to the proximal part of the tail; the lateral border-anterior axillary line corresponding with the length of the medial border; the cephalic border—a line joining the medial and lateral border at the level of the 12th rib; and the caudal border—the posterior lateral line of the hip. On the basis of the vascular territory demarcated by India ink injection, bilateral vascular pedicle island cutaneous flaps were harvested in living rats. Results showed total survival of all flaps. This flap is easily made, and it could be used as a reliable model for flap research.

The lateral branches of the common iliac artery

The description of the common iliac artery and its branches varies significantly in various anatomic references. The results of the observations of several authors are discussed. A study of 143 cadavers in which the branches of the common iliac arteries are investigated is reported. In this study 93 cases (65%) showed no branch from the common iliac artery. In 50 cases (35%) a lateral branch was found. Out of these 50, 18 were given off from the right side, 16 from the left and 16 from both sides. The average diameter of the branch lumen was about 3 mm. The branches supplied the iliopsoas muscle (in addition to the iliolumbar artery), occasionally the ureter, lymphnodes or kidney. In operative procedures near the bifurcation of the abdominal aorta it is necessary to look for lateral branches of the common iliac artery.

Erfahrungen mit der selektiven Katheterembolisierung der Arteria iliaca interna bei lebensbedrohlich blutenden Uteruskarzinomen*

Patients with heavily bleeding cervical or endometrial carcinomas were treated by embolisation. A catheter was placed into the internal iliac artery via the femoral artery. By the use of Gianturco-Anderson-Wallace springs, selective embolisation was performed distally to the superior gluteal or iliolumbar artery. Five patients between the age of 42 to 86 years (four cervical carcinomas, one endometrial carcinoma) were treated by embolisation. In four patients bleeding stopped after treatment. One patient died after further haemorrhage. Only minor side effects were seen. Thus, surgical ligature of the internal iliac arteries seems to be a thing of the past. Nevertheless, catheter embolisation should be performed only after alternative methods had been tried.

The free vascularised iliac crest graft: an animal model

An experimental model has been devised for the study of vascularised bone and physeal grafts. The albino rat is now widely used in microsurgical research, vessels of 0.5 mm diameter are anastomosed with consistent results and growth studies may be completed in a relatively short period. The rat iliac crest is supplied by a paired branch of the abdominal aorta, the deep circumflex iliac artery (DCIA): older texts may refer to this as the iliolumbar artery. Arising I to 2 cm distal to the origin of the renal vessels the DCTA crosses psoas, quadratus lumborum and iliacus, passing beneath the ureter. It penetrates the abdominal wall through a divarication of the inguinal ligament, adjacent to the anterior superior iliac spine. Cutaneous branches supply skin over the lumbar and gluteal regions. Two or 3 branches deep to the inguinal ligament supply bone and muscle of the iliac crest and the crest may be isolated on this pedicle if a cuff of muscle is preserved, usually on the inner aspect. A skin flap is included with the graft to improve anastomotic flow and to allow patency to be monitored. The crest is approached by raising an ellipse of skin on a DCIA pedicle and tracing the vessels proximally. The inguinal ligament is divided and reflected medially, exposing the iliac branches, which are protected in a cuff of muscle whilst the crest is otherwise stripped to periosteum. The abdominal portion of the DCIA is dissected to give a common pedicle of about 1.5 mm. On division of the ilium and the pedicle vessels the graft may be transferred to the femur or upper tibia, with anastomosis to either the superficial epigastric of femoral vessels. This model offers many advantages over the use of larger animal models and with careful microvascular technique flap survival should exceed 90%.