Left Iliac Artery Research Articles

Inferior gluteal artery aneurysm with arteriovenous fistula

A 78-year-old woman was referred with a pulsatile mass in the left buttock and pain in the left leg. She also complained of numbness from the left buttock to the posterior thigh. She had a history of pelvic fracture as the result of a traffic accident 2 years earlier. A computed tomography (CT) scan demonstrated a 35-mm 33-mm aneurysm under the gluteus maximus muscle (A), in a location that could cause compression of the sciatic nerve. An arteriogram showed an aneurysm arising from the distal inferior gluteal artery with rapid visualization of the associated vein, indicating an arteriovenous (AV) fistula (B). These findings were confirmed by three-dimensional CT angiography and demonstrated that the AV fistula perfused the left iliac vein and sacral venous plexus (Cover). We judged that surgical resection of the aneurysm and concomitant AV fistula carried a high risk of massive intraoperative bleeding or injury to the adjacent neurologic structures; therefore, we performed an endovascular intervention. A contralateral transfemoral sheath was placed into the left internal iliac artery with selective catheterization of the left inferior gluteal artery. Coil embolization of the inferior gluteal artery was performed via a microcatheter using four 5-mm Vortex coils (Boston Scientific Corp, Natick, Mass). After the artery was successfully embolized and complete angiographic exclusion of the aneurysm was achieved (C), intraoperative duplex scanning showed loss of flow within the aneurysm. Postoperative CT scan confirmed complete thrombosis of the aneurysm. The patient’s postoperative course was uneventful, and her leg symptoms resolved.

Delayed Upstream Migration of an Iliac Stent

Stent migrations are described after peripheral endovascular treatments. We report a case of an unusual iliac stent movement after a successful angioplasty. An occlusive distal intimal flap after aorto-iliac endoarterectomy was successfully fixed by stenting of the left external iliac artery. One month later, the patient was readmitted due to contralateral limb acute ischemia. Angiography revealed a right iliac artery thrombosis due to upstream stent migration from the left external iliac artery into the right common iliac artery. The patient underwent a combined surgical and endovascular rescue technique. Turbulent and pulsatile flow, associated with wall remodelling may explain this unexpected complication.

Coil embolisation of an internal iliac artery aneurysm after surgical repair of an infrarenal aortic aneurysm

We report a case of an 86-year-old asymptomatic patient, who underwent a repair of the infrarenal abdominal aortic aneurysm 13 years ago. He presented with a left internal iliac artery (IIA) aneurysm with a short neck of 3 mm, and a partially thrombosed lumen with a cross sectional diameter of 5.6 cm and a length of 8.9 cm. With respect to the high morbidity and mortality and awareness of the recommendation to treat aneurysms larger than 3 cm in diameter, we discussed the optimal treatment options. As endoprosthesis implantation was not feasible we performed a selective coil embolisation of the distal branches of the left internal artery, which successively lead to a complete thrombosis of the aneurysm. Although coiling additive to other procedures is applied frequently, only few cases of internal iliac aneurysm were treated with coil embolisation alone. During a first outpatient visit 2 months following the procedure the aneurysm was still completely thrombosed.

An unusual case of multiple aortic abnormalities: total occlusion of aortic arch, left external iliac artery, and bicuspid aortic valve in a 21-year-old man

An unusual case of total occlusion of aorta just distal to the left subclavian artery, bicuspid aortic valve, and occluded left external iliac artery in a 21-year-old man who was admitted with headache and severe hypertension is presented. We wish to report this case because so far there have been none reported with such multiple aortic abnormalities, although several documented cases of isolated total occlusion of aorta exist. Our patient underwent a successful surgical correction, i.e., patch plasty to the coarcted segment and end to side - end to side aortal-aortal bypass with Dacron graft.

Lumbosacral plexopathy associated with aortoiliac occlusive disease

Lumbosacral plexopathy associated with aortoiliac occlusive disease

Systemic application of anti-ICAM-1 monoclonal antibodies to prevent restenosis in rabbits: an anti-inflammatory strategy

After vascular intervention, cell adhesion molecules such as ICAM-1 and VCAM are fundamental in inflammatory processes. In particular, ICAM-1 expression is strongly associated with macrophage-rich areas in restenotic lesions. Therefore, we hypothesized an anti-restenotic effect by systemic application of anti-ICAM-1 monoclonal antibodies (mAb). Thirty two rabbits underwent balloon angioplasty and stent implantation either in the right or left iliac artery, Animals received either anti-ICAM mAb or saline solution as a control. Animals were sacrificed 7 (n=8) and 14 (n=8) days and tissue was analyzed for basic fibroblast growth factor (bFGF) and transforming growth factor beta (TGF-beta) expression. Sixteen animals were sacrificed 6 months following treatment and tissue was harvested for histomorphometric analysis. After balloon injury, bFGF significantly increased from 7 to 14 days only in the control group and was significantly higher compared to the anti-ICAM group. At 14 days after stent implantation, controls showed a significant increase of both bFGF and TGF-beta, whereas the anti-ICAM group only showed a significant increase of TGF-beta. Histomorphometric analysis for neointimal growth did not show any differences between control and anti-ICAM groups either after balloon injury or after stent implantation at 6 months. Administration of anti-ICAM-1 mAb following either balloon angioplasty or stent implantation results in a suppression of bFGF in the early phase of restenosis, whereas TGF-beta significantly increases from 7 to 14 days after stent implantation independent of anti-ICAM-1 mAb application. Therefore we conclude that anti-inflammatory strategies are able to interfere with growth factor expression after vascular injury.

Buttock claudication disclosing a thrombosis of the superior left gluteal artery: Report of a case diagnosed by a selective arteriography of the iliac artery, and cured by per-cutaneous stenting

We report on a case of left buttock claudication, occurring consistently after 150 meters walking, and disappearing after a short rest. As magnetic resonance angiography (MRA) did not show any explanation for this claudication, a selective angiography of left internal iliac artery was requested, which clearly identified a tight stenosis of the onset of the left superior gluteal artery. A per-cutaneous angioplasty together with stenting of this artery, induced a prompt and complete relief of pain at the three months follow-up visit.

The collateral pathway from the left internal thoracic artery to the left external iliac artery detected by multislice computed tomography

It is important to evaluate the presence or absence of the collateral pathway from the left internal thoracic artery in aortoiliac occlusive disease. This case report indicates that multislice computed tomography is a very useful method for detecting this collateral pathway.

Intra-arterial application of magnetic nanoparticles for targeted thrombolytic therapy: A rat embolic model

Targeted delivery of thrombolytic drug to the site of emboli exhibits potential to greatly reduce hemorrhagic side effect. A rat embolic model with an easy access of a magnet was established for study of the efficacy of magnetic drug targeting. In anesthetized rats, a whole blood clot produced in vitro was injected from the right iliac artery and lodged in the left iliac artery. Intra-arterial infusion of recombinant tissue plasminogen activator (rt-PA) thereafter significantly reversed the iliac flow within 15 min. Placement of an NdFeB magnet above the left iliac artery caused magnetic nanoparticle retention against hemodynamic dragging force in the presence and absence of the clot. Our results suggest the feasibility of this rat embolic model for the study of magnetic targeted delivery of thrombolytic drugs.

Isolated aneurysm of the internal iliac artery and disorders of the pelvic organs functions

Isolated aneurysm of internal iliac artery is very rare and often asymptomatic. Aneurysm itself can produce malfunction of the pelvic organs. Aneurysm rupture is followed by high mortality. A 76-year-old patient was admitted to the hospital with abdominal and left groin pain, disuric problems, obstipation and the signs of intestinal subocclusion. These problems persisted over the last few months. Digitorectal examination showed pulsatile tumor. Computed tomography and angiography revealed isolated aneurysm of the left internal iliac artery with a maximal diametar of 13.5 cm. The aneurysm was treated operatively using extraperitoneal approach in general anestesia. During the operation a Cell Saver was used. The left internal iliac artery was resected and ligated with end-aneurysmatic suture of its branches. Isolated aneurysm of the internal iliac artery should be considered by differential diagnosis in any case of the occurence of disorders of the pervic organs functions. Clinical findings, ultrasound examination, computed tomography and angiography are the diagnostic techniqnes of choice which can confirm the diagnosis. Surgical treatment with the use of retroperitoneal approach lead to complete recovery, so it could be considered the method of choice for patients with the condition permitting a radical surgical approach.

Fatal ischemic stroke related to nonpermissive peripheral artery access for percutaneous aortic valve replacement

This report describes an 85 year-old man who underwent percutaneous aortic valve replacement (PAVR). With a logistic euroSCORE of 37%, the patient had been refused surgical aortic valve replacement because of an unacceptably high peri-operative risk. During the PAVR procedure, severe resistance was encountered when advancing the 21 Fr delivery catheter through the left iliac artery despite pre-dilatation with a 7 mm balloon. Following this, PAVR was promptly achieved without difficulty, with excellent valve positioning, no peri-valvular leak and good hemodynamics. However, transesophageal echocardiography revealed a mobile echogenic mass within the outflow tract of the left ventricle. The mass was retrieved with a cardiac bioptome manipulated via the left femoral artery through a 9 Fr sheath. A right cerebral ischemic stroke manifested shortly after the post-procedure and the patient died on the fourth post-operative day. Post-mortem findings revealed a left subclavian artery occlusion by iliac vascular tissue. This report highlights the imperative for device-specific vascular access screening criteria and the need to minimize device size in order to safely accomplish PAVR.

Funnel Technique for First-Line Endovascular Treatment of an Abdominal Aortic Aneurysm With an Ectatic Proximal Neck

To describe a novel endovascular technique for proximal stent-graft fixation in an abdominal aortic aneurysm (AAA) with an ectatic aortic neck. An 84-year-old man with multiple comorbidities and an asymptomatic 7-cm infrarenal AAA with a 38-mm aortic neck diameter was treated with a 3-component Talent-LPS stent-graft system. After the left internal iliac artery was embolized with coils, a 34 x 16 x 170-mm Talent bifurcated stent-graft was placed in the lower part of the AAA. A 44-mm-diameter, 90-mm-long free-flow thoracic tube endograft (6-mm oversizing) was delivered to the proximal neck through the bifurcated device and deployed with at least 30 mm of overlap, leaving more than 40 mm extending into the infrarenal aorta to ensure expansion to its nominal diameter as well as an adequate seal. An iliac extension was deployed into the left external iliac artery, and 2 sequential iliac extensions were inserted from the bifurcated stent-graft limb to the right common iliac artery in a bell-bottom configuration. Serial computed tomographic angiograms at up to 18 months have documented the intact 3-component stent-graft, with no endoleak or migration and no increase in aneurysm sac diameter. This case illustrates the feasibility of placing a straight thoracic endograft as a proximal extension of a bifurcated aortic endograft into a dilated proximal aortic neck. This endograft configuration appears secure and effective, with no type I endoleak or migration over a midterm follow-up.

Treatment of Secondary Stent-Graft Collapse After Endovascular Stent-Grafting for Iliac Artery Pseudoaneurysms

We report the case of a patient who developed an asymptomatic pseudoaneurysm in the left external iliac artery after transplant nephrectomy. The pseudoaneurysm most probably arose as a suture aneurysm from the external iliac artery after removal of the graft renal artery. Obviously we can not exclude the possibility it was a true aneurysm, although this seems much less likely. The pseudoaneurysm was detected during a routine CT scan and was treated interventionally with a stent-graft. One month later the asymptomatic patient underwent a vascular ultrasound examination including color Doppler, power Doppler, and B-flow as a routine control. An endoleak with collapse of the stent-graft was diagnosed. There was no evidence of stent infection. At a reintervention, the pseudoaneurysm was successfully treated using two uncovered Palmaz stents at the proximal and distal edge of the stent graft. Peri- and post-interventional ultrasound and CT angiography confirmed the exclusion of the aneurysm without an endoleak.

Endovascular Treatment of Ruptured Iliac Aneurysm Previously Treated by Endovascular Means

A patient with a ruptured iliac aneurysm was admitted to the Emergency Department in hypovolemic shock. He had previously undergone surgical treatment for an infrarenal abdominal aortic aneurysm, which was managed with a terminal-terminal Dacron tube graft. Subsequently, he developed two iliac aneurysms, which were treated endovascularly with two wall-grafts in the right and one wall-graft in the left iliac arteries. He suffered chronic renal failure and arterial hypertension. Contrast-enhanced computed tomography showed rupture of the right iliac aneurysm and dislocation of the two wall-grafts. He was treated in an emergency situation with the implantation of an iliac endograft that bridged the two wall-grafts, which resulted in hemostasis and stabilization of his condition. Five days later, in an elective surgical situation, he was treated with the implantation of an aorto-uni-iliac endograft combined with a femoral-femoral bypass. He was discharged 5 days later in good condition. At the 4 year follow-up visit, the endoprosthesis remained in place with no evidence of an endoleak. In conclusion, overlapping of endografts should be avoided, if possible. Strict surveillance of the endovascularly treated patient remains mandatory.

Percutaneous Continuous Aortic Flow Augmentation for Cardiac Recovery in a Chronic Heart Failure Patient With Peripheral Vascular Disease

Peripheral vascular disease is an obstacle to the use of continuous aortic flow augmentation (CAFA). The authors used CAFA in a patient with a 50% stenosis of the left iliac artery. Five hours after initiating therapy, flow rates dropped from 1.47 L/min to 0.2 L/min, possibly due to obstruction around the inflow cannula near the site of the iliac artery stenosis. Flow was stabilized by adequate fluid infusion and successfully restored by slightly withdrawing the tip of the inflow catheter. This finding suggests that peripheral vascular disease is a relative-not an absolute-contraindication for CAFA, but requires close monitoring of flow during CAFA therapy.

P-526: An oocyte pick-up procedure complicated with pseudoaneurysm of the internal iliac artery

P-526: An oocyte pick-up procedure complicated with pseudoaneurysm of the internal iliac artery

Arsenic trioxide eluting stent reduces neointima formation in a rabbit iliac artery injury model

In-stent restenosis is caused by the neointimal hyperplasia, which involves abnormal growth of vascular smooth muscle cells (VSMC). Arsenic trioxide (As2O3) is known to be a potent inhibitor of cell proliferation. We therefore studied the role of an As2O3 eluting stent in the prevention of restenosis in a rabbit iliac artery model. Bare stents, or stents coated with poly-L-lactic acid (PLLA) and either 40 microg of As2O3, 180 microg of paclitaxel or vehicle were implanted into the left proximal iliac arteries of New Zealand rabbits. The delivery of drugs from stents in vitro and in vivo was evaluated by atomic fluorescence spectrophotometry and high-performance liquid chromatography, respectively. Histomorphometric measurements at 7 or 28 days showed that, comparing to rabbits receiving the PLLA stent, in animals treated with As2O3 eluting or paclitaxel eluting stent neointima thickness was reduced by 50% and 46%, the absolute neointimal area was reduced by 53% and 44%, while the absolute luminal area was increased by 46% and 43%, respectively. There were no significant differences in injury or inflammation scores among PLLA, As2O3 eluting and paclitaxel eluting stents. As2O3 eluting stent induced more TUNEL-positiv VSMC than the other stents. As2O3 levels measured in the arterial tissue were much higher than those in serum, which were nearly undetectable at 7 days after stent implantation. In in vitro studies, cultured rabbit arterial VSMC were stimulated with As2O3 or paclitaxel and analyzed for their cell cycle progression and apoptosis by flow cytometry and electron microscopy. As2O3 treatment resulted in a reduction of VSMC number in G1 phase with a concomitant increase in apoptosis of VSMC, whereas paclitaxel treatment led to blocking of VSMC in the G2/M phase. In a rabbit iliac artery model PLLA coated As2O3 eluting stent significantly suppressed in-stent restenosis by reducing proliferation and inducing apoptosis of VSMC.

Melatonin reduces ischemia/reperfusion‐induced superoxide generation in arterial wall and cell death in skeletal muscle

The purpose of this study was to determine the effect of melatonin on superoxide generation in arterial wall at an early phase of reperfusion and on endothelial dysfunction of microvasculature and cell viability of cremaster muscle at late phase of reperfusion (24 hr) after prolonged ischemia. Bilateral vascular pedicles which supply blood flow to the cremaster muscle were exposed. After surgical preparation, microvascular clamps were applied on the right iliac, femoral and spermatic arteries to create 4 hr of ischemia in both feeding vessels and the unexposed cremaster muscle. The vascular clamping was omitted on the left iliac, femoral and spermatic arteries and served as an internal control. Melatonin or Vehicle was via by intravenous injection at 10 min prior to reperfusion and 10 min after reperfusion. In the first experiment, the vascular pedicle was harvested after reperfusion to measure superoxide generation in real time by lucigenin-derived chemiluminescence. In the second experiment, endothelial-dependent and -independent vasodilatation was examined in the terminal arteriole of cremaster muscle which was then harvested to examine cell viability by WST-1 assay on day 2. Superoxide generation in arterial wall peaked at first 5-min of reperfusion and declined to near baseline after 60 min of reperfusion. Melatonin treatment significantly reduced superoxide generation in arterial walls and improved cell viability in cremaster muscles. Melatonin treatment also significantly reduced microvascular endothelial dysfunction which was still observable in the microcirculation of cremaster muscle after 24 hr of reperfusion. Melatonin reduces superoxide generation in the early phase of reperfusion resulting in attenuating endothelial dysfunction and muscle cell death in the late phase of reperfusion.

Peripheral Pseudoaneurysm in Active Behçet's Disease: Surgical and Perioperative Therapeutic Strategies

Since aneurysms in patients with Behçet's disease are often pseudoaneurysmal and adjacent arteries are highly inflammatory, there is not only a risk of rupture but also a high incidence of late surgical complications at anastomotic sites. Furthermore, there is no consensus on perioperative medical therapeutic strategy in patients with active vasculo-Behçet's disease who require surgery. Herein, we present two cases of active Behçet's disease, a 51-year-old male with rupture of the left internal iliac artery who required emergent operation and a 31-year-old male with a rapidly developed pseudoaneurysm in the right superficial femoral artery. Surgical and perioperative therapeutic strategies are also discussed.

Differential inhibition by hyperglycaemia of shear stress‐ but not acetylcholine‐mediated dilatation in the iliac artery of the anaesthetized pig

Clinical hyperglycaemia affects vascular endothelial function, but the effect on shear stress-induced arterial dilatation has not yet been established. We hypothesized that hyperglycaemia would inhibit this response via impaired glycocalyx mechanotransduction. Experiments were carried out in the anaesthetized pig in which pressure, blood flow and diameter of the left iliac artery were measured at two sites: proximal (d1) and distal (d2). Infusion of glucose, sufficient to raise blood glucose to 16-30 mm along the whole length of the artery, attenuated the shear stress-dependent dilatation in both sections of the artery with preservation of the responses to acetylcholine. The distal site was then isolated using snares and the lumen exposed to blood containing 25-35 mm glucose for 20 min. In the control situation, after exposure of both sections to normoglycaemia (5.7 mm glucose), both sections of artery showed increases in diameter in response to shear stress and acetylcholine. Hyperglycaemia attenuated the shear stress-dependent dilatation in the distal section only (P < 0.25), but not the response to acetylcholine. It is concluded from these results that the hyperglycaemia-impaired dilatation is consistent with loss of mechanotransducing properties of the endothelial glycocalyx by hyperglycaemia. These findings offer a possible explanation for the increased incidence of vascular disease in diabetic patients.