Internal Iliac Artery Research Articles

Mid-term outcomes of different treatments of internal iliac artery in endovascular aneurysm repair.

To evaluate the mid-term outcomes of different treatment strategies for the internal iliac artery (IIA) during EVAR. This was a retrospective study. All patients undergoing EVAR, who required treatment of at least one side of IIA from January 2013 to July 2022 in a single center, were included. According to the different treatment strategies for IIA, the patients were divided into UP (unilateral preservation), BP (bilateral preservation) and BE (bilateral embolization) groups. The primary outcomes included buttock claudication, bowel ischemia and iliac-related reintervention. Then patients who underwent IIA reconstruction were divided into IPG (iliac parallel stent graft) and IBG (iliac branch stent graft) groups according to the reconstruction technique. The primary outcomes included endoleak, iliac branch occlusion and iliac-related reintervention. A total of 237 patients were included, including 167 in the UP group, 9 in the BP group and 61 in the BE group. The mean follow-up time was 39.0 ± 27.7, 50.0 ± 22.1 and 25.8 ± 18.9 months in UP, BP and BE groups, respectively. Thirty cases (12.7%) of buttock claudication occurred, and it was significantly higher in the BE group than the UP group (26.2% vs. 7.8%, p < 0.001). There were no significant differences in the other follow-up outcomes among three groups. The K-M analysis indicated that the patients in the BE group had a lower survival rate than those in the other two groups (p = 0.024). 24 patients underwent IIA reconstruction, including 8 in the IPG group and 16 in the IBG group. The endoleak in the IBG group was significantly lower than that in the IPG group (0% vs. 25.0%, p = 0.041). The iliac-related reintervention, iliac occlusion and mortality were similar between the two groups. Overall it is beneficial for patients to preserve at least one side of IIA during EVAR as much as possible. Compared with IPG, IBG might be more applicable for IIA reconstruction.

The early outcomes of two separate anastomosis procedures in deceased kidney transplantation with double arteries: A retrospective comparative study

BackgroundKidneys with double renal arteries are used on a routine basis nowadays, and separate anastomosis in situ is one of the suitable arterial anastomosis procedures. The commonly used methods are parallel end-to-side anastomoses of double arteries to the external iliac artery, and end-to-end anastomosis to the internal iliac artery combined with end-to-side anastomosis to the external iliac artery. No studies have compared the prognoses of the two procedures in deceased kidney transplantation. MethodsWe retrospectively analyzed 35 consecutive deceased kidney transplantations with double arterial anastomoses in the urology department of China–Japan Friendship Hospital from January 2018 to April 2021. Group I comprised recipients with double parallel end-to-side anastomoses to the external iliac artery; Group II comprised the others. Their prognoses were then compared. ResultsThere were no significant differences between Group I and II in characteristics of recipients and donors. The mean eGFRs at 1, 3, 6 and 12 months post-transplant in Group I and II were 36.4 vs 54.1 (P = 0.009), 40.4 vs 54.4 (P = 0.02), 40.4 vs 56.9 (P = 0.02) and 39.8 vs 57.9 (P = 0.007) mL/min respectively. There was no difference in early postoperative complications and 1-year survival rates between the two groups (P = 1.00). ConclusionSeparate anastomosis is a reliable procedure for deceased kidney transplantation with double arteries. Double separate anastomoses to the external and internal iliac arteries have better graft function compared with double parallel anastomoses to the external iliac artery during the first year after transplantation.

Single-Center Mid-term Experience with E-Liac Branched Device from Artivion®

IntroductionThe use of iliac branch device (IBD) is increasing due to the less invasive character and accumulated experience of physicians in this endovascular technique. Clinical data regarding the E-liac stent graft from Artivion®, however, are scarce. This study shows the mid-term outcomes of the E-liac stent graft from a large single centre. MethodsPatients treated with IBD for (aorto-)iliac aneurysms between September 2015 and December 2022 with follow-up in our centre were included. (Post)operative (technical success, reintervention, 30-day mortality) and mid-term outcomes (endoleak, reintervention, hypogastric patency, mortality) were analysed. ResultsSixty-three patients (60 male, median age 70 years (IQR 66-;76)) were treated with 82 E-liac stent grafts for aorto-iliac aneurysms with a median follow-up of 38 months (IQR 22-51). The technical success rate was 95%. 97.6% of the interal iliac arteries remained patent during follow-up. No 30-day mortality was encountered. During follow-up one patient had an endoleak type 1b of both hypogastric arteries, however the patient refused additional interventions. One other patient had a type 2 endoleak with contained rupture. Paliative treatment was chosen because of the patient's severe comorbidities. One (1.6%) IBD-related reintervention was performed with relining of the stent graft. Secondary patency of the interal iliac artery was 95.1% and the mortality was 25.4% during follow-up. ConclusionsThis study shows high technical success rates for the E-liac stent graft, with corresponding good mid-term outcomes. The E-liac stent graft is a feasible, safe and effective stent graft in the treatment of aorto-iliac aneurysms.

Rapidly Enlarged Bilateral Isolated Internal Iliac Artery Aneurysms Associated With Systemic Lupus Erythematosus

Rapidly Enlarged Bilateral Isolated Internal Iliac Artery Aneurysms Associated With Systemic Lupus Erythematosus

Case Study: Co-existing Isolated Internal Iliac Artery Aneurysm and Solitary Kidney

Purpose: The purpose of this case study is to report on an isolated internal iliac artery aneurysm (IIIAA) with solitary kidney found during cadaveric dissection and to discuss potential clinical implications of such a variation. Methods: IIIAA and solitary kidney were discovered during cadaveric dissection performed by six nursing graduate students at Samford University in Birmingham, Alabama. Upon discovery, a literature review was performed to consider clinical implications, patient presentation, and management strategies associated with IIIAA and solitary kidney. This is the first time the pairing of these variations has been reported and thus it is difficult to speculate whether or not this person had symptoms associated with either of these conditions. Results: IIIAA is independently associated with bladder, ureter, rectal, iliac vein, and sciatic nerve symptoms. Solitary kidney is associated with hypertension and end-stage renal disease. Conclusion: As this variation was discovered post-mortem, it is unknown whether this condition was symptomatic.

Covered Endovascular Reconstruction of the Iliac Artery Bifurcation (CERIB).

The aim of this study was to present the covered endovascular reconstruction of the iliac artery bifurcation (CERIB) technique as a revascularization option for aorto-iliac occlusive disease (AIOD) involving the iliac artery bifurcation. This was a retrospective single-center study including all patients undergoing a CERIB procedure from January 2021 until December 2022. Covered endovascular reconstruction of the iliac artery bifurcation procedures were performed percutaneously with bilateral femoral access, excepting cases where simultaneous open femoral artery reconstruction was required due to the extension of peripheral arterial occlusive disease. Standard patient, procedural, and follow-up (FU) data including survival and arterial reinterventions were gathered and analyzed. A total of 13 patients were included (11/13 male, median age=70 [60-76] years). Additional open and/or endovascular procedures included endarterectomy of the femoral bifurcation (n=6), rotational atherectomy (n=2), and 1 axillary artery cutdown for upper limb access (n=1). Median operating time was 2.9 hours (1.5-4.9 hours); median radiation duration and dose were 28.4 (14.3-63.3 minutes) and 4090.6 (384.4-9430.1 cGray/cm2), respectively. The stent grafts used for CERIB were BeGraft peripheral n=31, BeGraft Aortic n=4 and BeGraft peripheral plus n=1 (Bentley InnoMed GmbH, Hechingen, Germany). In 2 patients with prior stenting of the common iliac artery (CIA), only the internal and external iliac arteries (IIA and EIA) were treated in this study, and in 2 cases, additional uncovered stents were required for relining. Technical success was 100%. During a midterm FU (median 18 [4-31] months), 2 patients died from cardiovascular reasons and 1 patient with prior iliac stenting required reinterventions for recurring occlusion. Covered endovascular reconstruction of the iliac artery bifurcation is a straightforward option for treating AIOD involving the iliac artery bifurcation that allows preservation of internal iliac artery perfusion and shows good early and midterm results. Prior iliac artery stenting may be a risk factor for early occlusion after CERIB. Aorto-iliac occlusive disease with involvement of the internal iliac artery is encountered regularly in vascular surgical practice, but the internal iliac artery is often not included in the revascularization strategy. The present article will increase the awareness for the relevance of including the internal iliac artery in revascularization strategies and presents CERIB as another method to be added to the armamentarium of (endo-)vascular surgeons and interventionalists.

Imaging for Hemorrhoidal Disease: Navigating Rectal Artery Embolization from Planning to Follow-up.

Hemorrhoid disease is very common, affecting greater than one-third of adults. Conservative management and several office-based procedures are useful in the treatment of internal hemorrhoids. Patients with refractory hemorrhoid disease have traditionally been treated with surgical hemorrhoidectomy. Rectal artery embolization has emerged as an alternative to surgical hemorrhoidectomy and has been shown to be safe and effective in case series and clinical trials completed over the past decade. Embolization has significantly less postprocedure pain when compared with surgical hemorrhoidectomy with similar outcomes. Pre- and postprocedure imaging are not routinely performed. Intraprocedural imaging consists of selective catheterization of the superior rectal arteries from the inferior mesenteric artery, and the middle rectal arteries from the internal iliac artery. The inferior rectal artery is seldom embolized due to the supply of the levator ani muscle and skin. To date, intermediate and large particles and fibered and nonfibered coils have been used successfully.

Effects of Internal Iliac Artery Ligation on Stress and Urge Incontinence: A Retrospective Evaluation.

Does bilateral internal iliac artery ligation (BIIAL), a fundamental intervention in the treatment of postpartum hemorrhage, increase the risk of urinary incontinence (UI)? This study aims to shed light on the effects of BIIAL on bladder perfusion and urinary system integrity, thereby elucidating urinary function disorders following pelvic surgery. Demographic and medical data were collected from a total of 192 female patients, with and without the application of BIIAL. Urinary incontinence conditions were assessed using the Questionnaire for Urinary Incontinence Diagnosis (QUID) test. The data collection process was conducted according to ethical standards, and the results were analyzed to determine the types of incontinence. In the group that underwent BIIAL, the number of pregnancies and births was statistically higher compared to the control group. A significant effect of BIIAL was seen in cases of urge urinary incontinence (UUI), while no meaningful impact was detected on stress urinary incontinence (SUI). After the BIIAL procedure, an increase in the rate of urinary leakage was seen in certain cases. Bilateral internal iliac artery ligation has proven to be a safe and effective intervention in the management of postpartum hemorrhage. The findings suggest a potential impact of BIIAL on UUI but not on SUI. Comprehensive and long-term prospective studies are needed to further investigate the effects of BIIAL on pelvic blood flow and bladder functions.

An arterial map of the uterine artery - a tool for endovascular and gynecological procedures

IntroductionThe anatomy of the uterine artery (UA) is highly complex, demonstrating various patterns of origin and course. The main objective of the present study is to provide the first anatomical heat map of the UA, demonstrating the location of its origin and course in the pelvis.MethodsIn July 2022, an assessment was conducted on the findings from 40 consecutive female patients who had undergone computed tomography angiography of the abdomen and pelvis. Morphometric features of the UA and its associated anatomical area were gathered in 19 categories.ResultsThe presented results are based on a total of 58 UAs. 40 UAs originated from the anterior trunk of the internal iliac artery (69.0%), 16 of the UAs originated from the umbilical artery (27.6%), and the remaining two originated from the inferior gluteal artery (3.4%). The median diameter of the UA at its origin was found to be 3.20 mm (LQ = 2.63; HQ = 3.89).ConclusionThe anatomy of the UA is highly complex, showcasing variable topography, origin patterns, and morphometric properties. In the present study, a novel arterial map of this vessel was made, highlighting the diversity in its origin location and course. In our studied cohort, the UA originated most commonly from the anterior trunk of the internal iliac artery (69.0%), as described in the major anatomical textbooks. Having adequate knowledge about the anatomy of this artery is of immense importance in various gynecological and endovascular procedures, such as hysterectomies and embolizations.

Initial Experience of the Covered Endovascular Reconstruction of Iliac Bifurcation Technique.

The distal landing zone in iliac arteries represents an important issue during endovascular repair of abdominal aortic aneurysms (EVAR). The aim of this study is to present a case series for landing in the external iliac artery (EIA) during EVAR while preserving blood flow in the internal iliac artery (IIA) with the covered endovascular reconstruction of the iliac bifurcation (CERIB) technique. This is a single-center, retrospective analysis of prospectively collected data of patients that underwent EVAR either for intact abdominal aortic aneurysm (AAA) or previous failed EVAR from December 2022 up to September 2023. Indications for treatment were presence of common iliac artery aneurysm (CIAA), short CIA, or endoleak type Ib (ETIb). For the distal sealing zone, we used balloon-expandable covered stent (BXCS). Primary outcomes were technical success and first-month patency rate. Secondary outcomes were endoleak and re-intervention rate. Sixteen patients being treated with 20 CERIBs were included in the study. Four patients had a previous failed EVAR, while 3 patients were treated urgently for a symptomatic para-renal aneurysm. The indications for treatment were EIb (n=2), short CIA (n=4), CIAA with narrow lumen (n=3), and CIA aneurysm (n=11). Platforms that were used were the Cook Zenith Alpha (n=5), Gore C3 (n=2 and 3 limbs), Endurant IIs (n=2, and 3 limbs), and a t-branch device (n=3). Technical success rate was 100% with no adjunctive procedure. No death or re-intervention was recorded for all patients at postoperative 30-day period and at 6 months for 2 patients. At first-month CTA, patency rate was 100% (20/20), while in 2 patients that had 6-month CTA, the patency was also 100% (2/2). No kinking or stenosis was also noted. Two patients had ETIII after branched EVAR (BEVAR), 2 patients had ETII, and 1 patient had gutter ET in the area of the CERIB. The CERIB technique seems to be effective and safe in the early period. It is suitable with a variety of commercial endograft platforms. It may be a valuable alternative to iliac branch devices when there are anatomical considerations. Longer follow-up is needed to conclude for long-term patency and durability. The distal landing zone in iliac arteries represents an important issue during EVAR while it is important to preserve blood flow in the internal iliac artery. The covered endovascular reconstruction of the iliac bifurcation (CERIB) technique is a technique for the preservation of internal iliac arteries during EVAR, while it is suitable with a variety of commercial endograft platforms. The CERIB technique seems to be effective and safe in the early period. It may be valuable alternative to iliac branch devices when there are anatomical considerations.

#1264 Effects of different vascular anastomoses on the transplanted kidney (Inflammation and fibrosis markers from a molecular biological perspective)

Abstract Background and Aims Ischemia-reperfusion injury (IRI) is an unavoidable occurrence in kidney transplantation, and the inflammatory response associated with IRI significantly influences allogeneic immunity and transplant outcomes. Minimizing cold ischemia time is essential to reduce IRI, and anastomosis to the internal or external iliac artery is the preferred arterial anastomotic approach. The purpose of this study was to investigate the effect of anastomotic placement on renal function and whether mRNA levels are a factor that may predict renal function decline after transplantation. Method This study retrospectively encompassed 65 living kidney transplant procedures conducted from January 2019 to March 2023. The cohort was categorized into two groups using preoperative CT scan assessments of calcification: the internal iliac artery anastomosis group (consisting of 31 patients) with calcification rates below 10%, and the external iliac artery anastomosis group (comprising 34 patients) with calcification rates exceeding 10%. We conducted a comprehensive comparison of preoperative, intraoperative, and postoperative parameters for both groups. Furthermore, logistic regression analysis was employed to explore the factors influencing renal function. Given the absence of well-defined criteria for assessing renal function post-transplantation, we established a criterion based on the recipient's estimated glomerular filtration rate (eGFR) at discharge, relative to the preoperative donor eGFR. Patients were categorized into two groups, with divisions falling above and below the midpoint of this criterion, and subjected to comparative analysis. In addition, pathology and RNA-seq analysis were performed on protocol kidney biopsies at 3 months and 1-year post-transplant. Results Preoperative and intraoperative parameters displayed no significant differences between the two groups, and postoperative renal function remained consistent. Notably, in the external iliac group, one patient required reoperation due to anastomotic hemorrhages, while in the internal iliac group, one patient needed re-anastomosis to the external iliac bone due to insufficient blood flow post-anastomosis. No instances necessitated treatment for rejection. The logistic regression analysis revealed that a lack of prior experience with hemodialysis significantly influenced eGFR in the favorable outcome group. Moreover, RNA-seq analysis and pathology identified mutations in the immune system and TGFβ pathway associated with IRI. Conclusion Despite no discernible impact on postoperative renal function attributable to variances in anastomotic arteries, the group with external iliac artery anastomosis exhibited diminished activity in the TGFβ pathway and immune system components associated with fibrosis three months post-operation, hinting at a potentially reduced susceptibility to long-term renal damage. In light of these findings, anastomosing to the external iliac artery appears to be a safe option, and when feasible, it may be the preferable choice for anastomosis in kidney transplantation.

Variability of the origin and course of the uterine artery in clinical practice

In 2020, approximately 287,000 mothers died during pregnancy or childbirth, with one of the leading causes of maternal mortality being peripartum hemorrhage. It can be treated both pharmacologically and procedurally, for example, through uterine artery ligation, embolization, or hysterectomy. In case of procedural treatment, it is essential for the medical team to familiarize themselves with the anatomical structure of the patient's uterine arteries. Various variations in the course of this vessel are distinguished, such as the uterine artery branching as a bifurcation with the inferior gluteal artery, a common trunk of the uterine artery with another vessel, or even its duplication. Using radiological techniques such as angiography, it is possible to visualize vessels and their variations, which can allow for better patient care. Unfamiliarity with the departure and trajectory of the uterine artery may be associated with an increased risk of postoperative complications, especially after hysterectomy, where the uterine arteries close at the level of the uterus or at the beginning of their departure from the internal iliac artery. Ligating them in other place may result in ischemia of an area that should be continuously supplied with blood. Also, during surgery, special attention should be paid to possible anatomical variations of the patient's uterine artery, which, although rare, can cause intraoperative complications. A thorough analysis of the departure and trajectory of the uterine artery by physicians can prevent postoperative complications and also allow for the safe conduct of embolization procedures. The following article presents a literature review on the departure and course of the uterine artery and its variations, as well as procedural interventions related to this vessel.

A case of abdominal aortic aneurysm presenting as symptomatic disseminated intravascular coagulation treated with endovascular aneurysm repair and postoperative administration of Nafamostat mesylate

BackgroundCases of abdominal aortic aneurysm discovered as purpura on the extremities with disseminated intravascular coagulation (DIC) are rare. The number of currently established strategies for the control of DIC with aortic aneurysm is limited.Case presentationAn 85-year-old woman was referred to the hematology department because of purpura on her shoulder and thigh. Enhanced fibrinolytic-type DIC was diagnosed by a blood test. Enhanced computed tomography (CT) revealed 60-mm abdominal aortic and 42-mm right common iliac aneurysms. We performed endovascular aneurysm repair (EVAR) and coiling of the right internal iliac artery with postoperative administration of Nafamostat mesylate. The patient promptly recovered from DIC, and the purpura gradually disappeared.ConclusionsWe safely performed EVAR with postoperative administration of Nafamostat mesylate for an abdominal aortic aneurysms that presented as symptomatic DIC.

Percutaneous Retrograde Trans-Gluteal Embolization of Type 2 Endoleak Causing Iliac Aneurysm Enlargement after Endovascular Repair: Case Report and Literature Review.

Late type II endoleaks (T2ELs) arising from the internal iliac artery (IIA) may present during follow-up after endovascular aortic repair (EVAR) of aortoiliac aneurysm and may warrant embolization if enlargement of the aneurysmal sac is demonstrated. When coverage of the IIA ostium has been made due to extensive iliac disease, access options can be challenging. Different treatment options have been reported over recent years, and a careful selection of the best one must be made based on the characteristics of each case. The present study reports a simple and reproducible sheathless percutaneous superior gluteal artery (SGA) access and provides a discussion based on a review of the existing literature on this topic.

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.

Exploring the Significance of Katikataruna Marma: An Ayurvedic Perspective on Vital Energy Center

This review article delves into the intricate concept of Marma points within the framework of Ayurvedic philosophy, with a specific focus on the Katikataruna Marma located in the Prushta region. Marma points, regarded as vital energy centers, house Prana, and hold profound implications for health. The Katikataruna Marma, characterized as a Kalantarapranahara Marma, embodies a delicate balance of Soumya and Agneya qualities, with their interplay dictating the trajectory of life. The precise location of Katikataruna Marma is explored across references, positioned either beside the vertebral column or above the Sphik on the Shronikarna. Anatomically, this Marma amalgamates diverse components: muscular elements such as the gluteal and pelvic muscles, vascular intricacies involving the internal iliac artery, neural and connective structures like sacro-iliac ligaments and lumbo-sacral nerves, skeletal components comprising the iliac bone and sacrum, and the pivotal sacro-iliac joint. Critical insights emerge regarding the aftermath of injuring the Katikataruna Marma. A disruption in the equilibrium of Soumya and Agneya Guna triggers a gradual decline, with blood loss (Shonita kshaya) inducing symptoms like anemia, pallor, malaise, and ultimately, mortality. Prognosis unfolds, emphasizing the manifestation of Pandu, Vaivarna, and Hina Rupa, elucidating the complex interplay between components in the Marma region. By dissecting the intricacies of the Katikataruna Marma, this article contributes to a deeper comprehension of Ayurvedic principles and their holistic approach to wellness. The exploration of Marma points transcends anatomical facets, resonating with Ayurveda's holistic philosophy of harmonizing physical, mental, and spiritual well-being.

Abstract 1154: Length And Proximal Extent Of Occlusion Dictates Severity Of Disease In A Mini-swine Model Of PAD

Background: There is ongoing need for large animal models of peripheral artery disease (PAD) that replicate human disease. We present mild (MI), moderate (MD) and Severe (S) phenotypes of PAD in an Ossabaw mini-swine platform. Methods: Metabolic syndrome was induced in swine (N=16; age= 4 mo) with a high fat/fructose/sodium diet for 8 weeks. Ischemia induction (T0) consisted of: (1) open ligation and resection of R Superficial Femoral Artery (SFA) for MI(N=4); (2) endovascular coil occlusion of R External Iliac Artery (REIA), RSFA and popliteal artery for MD (N=9); and (3) coil occlusion of REIA, RSFA, and right internal iliac artery (RIIA) for S (N=4). At 4 weeks (T4) and 8 (T8), all swine underwent angiography via carotid access, and bilateral gastrocnemius biopsy. All swine had measurements of ankle brachial indices (ABIs), and calf muscle tissue oximetry (STO 2 ) measurements at T0, T4 and T8, along with weekly measurement of walking performance on a treadmill (WP). Results: At T4 and T8 R ABI were increasingly decreased from MI to MD to S (table 1). Mean STO 2 difference between R and L calf at T4 and T8 had no changes in MI, while the differences were larger in S compared to MD (table 1). WP was increasingly decreased from MI to MD to S (table 1). The artery that grew the most on angiography at T4 and T8 were R profunda artery (RPFA) in MI; RIIA in MD; and LIIA in S (table 1). In MI, R PFA had faster flow at T4 and T8 compared to L PFA. At T4, MD and S had similar delays of RPFA reconstitution, this improved at T8 in MD but did not in S (table 1). On histology, MI had no obvious myopathy, MD and S had moderate and severe myopathy respectively. All S subjects developed poorly-healing ischemic ulcers. Conclusion: Length and proximal extent of occlusion dictated the characteristics and severity of phenotypes in our Ossabaw swine model of PAD. This mirrors PAD in humans and can be used to develop therapies for different disease severities.

Abstract 1153: Adipose-derived Mesenchymal Stem-cell Therapy Improves Arteriogenesis, Hemodynamics, And Walking Performance In A Porcine Model Of Peripheral Artery Disease

Background: There are few effective alternatives to revascularization for peripheral artery disease (PAD). We used our porcine model of PAD to test the hypothesis that adipose derived mesenchymal stem cells (ADMSC) injected around the aortic trifurcation in the pelvis improve ischemic limb hemodynamics and walking performance (WP). Methods: In Ossabaw miniswine (N=13, Age=6 mo) with metabolic syndrome, right (R) hindlimb ischemia was induced with R External Iliac and Superficial Femoral artery coil occlusion (T0) via carotid artery access. All swine had weekly testing of WP on a treadmill. At weeks 0 (T0), 4 (T4), and 8 (T8), ankle brachial indices (ABI) and muscle tissue oximetry (STO 2 ) were measured. At T4 and T8 all swine underwent angiography. At T4, in treatment (Tx) swine (N=4) ADMSC were isolated using stromal vascular fractionation of autologous abdominal wall fat. Using jugular vein access, a catheter with a retractable side-deploying needle was inserted in the R iliac vein and stabilized by a juxtaposed angioplasty balloon. The needle was deployed to access the retroperitoneum and ADMSC were infused around the aortic trifurcation. Results: Ischemic controls (IC) had no differences between T4 and T8 in ABIs, and mean STO 2 differences between R and L in calves and thighs. Tx improved both ABI and mean STO 2 measurements (table 1). IC had no changes in WP between T4 and T8, while Tx showed improvements (table1). On angiography, IC had growth of R Internal iliac artery (RIIA, the main inflow to the ischemic R hindlimb) and shorter appearance time (AT) of RIIA compared to L with no difference between T4 and T8. Tx showed increased growth of RIIA and shorter AT at T8 compared to T4 (table 1). Conclusion: In a clinically-relevant (similar to humans in size, anatomy, physiology and comorbidities) porcine model of PAD we found that ADMSC injection around the aortic trifurcation in the pelvis induces arteriogenesis and improves ischemic limb hemodynamics and walking performance.

Embolization of Vessels With Irregular Lumen Using the Coil Packing Technique Between the Amplatzer Vascular Plug II Lobes.

The Amplatzer Vascular Plug(AVP) series enables precise positioning and high migration resistance, allowing embolization in short segments; however, inadequate embolization or recanalization may occasionally occur. We hypothesized that leaks may occur when AVPs are implanted in vessels with irregular lumen due to insufficient adherence to the vessel. This hypothesis was tested by experiments with a vascular model. We employed a coil packing technique between the AVP lobes to embolize internal iliac arteries with an irregular lumen. Saline was injected through the Y-shaped glass tubes of the stenotic and the smooth model (without stenotic lesion), and the amount of leakage was measured when the AVP was deployed. The feasibility and effectiveness of filling coils between the lobes of AVP II were evaluated. A total of 11 cases were retrospectively reviewed using this technique for internal iliac artery embolization prior to endovascular aortic repair. The amount of leakage was significantly higher in the presence of stenotic lesions.Insertion of a 2.2 F microcatheter from the side of the proximal lobe of AVP II and filling of coils was achieved in all 11 cases. Follow-up contrast-enhanced CT showed no recanalization, leakage, or other obvious complications. Coil packing technique around Amplatzer Vascular Plugs could be an effective method and a reliable option for arterial embolization, especially in vessels with irregular lumens.

Prophylactic occlusion balloons of both internal iliac arteries in caesarean hysterectomy for placenta accreta spectrum disorder reduces blood loss: A retrospective comparative study

BackgroundThe placenta accreta spectrum is a complex disorder characterized by abnormal invasion of the placenta into the uterine wall, posing a significant risk of life-threatening haemorrhage for patients. Its incidence is on the rise, largely attributed to the increasing rates of caesarean sections. Management of this spectrum involves a multidisciplinary approach, although standardized protocols are not yet established. While caesarean hysterectomy remains the standard Gold, several adjunctive treatments have emerged in recent years to mitigate bleeding risk and associated morbidity. Among these, prophylactic occlusion balloons placed in the internal iliac arteries have shown promise. The aim of our study is to demonstrate the effect of prophylactic occlusion balloons in both uterine iliac arteries in the management of placental accreta spectrum disorders. MethodsA retrospective monocentric cohort study was conducted in the Department "C" of Gynaecology and Obstetrics at the Maternity Center of Tunis. The study spanned three years, from January 2nd, 2020, to December 31st, 2022. The study population consisted of two groups: Control Group (CG) comprised patients who underwent caesarean hysterectomy without internal-iliac prophylactic occlusion balloons, and Occlusion balloons of both internal iliac arteries Group (OBIIAG) included patients who underwent caesarean hysterectomy with internal-iliac prophylactic occlusion balloons. ResultsA total of 38 patients were included in the study, all of whom exhibited similar epidemiological characteristics and comparable personal and obstetric histories. The most prevalent risk factor among the patients was a history of caesarean section (92%). On average, patients were diagnosed at 30 weeks of gestation, with third-trimester bleeding being the most common presentation (71% of cases). The median gestational age at delivery was between 36 and 37 weeks. We observed a significant difference in blood loss between the two groups (2888 ml in the control group and 1828 ml in the group with internal-iliac prophylactic occlusion balloons, p < 0.05). Implementation of this technique resulted in a reduced need for massive transfusions (p < 0.01) and shorter operating times (126 min for the control group and 92 min for the group with internal-iliac prophylactic occlusion balloons; p = 0.04). There were no significant differences in morbidity between the two groups. ConclusionThe intra-iliac prophylactic occlusion balloons can help reduce the risk of hemorrhage and the morbidities that come with the placenta accreta spectrum disorder.