Ipsilateral Iliac Artery Research Articles

The Effect of Arterial Elongation on Isolated Common Iliac Artery Pathologies.

to investigate the effects of vessel geometry on steno-occlusive and dilatative common iliac artery (CIA) pathologies. this single-center, retrospective study included 100 participants, namely 60 participants with a unilateral, isolated CIA pathology who were divided into three pathology-based groups (a stenosis group, n = 20, an occlusion group, n = 20, and an aneurysm group, n = 20) and 40 participants without a CIA pathology (control group). All participants underwent abdominal and pelvic computed tomography angiography. The aortoiliac region of the participants was reconstructed into three-dimensional models. Elongation parameters (tortuosity index (TI) and absolute average curvature (AAC)) and bifurcation parameters (iliac take-off angle, iliac planarity angle, and bifurcation angle) were determined using an in-house-written piece of software. Demographic data, anthropometric data, cardiovascular risk factor data, and medical history data were obtained from participants' electronic health records. The following statistical methods were used: one-way ANOVA, chi-square test, t-tests, Wilcoxon test, Kruskal-Wallis test, and multivariate linear regression. in the occlusion group, both TI and AAC values were significantly higher on the contralateral side than on the ipsilateral side (both p < 0.001), whereas in the aneurysm group the AAC values were significantly higher on the ipsilateral side than on the contralateral side (p = 0.001). The ipsilateral and contralateral TI and AAC values of the iliac arteries were significantly higher in the aneurysm group than in the other three groups (all p < 0.001). Age significantly affected all of the elongation parameters except for the TI of the infrarenal aorta (all p < 0.010 except the TI of the infrarenal aorta). In addition, the AAC values for the iliac arteries were significantly associated with obesity (ipsilateral iliac artery, p = 0.045; contralateral iliac artery, p = 0.047). Aortic bifurcation parameters did not differ significantly either within each group (ipsilateral versus contralateral side) or between the individual groups. occlusions tend to develop in relatively straight iliac arteries, whereas unilateral, isolated CIA aneurysms are more likely to occur in elongated aortoiliac systems.

Clinical Patterns, Predictors, and Results of Graft Limb Occlusion following Endovascular Aneurysm Repair

To assess the incidence, clinical patterns, and outcomes of graft limb occlusion (GLO) following endovascular aneurysm repair (EVAR). A retrospective study of patients undergoing EVAR from 2002 to 2017 at 2 mid-sized suburban teaching hospitals. The ipsilateral and contralateral aorto-common iliac artery (A-CIA) angle and common iliac artery-external iliac artery (CIA-EIA) angle were determined. The diameter of the EIA, graft extension to the EIA, and prior CIA stenting was recorded. Of the 373 patients who underwent EVAR, 319 were analyzed. 22 patients had 23 limbs with GLO (21 unilateral and 1 bilateral) with a mean follow-up of 9.1±2.1years. There were no statistically significant differences in mean age, gender, size of the abdominal aortic aneurysm, and risk factors of hypertension, coronary artery disease, diabetes mellitus, and chronic obstructive pulmonary disease in patients with and without GLO. There was no statistically significant difference in A-CIA and CIA-EIA angles. A smaller diameter EIA (6mm or less), graft extension to EIA, and prior CIA stenting were significant predictors of GLO. Four limbs had GLO within 1month of EVAR, only open thrombectomy was performed in 2 limbs, open thrombectomy with simultaneous axillo-femoral graft in 1 limb, and open thrombectomy with self-expandable stent placement in 1 limb. 12 limbs had GLO within 1-12months treated with only open thrombectomy in 3 limbs, open thrombectomy with fasciotomy in 1 limb, open thrombectomy with graft extension to EIA in 1 limb, and crossover femoral-femoral graft performed in 3 limbs. Seven limbs had GLO within 1-5years with a crossover femoral-femoral graft performed in 4 limbs and open thrombectomy with graft extension to EIA was performed in 1 limb. Six limbs with GLO following EVAR did not undergo any intervention. One patient had an above the knee amputation 3years following occlusion of the axillo-femoral graft and 1 patient returned in 4years with an increase in size of the excluded aneurysm leading to acute rupture and death. GLO leads to significant morbidity and mortality following EVAR. Predictors of GLO following EVAR include a small diameter EIA, prior CIA stenting and graft limb extension to the EIA.

Clampless In-Situ Immobilized Branching (CLIMB) to Reconstruct the Internal Iliac Artery.

Surgical reconstruction of the internal iliac artery (IIA) or its branches is sometimes demanding because of difficulty in distal clamping and suturing in the narrow pelvic space. Here we present a hybrid technique of ClampLess In-situ imMobilized Branching (CLIMB) to reconstruct IIA. in the CLIMB technique, an 8 mm artificial graft is sutured onto the surface of the common iliac artery (CIA) without clamping. Following puncture of the CIA wall, stent grafts are bridged from IIA to the graft. Finally, the graft is sutured to the ipsilateral external iliac artery (EIA). Concomitant endovascular aneurysm repair or IIA branch embolization can also be performed. We applied this technique to the patients unsuited for other IIA reconstruction. eleven patients underwent the current technique. All but one patient underwent contralateral IIA interruption. Seven patients had a history of aorto-iliac repair before the index surgery. Iliac extender, internal iliac component, Viabahn VBX or Fluency covered stent were used for bridging the graft. Simultaneous IIA branch embolization was performed in 2 patients. Distal landing zones were IIA in 7 grafts, superior gluteal artery in 4 grafts and inferior gluteal artery (IGA) in 1 graft. Technical success was achieved in all cases. No patient complained of buttock claudication or other ischemic symptoms on the treatment side. During a mean follow-up period of 38 months, 11 out of 12 grafts were patent without any related endoleak. One IGA graft occluded at 56 months after surgery. the CLIMB technique is a viable alternative to preserve IIA with an acceptable mid-term durability.

Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement.

Purpose Insertion of a ureteral access sheath (UAS) may fail in some patients in retrograde intrarenal surgery (RIRS), and this study aimed to seek preoperative risk factors for the failure of 12/14F UAS placement. Methods We retrospectively analyzed 260 consecutive patients who underwent RIRS between May 2020 and March 2022 at our institution. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected and compared between the success and failure UAS placement groups. Results Twenty-nine (11.2%) patients failed to insert the UAS. Age, gender, height, weight, stone side, stone location, length of history, and computed tomography (CT)-based parameters were not significant differences between the two groups. Univariate logistic regression analyses showed sex (female/male) (odds ratio: 0.287 and 95% CI [0.107, 0.722], p=0.013), length of history 15–31 days (odds ratio: 0.315 and 95% CI [0.102, 0.974], p=0.045), length of history >31 days (odds ratio: 0.202 and 95% CI [0.051, 0.805], p=0.023), and diameter of the ipsilateral common iliac artery (odds ratio: 1.285 and 95% CI [1.018, 1.623], p=0.035) were associated with UAS placement. Conclusion Our study indicated that males, the short length of history, and the short diameter of the ipsilateral common iliac artery were the risk factors for the failure of UAS placement.

Regenerative Effects of Locally or Intra-Arterially Administered BMSCs on the Thin Endometrium.

Stem cell–based therapy plays a pivotal role in the regeneration of damaged endometrium. Previous studies have demonstrated the therapeutic potential of bone marrow mesenchymal stem cells (BMSCs) through diverse administration ways. However, the homing, survival, and differentiation potential of these differently administered BMSCs are poorly defined, and the best route of administration is not well-defined. Herein, we aim to compare the engraftment, retaining time, and therapeutic efficiency of differently administered BMSCs. To achieve this, GFP/Luc-labeled BMSCs administered in two modes were assessed in a thin endometrium rat model: either into the damaged horns directly or through the ipsilateral iliac artery. The retaining time and hemi-quantitative distribution were evaluated by in vivo bioluminescence imaging and immunohistological analysis. Locally administered BMSCs were strongly detected in the abdomen at the first 4 days post treatment but underwent a rapid decrease in luminescent signal afterward and were rarely found 28 days after treatment. In contrast, the retaining time of BMSCs injected through the iliac artery was longer, reflected by more GFP-positive cells detected in the uterine section 28 days post treatment. Differentiation toward endometrial stromal cells was observed. Both routes of administration contributed to the restoration of the damaged endometrium, showing a comparable increase in the endometrial thickness and a decrease in fibrosis. However, more importantly, higher expression of LIF and VEGF, better recruitment, and longer retainment were found in the intra-arterial administration, contributing to the establishment of the optimal administration mode in clinical practice.

Outcomes of Hypogastric Coverage and Occlusion during Endovascular Treatment of Aortoiliac Occlusive Disease

The risk of hypogastric occlusion (HO) following bare-metal stent (BMS) coverage of the hypogastric origin during endovascular treatment of aortoiliac occlusive disease (AIOD) is unclear. This study sought to determine the rate and clinical significance of HO following BMS coverage during iliac stenting for complex AIOD. Consecutive patients undergoing elective iliac stenting for AIOD from 2010-2018 at Cleveland Clinic were reviewed. Patients with BMS coverage of a patent hypogastric origin were included. Rate of HO were determined by review of intraoperative angiography and follow up imaging. Predictors of HO were identified by univariable and multivariable logistic regression. Outcomes were compared between those who did and did not develop HO. There were 251 patients (338 limbs) with BMS coverage of the hypogastric origin during treatment of AIOD. Lesion severity was classified as TASC C/D in 249/338 (73.7%) of cases. Bilateral hypogastric coverage occurred in 93/251 (37.1%) patients. Hypogastric patency was 78.1% at 24-months following coverage. Recanalization of an ipsilateral external iliac artery (EIA) occlusion was predictive of HO (HR 3.12, 95% CI: 1.33, 7.34; P= 0.009). Increased luminal diameter of the hypogastric origin protected against HO (HR 0.64; 95% CI: 0.47, 0.88; P= 0.006). Perioperative outcomes were no different between patients with and without HO. There were no cases of gluteal necrosis, spinal cord ischemia, or pelvic organ ischemia. Four-year mortality and limb salvage were not affected by HO. HO was associated with decreased primary patency of ipsilateral iliac stents and increased risk of ipsilateral reintervention (HR 5.49; 95% CI: 1.82, 16.58; P= 0.002). HO is relatively infrequent following BMS coverage during treatment of AIOD. Luminal diameter of the hypogastric origin and ipsilateral EIA occlusion are associated with occlusion. HO is well tolerated in AIOD, though it is potentially associated with increased risk iliac stent occlusion and reintervention.

P–802 The fate and regenerative efficiency of differently administered BMSCs in thin-endometrium rat models

Abstract Study question This study aims to compare the engraftment, retaining time and therapeutic efficiency of differently administered BMSCs and help to select an optimal therapeutic route in clinical settings. Summary answer Compared with intrauterine infusion, BMSCs could better promote angiogenesis by upregulating related cytokines, such as VEGF, when administered through the ipsilateral iliac artery. What is known already MSC-based therapy has become a promising method for endometrial disease(thin endomtrium or Ashernmen’s syndrowe). Therapeutic effects could always be observed even though different MSC administration routes or MSCs of different tissue sources were used in these studies. Only a few studies compared efficacy of different transplantation routes. However, the results seem to be controversial. Comparable therapeutic effects were reported in some studies, while others stated that systematic administration gave a better outcome than local administration. Study design, size, duration Experimental animal study. Forty-eight female Sprague-Dawley (SD) rats were used in this study. They were randomly assigned to 4 groups: normal, injured, intra-arterial and intra-uterine group. For all rats except for normal group, the thin endometrium models were established by infusing 95% ethanol into the uterine horns and BMSCs were transplanted either locally or intra-arterially after modeling. The therapeutic efficacy were evaluated in the following month. Participants/materials, setting, methods The thin endometrium models induced by ethanol in SD rats, GFP/Luciferin labeled BMSCs were injected either locally or intra-arterially. The retaining time and quantitative distribution were assessed by in vivo bioluminescence imaging and immune-histological analysis. The precise location and differentiation of differently administered BMSCs were determined by immunofluorescence methods. The endometrial fibrosis, angiogenesis were detected by immunohistochemistry and western blotting at a consecutive time after treatment to compare the therapeutic efficiency of two administration methods. Main results and the role of chance The engraftment and differentiation abiility were comparable in 2 groups. The luminescent signal both remained distinct and strong in the abdomen in the first 4 days post-treatment(7.98 × 105 and 6.02 × 105p/s for IU and IA group), indicating the precise and concentrated distribution of BMSCs administered both locally or intra-arterially. The luminescent signals disappeared under bioluminescence imaging over time. We further evaluated the precise distribution, differentiation ability and retaining time of the BMSCs delivered in two strategies by immunofluorescence analysis. All the GFP positive cell localized in stroma, but not in the epithelium or myometrium. Furthermore, there are significantly more positive staining in basal layer of the endometrium close to the glands and vessels than the outer layer of the endometrium in the intra-arterial group. At the 28th days post treatment, we could capture a few GFP staining in the basalis layel of endometrium in intra-arterial group and there were no GFP fluorescence signals detected in intra-uterine group(P &amp;lt; 0.05), suggesting a better survival of BMSCs administered intra-arterially. Differentiation ability of differently administered BMSCs were similar. A few BMSCs began to differentiate into stromal cell 12 days after therapy. Limitations, reasons for caution No pregnancy tests were carried out in these rats to further confirm the regeneration of thin endometrium and compare the therapeutic efficacy. Wider implications of the findings: Our study unveiled that the location of MSCs might determined their regenerarive ability and retaining time, and provided an optimal therapeutic route in clinical settings. Trial registration number Not applicable

Congenital absence of bilateral common iliac arteries.

The common iliac arteries originate at the body of the fourth lumbar vertebra and bifurcate after approximately 5 cm into the external and internal iliac arteries. Anomalies of the iliac arteries are rare, with a reported incidence of only 6 in 8000 patients.1Greebe J. Congenital anomalies of the iliofemoral artery.J Cardiovasc Surg. 1977; 18: 317-323PubMed Google Scholar We present a case of a 66-year-old man with a history of diabetes and hypertension who presented with an ischemic left foot wound. Preoperative aortoiliac imaging studies were not obtained because the patient had palpable bilateral femoral pulses. Aortoiliac angiography demonstrated the absence of bilateral common iliac arteries (A and B/Cover). The aorta terminated into two internal and two external iliac arteries. The left external iliac artery was cannulated, and the remainder of the case was uneventful. The congenital absence of bilateral common iliac arteries has been described once after incidental finding on autopsy2Mansfield A.O. Howard J.M. Absence of both common iliac arteries: a case report.Anat Rec. 1964; 150: 363-364Crossref PubMed Scopus (16) Google Scholar and once intraoperatively during a placenta accreta case requiring internal iliac artery ligation for hemorrhage control.3El-Agwany A.S. Bilateral absence of common iliac artery: abnormal anatomical variation of the internal iliac artery during ligation in conservative surgical management of placenta previa accreta.Indian J Gynaecol Oncol. 2016; 14: 329-330Google Scholar Other case reports have described the unilateral absence of common iliac arteries with various symptoms depending on the presence of in-line flow to the femoral artery.4Dumanian A.V. Frahm C.J. Benchik F.A. Wooden T.F. Intermittent claudication secondary to congenital absence of iliac arteries.Arch Surg. 1965; 91: 604-606Crossref PubMed Scopus (15) Google Scholar,5Llauger J. Sabate J.M. Guardia E. Escudero J. Congenital absence of the right common iliac artery: CT and angiographic demonstration.Eur J Radiol. 1995; 21: 128-130Abstract Full Text PDF PubMed Scopus (11) Google Scholar The absence of a common iliac artery has been described with an associated absence of the ipsilateral external iliac artery. In that case, collateral branches from the ipsilateral internal iliac artery had reconstituted the common femoral artery.4Dumanian A.V. Frahm C.J. Benchik F.A. Wooden T.F. Intermittent claudication secondary to congenital absence of iliac arteries.Arch Surg. 1965; 91: 604-606Crossref PubMed Scopus (15) Google Scholar No other arterial variations were identified in this case. To the best of our knowledge, this is the only angiographic image demonstrating the absence of bilateral common iliac arteries in the literature. This rare anatomic variant will likely just be an incidental finding, but it could have clinical implications if a distal landing zone for endovascular aortic aneurysm repair or covered endovascular reconstruction of an aortoiliac bifurcation for occlusive disease is required. The patient provided written informed consent for the description of his case before submission of our report. Download .docx (.15 MB) Help with docx files Figure B Congenital absence of bl cia.docx

Abstract 335: Phase Contrast Magnetic Resonance Imaging as a Novel Complementary Tool for Investigations of Peripheral Artery Disease

Therapeutic angiogenesis is pertinent to the acute survival of distal ischemic tissue and a relevant treatment for critical limb ischemia (CLI). Therapeutic arteriogeneis is pertinent to the restoration of function, via collateral vessel formation in proximal tissue that is not typically ischemic, and a relevant treatment for preventing intermittent claudication from advancing to CLI. In preclinical models of peripheral artery disease (PAD), laser perfusion imaging methods are applicable to the former. However, recently published results indicate they underestimate recovery and their limited penetration depth restrict their application to the latter. Our objective was to evaluate whether phase contrast magnetic resonance imaging (PC-MRI) could be used as a complementary method in murine models of PAD. C57BL/6 male mice underwent femoral artery ligation (n=5). Mice were imaged prior to and day 3 after surgery. PC-MRI uses the phase of the MRI signal to calculate velocity of blood flow within a voxel. Integrating velocity across the vessel lumen results in flow measurements. Maximum velocity and mean volumetric flow were compared at the infrarenal aorta and ipsilateral (Ip) and contralateral (Con) iliac arteries. Maximum velocities did not change in the aorta or Con (pre vs. day 3: aorta, 55.4±7.2 vs. 48.9±9.4 cm/sec; Con, 45.7±7.5 vs. 40.7±8.0 cm/sec). Mean volumetric flows also did not change in the aorta or Con (pre vs. day 3: aorta, 2.0±0.7 vs. 1.53±0.4 mL/min; Con, 1.1±0.4 vs. 0.92±0.3 mL/min). In the ipsilateral iliac artery, maximum velocity was reduced by ~35% (pre vs. day 3: 43.6±5.7 vs. 28.4±5.5 cm/sec, p=0.002), leading to a reduction in mean flow of ~41% (1.1±0.4 vs. 0.63±0.3 mL/min, p=0.04). Ip/Con ratios for both metrics were: 0.98±0.2 vs. 0.74±0.2 cm/sec, p=0.03; and, 1.0±0.1 vs. 0.72±0.3 mL/min, p=0.03. Our previous work demonstrated the ability to promote proximal-arteriogenesis by inducing distal-angiogenesis via application of a slow-release growth factor. Having developed a non-invasive method to directly quantify velocity and flow in large proximal vessels, we will have the opportunity to explore the biomechanical mechanisms coupling angio- and arterio-genesis even though they occur temporally and spatially separated.

Recurrent central catheter complications in a newborn: can we blame neonatal lupus?

We present the case of a preterm newborn, whose mother had medical history of systemic lupus erythematosus and antiphospholipid syndrome treated in pregnancy with enoxaparin, prednisolone, azathioprine and hidroxicloroquine. Routine...

Secondary Procedures Following Iliac Branch Device Treatment of Aneurysms Involving the Iliac Bifurcation: The pELVIS Registry

Purpose: To evaluate the incidence and reasons for secondary procedures in patients treated with iliac branch devices (IBDs) for isolated iliac aneurysm or aortoiliac aneurysms involving the iliac bifurcation. Methods: Between January 2005 and December 2015, 575 surgical-high-risk patients (mean age 72.0±8.4 years; 558 men) with isolated iliac aneurysms (n=79) or aortoiliac aneurysms involving the iliac bifurcation (n=496) were treated with placement of 650 ZBIS or Gore IBDs (75 bilateral) in 6 European centers. The primary outcome was procedure-related reinterventions for occlusion or high-grade (>70%) stenosis of the bridging device, occlusion of the ipsilateral common or external iliac artery (EIA), type I/III endoleak, rupture, or infection following IBD implantation. Clinical and radiological data were analyzed based on preset definitions of comorbidities, aneurysm morphology, intraoperative variables, and follow-up strategies. Results: Nine (1.6%) reinterventions were performed within 30 days for occlusion or endoleak. Among 10 (1.5%) occluded EIAs ipsilateral to a deployed IBD, 6 underwent a reintervention with additional stent placement after thrombolysis (n=4) or a femorofemoral or iliofemoral crossover bypass (n=2). Three of 14 patients with early type I endoleak had a reintervention for an insufficient proximal sealing zone (stent-grafts in 2 common iliac arteries and 1 bifurcated endograft). Mean clinical and radiological follow-up were 32.6±9.9 and 29.8±21.1 months, respectively. Forty-two (7.3%) patients underwent reinterventions in the follow-up period. The overall postoperative reintervention rate was 8.9%. Both external and common iliac segments occluded in 30 (4.6%) IBDs; 2 patients had a crossover bypass and 14 were treated with endovascular techniques. In the other 14 patients, no specific treatment was performed. Seven (1.2%) patients with isolated EIA occlusion were treated during follow-up. Nineteen of the overall 28 patients with type I endoleak underwent endovascular repair. The other 9 were under radiological surveillance due to less significant (<5 mm) sac increase. No reintervention was performed to recanalize 11 (1.6%) occluded internal iliac arteries. Conclusion: Midterm experience with placement of IBDs is associated with a low incidence of secondary procedures due to type I endoleaks and occlusions. The main reasons for reinterventions seem to be short proximal sealing zone and poor conformability of the ZBIS device in elongated EIAs.

Reverse Retrograde Approach: An Alternative Method for Ipsilateral Access to the Superficial Femoral Artery

Access for endovascular treatment of the superficial femoral artery (SFA) is usually gained through an antegrade approach from the ipsilateral common femoral artery (CFA), or by crossing over from the contralateral CFA. In this technical note, an alternative method, based on retrograde access of the ipsilateral iliac artery (IA), and conversion into an antegrade approach to the SFA, is described. Successful reverse ipsilateral catheterisation was obtained in 15/16 patients. Calcification of the CFA and IA required a crossover approach in one case. There were no complications related to the technique, except for moderate bleeding in relation to the deployment of a closure device.

Ipsilateral common iliac artery plus femoral artery clamping for inducing sciatic nerve ischemia/reperfusion injury in rats: a reliable and simple method

The aim of this study was to develop a practical model of sciatic ischemia reperfusion (I/R) injury producing serious neurologic deficits and being technically feasible compared with the current time consuming or ineffective models. Thirty rats were divided into 6 groups (n = 5). Animal were anesthetized by using ketamine (50 mg/kg) and xylazine (4 mg/kg). Experimental groups included a sham-operated group and five I/R groups with different reperfusion time intervals (0 h, 3 h, 1 d, 4 d, 7 d). In I/R groups, the right common iliac artery and the right femoral artery were clamped for 3 hrs. Sham-operated animals underwent only laparotomy without induction of ischemia. Just before euthanasia, behavioral scores (based on gait, grasp, paw position, and pinch sensitivity) were obtained and then sciatic nerves were removed for light-microscopy studies (for ischemic fiber degeneration (IFD) and edema). Behavioral score deteriorated among the ischemic groups compared with the control group (p < 0.01), with maximal behavioral deficit occurring at 4 days of reperfusion. Axonal swelling and IFD were found to happen only after 4 and 7 days, respectively. Our observations led to an easy-to-use but strong enough method for inducing and studying I/R injury in peripheral nerves.

Alternative access techniques with thoracic endovascular aortic repair, open iliac conduit versus endoconduit technique

Iliac artery endoconduits (ECs) have emerged as important alternatives to retroperitoneal open iliac conduits (ROICs) to aid in transfemoral delivery for thoracic endovascular aortic repair (TEVAR). We present, to our knowledge, the first comparative analysis between these alternative approaches. All patients undergoing TEVAR with either ROIC (n= 23) or internal EC (n= 16) were identified. The mean age of the cohort was 72.4± 11.5years (82.1% female). Device delivery was accomplished in 100% of cases. The primary outcome was the presence of iliofemoral complications, which was defined as: (1) the inability to successfully deliver the device into the aorta via the ROIC or EC approach; (2) rupture, dissection, or thrombosis of the ipsilateral iliac or femoral artery; and/or (3) retroperitoneal hematoma requiring exploration and evacuation. Secondary outcomes were 30-day mortality and rates of limb loss, claudication, or revascularization. At a median follow-up of 10.1months, the incidence of iliofemoral complications was less for the EC approach compared with the ROIC technique (12.5% vs 26.1%; P= .301). No patients sustained limb loss. Revascularization was performed in two patients after ROIC. Lower extremity claudication occurred in one patient after EC. Early mortality was seen in one patient who underwent EC. Two-year Kaplan-Meier survival for the entire cohort was 74.4%, and did not differ between groups (ROIC, 78.3% vs EC, 68.8%; P= .350). Two-year Kaplan-Meier freedom from limb loss, claudication, or revascularization did not differ between the two approaches (ROIC, 91.3% vs EC, 93.8%; P= .961). Results of this early comparative evaluation of alternative access routes for TEVAR suggest that an EC approach is safe, effective, and associated with low rates of early mortality and late iliofemoral complications. In selected patients, the EC may be considered an appropriate delivery route for transfemoral TEVAR.

A rare case of May-Thurner-like syndrome in an elderly lady

An elderly lady presented with decreased mobility, sputum production and intermittent confusion. She was treated for chest sepsis, fast atrial fibrillation, and acute kidney injury, and also noted to have a swollen left leg. Venous duplex imaging showed extensive thrombus within the left common iliac, left external iliac and left common femoral veins. A CT Venogram showed compression of the left common iliac vein between an osteophyte at L5 and a calcified ipsilateral common iliac artery. It also showed a pelvic kidney with an extra renal pelvis and large renal cyst which was indirectly contributing to venous compression by splinting the left iliac artery. A decision was made after discussion at the Vascular MDT that the patient was not fit enough for surgery and to manage her medically with anticoagulation. Discussion: Proximal DVT’s are rarer than distal thrombosis, but have similar causes. One of the rarer causes of proximal DVT is May-Thurner syndrome and its variants known collectively as non-thrombotic iliac vein lesions. May-Thurner originally described DVT formation caused by extrinsic compression of the left common iliac vein between the overriding contralateral (right) common iliac artery and adjacent lumbar vertebrae. The best imaging modality is a CT Venogram. Duplex ultrasonography can be used, although it can be difficult to visualize the iliac veins. The mainstay of management is surgical thrombectomy, or thrombolysis, followed by stenting of the affected vessel. However, if intervention is not appropriate, then it can be managed medically with anticoagulation.

Single-center experience in the endovascular management of isolated iliac artery aneurysm

Isolated iliac artery aneurysms (IAA) are relatively uncommon and represent 2-7% of all intra-abdominal aneurysms. Surgery is the gold standard treatment for IAA. However, endovascular stent-graft placement is gaining acceptance as an alternative to surgery especially in patients with high surgical risk. To evaluate the effectiveness and safety of endovascular management of isolated IAA having various anatomic and pathologic bases. Between 2008 and 2011, 31 patients who underwent endovascular treatment for isolated IAA were retrospectively analyzed. The mean aneurysm size was 43 mm (range, 30-71 mm). The age ranged from 37 to 87 years (mean, 70.0 years). Isolated IAAs were treated in one of three different ways: (i) infrarenal aortic stent-graft placement with limb extension; (ii) stent-graft placement for isolated iliac artery coverage; and (iii) embolization with a coil and a vascular plug combined with femoral-femoral bypass grafting. All patients were assessed by contrast-enhanced computed tomography (CT). The mean follow-up period was 25.1 months (range, 1-60 months). Common iliac artery involvement was seen in 28 patients. Ten (35.7%) of those patients also had an internal IAA. Three patients had an isolated internal IAA. Infrarenal stent-graft placement was performed in 25 patients. Stent-graft placement for coverage of the only iliac artery was performed in five patients. One patient, who had a mycotic aneurysm of the right common iliac artery underwent coil embolization of the ipsilateral common iliac artery with concurrent femoral-femoral bypass graft. Five of the 31 patients (16.1%) with stent grafts had type II endoleaks at the time of the last imaging study, one of those patients underwent percutaneous embolization with glue. None of the patients showed major procedure-related complications. Percutaneous management of IAA is effective and safe with various techniques depending on the anatomical and pathologic features of the isolated IAA.

Inhibition of Growth in a Rabbit VX2 Thigh Tumor Model with Intraarterial Infusion of Carbon Dioxide–Saturated Solution

PurposeTo evaluate the efficacy of intraarterial infusion of CO2-saturated solution in rabbit VX2 thigh tumors. Materials and MethodsFourteen Japanese white rabbits had VX2 tumors implanted in the right femoral muscle 3 weeks before intraarterial infusion. Rabbits were divided into control and CO2 groups (n = 7 each). Fifty milliliters of solution (saline solution and CO2-saturated solution for the control and CO2 groups, respectively) was administered via a 24-gauge catheter in the ipsilateral iliac artery close to the feeding artery of the VX2 tumor. All rabbits were killed for tumor harvest on day 3 after the procedure. Tumor volume was evaluated with in vivo direct caliper measurement and contrast-enhanced computed tomography (CT). Tumor apoptotic changes were examined by DNA fragmentation assay and immunoblot analysis. The tumor growth ratio and apoptotic cell rate were analyzed. ResultsBody weight was equally increased in both groups, but the mean tumor growth ratio was significantly decreased in the CO2 group compared with the control group (−9.5% ± 7.9 vs 27.2% ± 6.6 and 4.1% ± 4.4 vs 35.7% ± 4.5 measured by calipers and contrast-enhanced CT, respectively; P < .01). Apoptotic activity in the CO2 group was higher than in the control group (number of apoptotic cells per area, 215.0 ± 58.7 vs 21.8 ± 5.4; adjusted relative density of cleaved caspase-3, 0.23 ± 0.07 vs 0.04 ± 0.01; P < .01). ConclusionsIntraarterial infusion of CO2-saturated solution inhibits rabbit VX2 thigh tumor growth by activation of apoptotic cell death through cleaved caspase-3 upregulation.

Study on elasticity of ipsilateral external iliac artery with echo-tracking after gunshot wound in pig limbs

Objective To explore the value of echo-tracking technique in the detecting the ipsilateral external iliac artery elasticity after gunshot wound in pig limbs.Methods Two-dimensional ultrasound imagings and elasticity parameters of external iliac artery of fifteen pig limbs were obtained respectively,and the results were compared with pre-injury groups.The animals were sacrificed after ultrasonography.Pathological examinations of adjacent external iliac artery of injured pig limbs were analyzed.Results Two-dimensional ultrasound imagings of external iliac arteries had no significant changes post-injury.The changes of elasticity parameters were significiant differences in the injured group comparing with the pre-injured group (P ＜0.05),including the increased stiffness parameter(β),pressure-strain elasticity modulus (Ep)and the decreased arterial compliance(AC).Pathological result showed that the internal elastic lamina of artery detected were flat,endothelial cells came off discontinuously and structure of them were undefined.Conclusions Echo-tracking technique can find the elastic changes of adjacent artery indirect injured by gunshot wound sensitively and which can suggest the occurrence of vascular indirect injury. Key words: Ultrasonography; Wound, gunshot ; Iliac artery; Elasticity

PMMA embolization to the left dorsal foot artery during percutaneous vertebroplasty for spinal metastases

Distal arterial embolization to the foot with PMMA during vertebral augmentation has not been previously reported. We report a rare case of distal PMMA embolization to the dorsal foot artery during ipsilateral percutaneous lumbar vertebral augmentation in a patient with spinal osteolytic metastases. A 68-year-old woman was admitted because of severe disabling low back pain. Plain roentgenograms, MRI and CT-scan revealed osteolysis in the L4 and L5 vertebral bodies with prevertebral soft tissue involvement. Percutaneous vertebroplasty with PMMA was performed in L2 to L5 vertebrae under general anesthesia. Intraoperatively, leakage into the segmental vessels L3 and L5 was observed. Four hours after the procedure the clinical diagnosis of acute ischemia and drop foot on the left was made. CT-angiography justified linear cement leakage in the course of the left third lumbar vein and fifth lumbar artery, and to the ipsilateral common iliac artery. The patient was treated with low molecular heparin and the ischemia resolved without further sequelae 1 week postoperatively. PMMA leakage is a complication associated with vertebroplasty and kyphoplasty. Although the outcome of the PMMA embolization to the vessels resolved without sequelae, in our case spine surgeons and interventional radiologists should be aware on this rare complication in patients with osteolytic vertebral metastases even when contemporary cement containment techniques are used.

Balloon Occlusion of the Contralateral Iliac Artery to Assist Recanalization of the Ipsilateral Iliac Artery in Total Aortoiliac Occlusion: A Technical Note

Endovascular recanalization of chronic total aortoiliac occlusion is technically challenging. Inability to reenter the true aortic lumen, following retrograde iliac recanalization, is one of the most common causes of failure. We describe a case of a total aortoiliac occlusion where balloon occlusion of the right common iliac artery, following its recanalization from a brachial approach, was used to facilitate antegrade recanalization of the occluded contralateral left common iliac artery.