Origin Of Internal Iliac Artery Research Articles

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.

Variability in morphology and branching of the internal iliac artery: Implications for pelvic surgery

PurposeThe internal iliac artery displays variations that may predispose it to inadvertent injury during pelvic surgeries. This study aimed to describe variations of the internal iliac artery among Kenyans. Basic proceduresFifty-seven pairs of right and left-sided hemi-pelvises, 48 from males and 9 from females, were used in this study. We collected data on the internal iliac artery origin, relations, termination, branching, length and course of parietal branches. Data were then coded and entered into SPSS (version 21, Chicago, IL), where we performed descriptive statistics and analyses. FindingsIn all cases, the internal iliac artery originated singly from the common iliac artery. The IIA originated above the vertebral level of the L5/S1 disk (pelvic brim) in 30/57 (52.6%) cases, with the highest observed at L4. In most cases (32/57 [56.8%]), the IIA terminated at S1 vertebral level. The internal iliac artery lay medial, anterior and lateral to the sacroiliac joint in 37/57 (64.9%), 18/57 (30.6%) and 2/57 (5%) cases, respectively. Regarding parietal branching, 39/57 (64.8%) cases had a type 1 pattern as per the Adachi classification. The mean diameter and length of the internal iliac artery were 7.32 ± 1.69 mm and 36.97 ± 14.12 mm, respectively. The differences in dimensions of the IIA between the left and the right sides were not significant. Principal conclusionsA considerable proportion of the Kenyan population demonstrates an origin of the internal iliac artery above the pelvic brim. Unique termination via trifurcation and ramification may also be observed in the Kenyan population. Surgeons and radiologists performing vascular interventions in the pelvis should be mindful of these variations.

Therapeutic management of isolated internal iliac artery aneurysms

ObjectiveIsolated internal iliac artery aneurysms (IIIAAs) are rare, life-threatening entities for which the optimal treatment strategy has not been established. This study aimed to evaluate the outcomes of open and endovascular treatment of IIIAAs. MethodsIIIAA cases between January 2009 and March 2019 at two hospitals were retrospectively reviewed. Demographic, clinical, ancillary testing, treatment, and outcome data were collected and analyzed. ResultsForty-two patients (37 men and 5 women) with a mean age of 71 years were included. Twenty-five patients (60%) had a history of hypertension. Twenty-two patients (52%) were asymptomatic, and 16 (38%) presented with abdominal pain (12 with ruptured aneurysms). The 42 included patients had 43 treated IIIAAs. The following surgical techniques were used: surgical resection (n = 6), endovascular coil embolization (n = 12), endovascular stent graft placement across the internal iliac artery origin (n = 8 with 9 aneurysms), and combined coil embolization and stent graft placement (n = 16). The immediate technical success rate was 67%, 67%, and 88% for embolization, stent graft placement, and combined method, respectively. Open surgery was associated with the longest operative time and hospital stay. Overall 30-day mortality was 5% for all patients and 17% for patients with ruptured IIIAAs. Buttock claudication occurred in 7 of 40 patients who survived (18%). The median follow-up time was 56 months. The combined approach was associated with the lowest rates of endoleak (6% vs 25% and 29%) and reintervention (6% vs 17% and 29%) of the three endovascular methods. ConclusionsEndovascular coil embolization with stent graft placement is a feasible, safe, and effective treatment approach for large IIIAAs without adequate aneurysm necks.

Onyx Embolization for Occlusion of the Proximal Internal Iliac Artery During EVAR in Patients with Unsuitable Landing Zones in the Common Iliac Artery.

Twenty percent of the patients with AAA have an aneurysm involving the common iliac arteries. Large common iliac diameter can be treated with an iliac branched device or extension of the stent graft to the external iliac artery with occlusion of the ipsilateral internal iliac artery (IIA) to prevent type 2 endoleaks. This study describes and evaluates a embolization technique using Onyx in conjunction with EVAR in aneurysms with poor landing zones in the common iliac arteries. Patients with Onyx IIA embolization during EVAR, identified from the hospital operating code database, constitute the study population. Onyx embolization was performed by injection at the IIA origin. Peri- and postoperative complications were collected from the medical records. Thin-sliced CT scan was performed 1month and 1year after the procedure. Thirty-six patients with complex iliac anatomy and insufficient landing zones (without sealing possibility for standard stent grafts) were identified out of 243 consecutive EVAR treatments during a 13-year period. In seventeen patients (7%), the IIA was embolized with Onyx. Technical success was obtained in all 17 patients, without adverse event or procedural complication. No complication related to the embolization procedure was noted during follow-up. During EVAR treatment of patients with aneurysm involving the common iliac artery, Onyx embolization of IIA is a feasible option without need of selective catheterization of the IIA orifice, potentially preserving important branches of the IIA and simplifying emergency procedures.

Internal iliac coverage during endovascular repair of abdominal aortic aneurysms is a safe option: A preliminary study.

Endovascular aneurysm repairs lacking suitable common iliac artery landing zones occasionally require graft limb extension into the external iliac artery, covering the internal iliac artery origin. The purpose of this study was to assess incidence of type II endoleak following simple coverage of internal iliac artery without embolization during endovascular aneurysm repair. Three hundred eighty-nine endovascular aneurysm repairs performed by a single surgeon (2004-2015) were reviewed. Twenty-seven patients underwent simple internal iliac artery coverage. Type II endoleak was assessed from operative reports and follow-up computed tomography imaging. No patient suffered type II endoleak from a covered internal iliac artery in post-operative computed tomography scans. Follow-up ranged from 0.5 to 9 years. No severe pelvic ischemic complications were observed. In conclusion, for selected cases internal iliac artery coverage without embolization is a safe alternative to embolization in endovascular aneurysm repairs, where the graft must be extended into the external iliac artery.

Occlusion of the Internal Iliac Artery Is Associated with Smaller Prostate and Decreased Urinary Tract Symptoms

PurposeTo characterize the relationship of proximal internal iliac artery (IIA) occlusion or embolization on prostate volume (PV) and the presence of lower urinary tract symptoms (LUTS) or benign prostatic hyperplasia (BPH). Materials and MethodsThe study included 2 parts: Part 1 comprised 99 men ≥ 50 years old who underwent abdominopelvic computed tomography angiography for lower extremity claudication assessed in a retrospective cohort design; Part 2 comprised 18 patients who underwent iatrogenic IIA embolization during endovascular aneurysm repair assessed by a within-subjects approach. Prostate volume and IIA origin diameter were measured; IIA occlusion was noted. Chart review documented body mass index, LUTS, impotence, and buttock claudication. ResultsOf 99 men in Part 1, 60 had no IIA occlusion, and 39 had IIA occlusion (17 unilateral, 22 bilateral). Prostate volume differed significantly between groups (no IIA occlusion, 27.3 mL; unilateral IIA occlusion, 20.7 mL; bilateral IIA occlusion, 17.1 mL; P = .001). Men without IIA occlusion had more LUTS (27%) than men with IIA occlusion (10%; P = .04). The number of men with complaints of impotence or buttock claudication was similar in both groups (40% vs 46%; P > .05). Multiple regression showed that age and IIA occlusion were independent predictors of PV (P < 0.05), whereas body mass index was not (P > .05), and that IIA occlusion was the only independent predictor of LUTS/BPH (P < .05). Among the 18 men in Part 2, PV declined by 29% after embolization (P = .00001); 6 men had improvement or resolution of LUTS. ConclusionProximal IIA occlusion is associated with nearly one-third reduction in PV and decreased findings of LUTS/BPH.

Morphological considerations on the origin and morphometry of the internal iliac arteries

Abstract The origin of the internal iliac artery, right and left, was studied in 76 cases, 58 cases of male (76.32% of all cases) and 18 female cases (23.68% of all cases). The origin of the internal iliac arteries was considered in relation to the spine (lumbar-sacral). The right internal iliac artery males originates in a range from the upper edge of L4 vertebra - the lower part of fin sacral. It is found that in males, in most cases, 43 cases (74.14% of male cases), right internal iliac artery originates at different levels of sacral fin. We considered that the right iliac artery low origin only the cases in the lower part of the fin sacral, 10 cases (17.24% of male cases). Cases of high origin of the artery, above the fin sacral we found it in 15 cases (25.86% of male cases). From high origins, in the upper edge of the L4 vertebra and intervertebral disc at L4-L5, I met only one single case. Right internal iliac artery in females originated in a range between the upper edges of L5 - the lower part of sacral fin. In females, the right internal iliac artery origin, is located within narrower than in men, but in women, most frequently, 14 cases (77.78% of female the cases) was the origin of the internal iliac located at different levels of sacral fin. The females have not met internal iliac origin above the L5 vertebra or intervertebral disc level L4-L5. High origin was met it in 4 cases (22.22% of female the cases) and low origin in 6 cases (33.33% of female the cases). The level of the left internal iliac artery origin we studied 78 cases, finding it in the same range as in males, i.e., the upper edge of L4 vertebra - the front of the sacrum. In males, on a number of 57 cases (73.08% of all cases) the origin of the left internal iliac artery was made between the upper edge of the vertebra L4 - the front face of the sacrum, most commonly, in 44 cases (77 19% of male the cases) located in the sacral fin. The artery high origin I found it in 9 cases (15.79% of male the cases) and low origin in 18 cases (31.58% of male the cases). I have not met artery origin at L5-S1 intervertebral disc. In terms of low origin, only in males, the left internal iliac artery originated from the anterior to the sacrum, something not found the right internal iliac artery. In females, the 18 cases followed, had their origins in the range lower half of the L5 - middle sacral fin, 17 cases (94.44% of female the cases), terminating at the sacral fin. It is found that in women the origin of the left internal iliac artery is within narrower than the other cases described so far, showing the highest level of origin, this artery in females do not possess low origin. The high origin is present in a small percentage, only 5.56% of cases, encountering any case the origin of the left internal iliac artery is located at the L4 vertebra or the intervertebral discs at L4-L5 or L5-S1. Internal iliac artery diameter was followed on 90 cases, 44 cases for the right internal iliac artery and 46 cases for left internal iliac artery. In males, the right internal iliac artery I found a caliber between 3 to 9.8 mm. In women the right internal iliac artery caliber found between 3.9 to 6.9 mm.

Femoral-femoral stabilizing buddy wire for embolization of the internal iliac artery

Internal iliac artery (IIA) embolization is performed in a variety of clinical scenarios, most commonly in patients undergoing endovascular aneurysm repair (EVAR) with an iliac artery aneurysm or inadequate distal landing zone. In these patients, IIA embolization with iliac limb extension is often performed. While IIA embolization can be routinely performed with either ipsilateral or contralateral femoral arterial access, it can be challenging in some patients with an acutely angulated aortic or iliac bifurcation and in patients with short or ectatic common iliac arteries. In this select group of patients with difficult anatomy, IIA embolization can be challenging and may lead to increased radiation exposure and contrast administration. Having a sheath precisely positioned and stabilized at the internal iliac artery origin will facilitate embolization of the IIA. This report describes a novel technique in which crossover femoral-femoral artery buddy wire placement achieves stable positioning of large sheaths for concurrent IIA embolization at the time of EVAR.

Technique of Reversed Flared Iliac Stent Graft for Iliac Aneurysms With Discrepant Size Diameters

Endovascular treatment of iliac artery aneurysms (IAAs) in patients with discrepancy in iliac artery diameters can be challenging because of limited availability of reversed flared stent graft limbs. The authors describe the technique of reversing a Cook Zenith (Bloomington, IN) iliac stent graft extension to accommodate for significant discrepancy in diameter between the common iliac artery (18 mm) and the external iliac artery (11 mm). A 75-year-old male patient with a 7.3-cm right internal IAA was treated with endovascular exclusion of distal internal iliac artery branches using Amplatzer plugs (AGA Medical Corp, Plymouth, MN) and coverage of the internal iliac artery origin using a reversed 12 × 20 mm Cook Zenith TLFE Iliac extension limb (Bloomington, IN). The 12 × 20 mm iliac extension limb was unsheathed on-site using a strict sterile technique, reversed within the introducer and resheathed. Following percutaneous bilateral femoral access and exclusion of the anterior and posterior divisional branches of the internal iliac artery, the reversed flared iliac limb device was deployed from the distal common to the external iliac artery. Completion angiography and follow-up computed tomography angiography revealed no endoleak. The patient was dismissed on postoperative day 1 without complications. The technique of reversed flared iliac stent graft limb is a feasible option in patients with iliac aneurysms and significant discrepancy in the diameter of the iliac arteries.

Customized Tapered Stent-Grafts in the Endovascular Management of Internal Iliac Artery Aneurysms: A Useful Adjunct to Conventional Endovascular Options

The endovascular exclusion of an isolated iliac artery aneurysm is recognized as a safe and favorable alternative to open surgical repair, with low associated morbidity and mortality. It has particular advantages in the treatment of internal iliac artery aneurysm (IIAA) given the technical difficulties associated with open surgical repair deep within the pelvis. We describe the use of customized tapered stent-grafts in the exclusion of wide-necked IIAA in five male patients considered high-risk for conventional surgical repair, in whom the common and external iliac artery morphology precluded the use of standard endovascular devices. In each case, IIAA outflow was selectively embolized and the aneurysm neck excluded by placement of a customized tapered stent-graft across the internal iliac artery origin. This technique was extremely effective, with 100% technical success, no serious associated morbidity, and zero mortality. In all five patients sac size was stable or reduced on computed tomography follow-up of up to 3 years (mean, 24.4 months), with a primary patency rate of 100%. We therefore advocate the use of customized tapered stent-grafts as a further endovascular option in the management of IIAA unsuitable for conventional endovascular repair.

How Safe is Bilateral Internal Iliac Artery Embolization Prior to EVAR?

To assess the outcomes of patients after bilateral internal iliac artery (IIA) embolization prior to endovascular aneurysm repair (EVAR). Thirty-nine patients (age range 55-88 years, mean 72.5 years; 2 women) underwent IIA embolization/occlusion before EVAR. There were 28 patients with aorto-biiliac aneurysms and 6 with bilateral common iliac artery (CIA) aneurysms. Five patients with unilateral CIA aneurysms had previous surgical ligation of the contralateral IIA or inadvertent covering by the stent-graft of the contralateral IIA origin. Outcomes were assessed by clinical follow-up. Severe ischemic complications were limited to spinal cord ischemia in 1 patient (3%) who developed paraparesis following EVAR. No other severe ischemic complications such as buttock necrosis, or bowel or bladder ischemia, occurred. Buttock and/or thigh claudication occurred in 12 patients (31%) and persisted beyond 1 year in 3 patients (9%). Sexual dysfunction occurred in 2 patients (5%). Patients who underwent simultaneous embolization had a 25% (3/12) ischemic complication rate versus 41% (11/27) in those with sequential embolization (p = 0.48). Embolization limited to the main trunk of the IIA resulted in a significantly reduced ischemic complication rate of 16% (3/19) versus 55% (11/20) of patients who had a more distal embolization of the IIA (p = 0.019, Fisher's exact test). Severe complications after bilateral IIA embolization are uncommon. Although buttock/thigh claudication occurs in around 30% of patients soon after the procedure, this resolves in the majority after 1 year. There is no obvious benefit for sequential versus simultaneous IIA embolization in our series. Occlusion of the proximal IIA trunk is associated with reduced complications compared with occlusion of the distal IIA.

Palma Procedure for Acute Intraabdominal Major Venous Injury

We report a patient with multiple vascular injuries, including a ruptured anterior wall of inferior vena cava at the point of bifurcation, a ruptured anterior and posterior wall of left external iliac vein, ruptured urinary bladder and ligated left common iliac artery immediately proximal to the origin of internal iliac artery. These injuries were caused iatrogenically at the time of hysterectomy due to treat massive vaginal bleeding due to placenta previa and accreta. Due to the complexity of the injuries, a staged management was used in the treatment of this patient. First stage consisted of bleeding control and patient stabilization. Second stage of management consisted of definitive arterial and venous reconstruction by endovascular and vascular surgery intervention, which included a left femoral vein thrombectomy and a Palma procedure to restore venous drainage of the left extremity.

Palma Procedure for Acute Intraabdominal Major Venous Injury

We report a patient with multiple vascular injuries, including a ruptured anterior wall of inferior vena cava at the point of bifurcation, a ruptured anterior and posterior wall of left external iliac vein, ruptured urinary bladder and ligated left common iliac artery immediately proximal to the origin of internal iliac artery. These injuries were caused iatrogenically at the time of hysterectomy due to treat massive vaginal bleeding due to placenta previa and accreta. Due to the complexity of the injuries, a staged management was used in the treatment of this patient. First stage consisted of bleeding control and patient stabilization. Second stage of management consisted of definitive arterial and venous reconstruction by endovascular and vascular surgery intervention, which included a left femoral vein thrombectomy and a Palma procedure to restore venous drainage of the left extremity.

Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair.

When abdominal aortic aneurysms and common iliac artery (CIA) aneurysms undergo concomitant endovascular repair, endograft limb extension into the external iliac artery is often necessary. Usually, the internal iliac artery (IIA) is coil embolized in such a case to prevent endoleak. It has been our practice to coil embolize the IIA only in cases where there is not adequate stent graft seal in the CIA immediately proximal to the IIA origin (effectively sealing the entire IIA origin). In this study, we evaluated the outcomes of this approach. We retrospectively reviewed 204 consecutive endovascular abdominal aortic aneurysm repairs at Dartmouth-Hitchcock Medical Center from 1996 to 2001. Computed tomographic angiography with three-dimensional reconstruction was the primary preoperative imaging modality, and the decision to cover the IIA without concomitant coil embolization was based before surgery on the presence of adequate graft oversizing (> or =10% to 15%) in the most distal 5 mm of CIA and 15 mm of proximal external iliac artery, respectively. The IIA was occluded 33 times in 31 patients. In 22 cases (67%), the IIA was covered without coil embolization (COVER group). The remaining 11 patients (33%) with inadequate graft oversizing in the CIA underwent IIA coil embolization (COIL group). The follow-up periods for the COVER and COIL groups were 19 +/- 2 months and 10 +/- 3 months, respectively. All operations in both groups were technically successful without evidence of endoleak at completion angiography. No endoleaks, graft migrations, or aneurysm enlargements were associated with the covered or coiled IIAs during the follow-up period. No clinical sequelae were seen in the COVER group, with the exception of buttock claudication in six patients (27%) that resolved completely in five patients. In the COIL group, five patients (45%) had buttock claudication. In addition, one case of buttock necrosis and one case of ischemic neuropathy occurred in the COIL group. Covering the IIA without coiling effectively excluded the CIA aneurysm in every case and was associated with a low incidence rate of complications compared with coil embolization. With detailed preoperative imaging and patient selection, IIA coil embolization may not be necessary in as many as two thirds of patients who need IIA occlusion.

Göttingen miniature swine as a model for diet-induced atherosclerosis

Twenty-four Göttingen Miniature Swine/csk, in order to evaluate their potential usefulness as a model for experimental atherosclerosis studies, were fed diets of three types, a high-fat plus high cholesterol diet, a high-fat diet, and a commercial diet. Each group consisted of 4 males and 4 females. Swine fed the experimental diet were investigated by gross, microscopic and serum biochemical examination on the 1st, 3rd, 6th and 9th month after start of experimentation. Lesions of atherosclerosis were observed in the high-fat plus high-cholesterol diet group. After a month on the experimental diet, intimal thickening was detected in the abdominal aorta just above the origin of internal iliac artery, left coronary artery and ascending aorta by microscopic examination. Thereafter, on the 9th month after the start, there was more extensive and severe atherosclerosis. These lesions were classified into two types by the difference in the histologic architecture of arterial wall. One was fatty streaks that were in thoracic aorta belonging to the elastic type and the other was fibrous plaques that were in abdominal aorta and iliac artery and so on, belong to the transitional or muscular type. High-fat plus high-cholesterol diet feeding led to elevated serum cholesterol and beta-lipoprotein levels, and had an effect on several kinds of metabolism. All of the swine fed high-fat or commercial diet had little gross, microscopic lesions and had no change in serum cholesterol and beta-lipoprotein levels. Hypercholesterolemia and hyper-beta-lipoproteinemia had a close relation to the development and acceleration of atherosclerosis. It was possible to show that the diet induced atherosclerosis was similar in quality to that observed in humans, and that the Göttingen miniature swine was a suitable animal for the study of atherosclerosis.