Occlusion Of External Iliac Artery Research Articles

Hipogastric Artery Stenosis in a Patient With Severe Chronic Ischemia

Atherosclerotic lesions of the hypogastric artery have been recognized as a cause of buttock claudication, thigh claudication, and impotence, and usually treated by endovascular procedures and in some instances with open surgery. We report an unusual case of a total occlusion of the left external iliac artery, severe stenosis of the left hypogastric artery with rest pain, and ischemic lesion in the left foot that was successfully treated with hypogastric angioplasty and covered self-expanding stent implant. The patient recovered distal pulses, rest pain disappeared, and the ischemic lesion healed; currently the patient walks without intermittent claudication, and the lesion of the toe has healed.

Novel application of the “CART” technique for endovascular treatment of external iliac artery occlusions

We report the novel application of the Controlled Antegrade and Retrograde subintimal Tracking technique for the endovascular treatment of occlusions of the external iliac artery (EIA). We hypothesized that this technique would limit the extent of subintimal dissection to the length of the EIA occlusion, thus preserving patency of the internal iliac artery proximally and the circumflex iliac artery distally and minimizing the length of stent required to treat the occlusion, including the length of stent placed in the common femoral artery. The technical execution and clinical experience with this technique is reported.

Intraoperative Buttock Ischemia with Postoperative Necrosis following Infrainguinal Bypass Surgery

Buttock necrosis is a rare presentation of severe pelvic ischaemia. It has been reported following open abdominal aortic repair and after internal iliac embolisation prior to endovascular treatment of aortic aneurysm. The internal iliac arteries are the major blood supply to the pelvis and buttocks. Collateral connections between the rectal and gluteal branches of the internal iliac artery and the deep femoral artery are well recognised. Iatrogenic interruption of this collateral circulation following rectal surgery resulting in limb ischaemia has been described. We present an exceptional case of buttock necrosis following infrainguinal bypass in a patient with bilateral internal iliac and left external iliac artery occlusions. The case is the first such reported to our knowledge.

Alternative Hybrid Reconstruction for Bilateral Common and Internal Iliac Artery Aneurysms Associated With External Iliac Artery Occlusion

To describe an alternative reconstruction for bilateral common (CIA) and internal (IIA) iliac artery aneurysms associated with external iliac artery (EIA) occlusion in a patient unfit for open surgery. A high-risk 81-year-old man presented with contained rupture of a left CIA aneurysm in the presence of bilateral CIA and IIA aneurysms associated with complete occlusion of the left EIA and normal patency of both common femoral arteries. In an emergent procedure, the left EIA was recanalized subintimally, and the right IIA was embolized with a 14-mm Amplatzer Plug. The main body of a standard Excluder endograft was deployed just distal to the origin of the left renal artery, and the ipsilateral leg was extended into the proximal right EIA. On the contralateral side, a short 10-mm-diameter limb was inserted through a 12-F sheath and deployed in the CIA, proximal to the iliac bifurcation. Via a percutaneous left brachial artery access, 3 covered stents (9x59 mm, 10x59 mm, 10x59 mm) were deployed from the distal IIA to the endograft contralateral limb. A right-to-left femorofemoral crossover bypass graft concluded the operation. The patient was discharged on the 5th postoperative day without complications; follow-up imaging at 6 months showed patency of the stent-graft and crossover bypass, with complete exclusion of the aneurysms and no evidence of endoleak. This case demonstrates an effective solution for complex aortoiliac lesions using commercially available devices, underlining how an accurate knowledge of alternative endovascular techniques and materials is crucial in the management of complex cases.

Extraanatomic Bypass and Coronary Artery Grafting for Coral Reef Aorta

A 63-year-old man complained of abdominal angina and intermittent claudication. Multidimensional angiography showed focal calcified obstruction of the suprarenal aorta, occlusion of the right external iliac artery, and instent restenosis in the right coronary artery. Extraanatomic bypass was performed from the ascending aorta to the left external iliac and right femoral arteries, using an 8-mm bifurcated graft, with concomitant off-pump coronary artery grafting. The patient's digestive symptoms and leg claudication disappeared.

Endovascular Treatment Strategies in Aortoiliac Occlusion

The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.

Combined Retrograde–Antegrade External Iliac Artery Occlusion Recanalization Through Collaterals: Description of a New Technique

Combined Retrograde–Antegrade External Iliac Artery Occlusion Recanalization Through Collaterals: Description of a New Technique

Hybrid Open Endovascular Repair of Para-Anastomotic Common Iliac Artery Aneurysm in the Presence of Bilateral External Iliac Artery Occlusions

We describe a successful hybrid open endovascular repair of a large tender para-anastomotic common iliac artery aneurysm arising after previous open abdominal aortic aneurysm repair in a high-risk patient with bilateral chronic total external iliac artery occlusions.

Migration of Embolization Coils: Our Experience

We refer with interest to the Case Report by Shah et al. [1], who reported the passage of embolization coils in their patient following embolization of a splenic pseudoaneurysm. We also report a similar complication in our recent practice. A 65-year-old patient who was diagnosed with metastatic endometrial carcinoma in 2005 presented in September 2007 with rectal bleeding. She was being anticoagulated with warfarin for a deep vein thrombosis diagnosed in March 2007. In late August 2008, her warfarin was stopped due to hematuria and bleeding per rectum. Her International Normalized Ratio (INR) was found to be 4.4 at this time. On admission in September 2008, the patient’s INR was 1.6. She settled with conservative management, was advised to stop taking warfarin, and was discharged home. She had an outpatient CT scan 2 weeks later. This showed a cavitating mass adjacent to the right internal iliac vessels and the sigmoid colon. She re-presented 2 days later with further rectal bleeding and abdominal pain, then underwent angiography with a view to embolization. The angiogram showed an occlusion of the right external iliac artery just beyond its origin (Fig. 1). Selective catheterization of the right external iliac artery (Fig. 2) showed contrast extravasation into the lumen of the sigmoid colon. The right internal and external iliac arteries were embolized using platinum coils with a good angiographic result (Fig. 3). The patient then underwent an immediate femoral-femoral crossover graft, to preserve perfusion of her right leg. She made a good recovery and was discharged. The patient was readmitted 18 days later with symptoms of vomiting. At admission, she said that she had also passed two coils per rectum while at home. An abdominal radiograph from this admission (Fig. 4) showed that the

Perioperative thrombotic occlusion of left external iliac artery during anterior lumbar interbody fusion

We report a case of thrombotic occlusion of left external iliac artery during the procedure of anterior lumbar interbody fusion. The diagnosis was confirmed by computed tomography angiography. The patient also developed severe rhabdomyolysis postoperatively. In spite of receiving emergent thromboendarterectomy, the patient expired on postoperative day 3. This report attempts to remind spinal surgeons and anesthesiologists of this rare but potentially fatal complication, and discuss the possible mechanism, management, and prevention.

Phantom limb claudication

A fit and well 29-year-old man underwent a right above-knee amputation in 1976 as a result of severe trauma sustained in a road traffic accident. After rehabilitation, he remained well and mobilized independently with his prosthesis. Twenty nine years later he was admitted to hospital for an infection of his stump following minor trauma. There was no history of diabetes, hypertension or smoking. He was taking aspirin and lipid-lowering medication. During his admission and subsequent follow up, he gave a clear history of not only right stump (thigh) claudication but also claudication in his absent right calf when mobilizing with his prosthesis after walking 50 yards. The pain was relieved quickly by ceasing to walk. The claudication persisted after the stump was well healed. At re-presentation, both the arterial duplex scan and magnetic resonance angiogram showed occlusion of the right external iliac artery (Figure 1). His stump healed well with no surgical intervention or complication. He was advised to exercise to improve the claudication. After 4 months he was able to walk 100 yards without claudicating.

Acute lower limb ischemia as the initial symptom of acute myeloid leukemia

Although coagulatory system disorders are well recognized in patients with acute leukemia, these usually present with either hemorrhagic complications or thrombosis of small vessels. Large vessel thrombosis is a very rare clinical presentation. We present a patient with previously undiagnosed acute myeloid leukemia (M5), who was referred to our hospital with symptoms of acute ischemia of his right lower limb. Occlusion of the right external iliac artery due to a combination of leucostasis and coagulation disorders was noted and successfully treated with urgent leukapheresis, immediate chemotherapy and surgical thromboembolectomy.

Feasibility of a Branched Stent-Graft in Common Iliac Artery Aneurysms

To evaluate the short-term feasibility, efficacy, and safety of a modular bifurcated stent-graft with an internal iliac artery (IIA) side branch for endovascular repair of aortoiliac aneurysms. Between 2002 and 2005, 10 male patients (median age 75 years, range 59-83) were treated with a bifurcated stent-graft that included a unilateral side branch for the IIA. The median diameters of the abdominal aortic and common iliac artery (CIA) aneurysms were 56 mm (range 33-80) and 40 mm (range 27-60), respectively. Four patients were treated mainly for the CIA aneurysm. Postoperative endoleaks, patency rate, and vessel morphology were determined with contrast-enhanced computed tomography (CT). All endografts were implanted in the desired position. One IIA occluded intraoperatively, and 1 external iliac artery occlusion was noted 6 months postoperatively; both occlusions were asymptomatic and remain untreated. Three graft-related endoleaks were treated with implantation of adjunctive stent-grafts (2 intraoperative and 1 late). Median follow-up by CT was 2 months (1 week to 32 months). One patient died of myocardial infarction 13 days postoperatively; the stent-graft was patent at autopsy. Stent-grafts with an IIA side branch offer an opportunity to repair aortoiliac aneurysms without sacrificing the IIA. Implantation of the IIA branch is more complex than routine endovascular aneurysm repair and may have contributed to a periprocedural cardiac death. More patients and longer follow-up are needed to verify these data.

Arterial Misplacement of a Femoral Central Venous Catheter Complicated with Acute Arterial Occlusion

Femoral vein catheterization is often carried out during resuscitation and in critical care units. It is usually achieved via a blind, external landmark-guided technique, through manual localization of the femoral artery. However, this approach can be challenging in patients with severe shock because of absence or ambiguity of the arterial pulse. We report a case of inadvertent cannulation, with a large-bore catheter, of the right femoral artery, which was mistaken as a venous route for medication and massive transfusion. The large cannula caused direct mechanical obstruction, while intra-arterial medications induced vascular injury and vasospasm. Both factors led to thrombosis and occlusion of the right external iliac artery, thus jeopardizing the distal blood supply, and ultimately resulting in muscle necrosis of the involved limb, and the need for thrombectomy and extensive fasciotomy to salvage the extremity. This case highlights that correct placement of a central venous catheter should be clearly ascertained before the catheter is used for medical treatment, especially when catheterization is performed in shock status.

A rare cause of peripheral ischemia

A 25-YEAR-OLD FEMALE patient presented at this hospital with clinical signs of acute ischemia of her left leg. After an angiography showing an occlusion of the left external iliac artery, an embolectomy was performed. After induction ofgeneral anesthesia, a transesophageal echocardiography (TEE) probe was inserted and the following images were obtained (Figs 1 and 2). What is the diagnosis?

Complete External Iliac Artery Occlusion in a 34-year-old Cyclist

Iliac artery syndrome is a rare clinical entity in professional cyclists. This syndrome typically occurs in cyclists who have accumulated 100 000 miles in a lifetime. They present with buttock and thigh claudication on maximal cycling, which is relieved by rest. Ankle brachial indices (ABI’s) may be normal at rest, and are typically reduced with exercise. The pathology is a 5–6 cm narrowing, due to intimal hyperplasia, of the mid-point of the external iliac artery. We report a case of this syndrome with a previously undescribed variation, in a 34-year-old man. In addition to the “usual” stenosis of his external iliac, he had a superimposed occlusive thrombus in the vessel.

Bactericidal/permeability-increasing protein attenuates systemic inflammation and acute lung injury in porcine lower limb ischemia-reperfusion injury.

To investigate the role of recombinant bactericidal/permeability-increasing protein (rBPI21) in the attenuation of the sepsis syndrome and acute lung injury associated with lower limb ischemia-reperfusion (I/R) injury. Gut-derived endotoxin has been implicated in the conversion of the sterile inflammatory response to a lethal sepsis syndrome after lower torso I/R injury. rBPI21 is a novel antiendotoxin therapy with proven benefit in sepsis. Anesthetized ventilated swine underwent midline laparotomy and bilateral external iliac artery occlusion for 2 hours followed by 2.5 hours of reperfusion. Two groups (n = 6 per group) were randomized to receive, by intravenous infusion over 30 minutes, at the start of reperfusion, either thaumatin, a control-protein preparation, at 2 mg/kg body weight, or rBPI21 at 2 mg/kg body weight. A control group (n = 6) underwent laparotomy without further treatment and was administered thaumatin at 2 mg/kg body weight after 2 hours of anesthesia. Blood from a carotid artery cannula was taken every half-hour for arterial blood gas analysis. Plasma was separated and stored at -70 degrees C for later determination of plasma tumor necrosis factor (TNF)-alpha, interleukin (IL)-6 by bioassay, and IL-8 by enzyme-linked immunosorbent assay (ELISA), as a markers of systemic inflammation. Plasma endotoxin concentration was measured using ELISA. Lung tissue wet-to-dry weight ratio and myeloperoxidase concentration were used as markers of edema and neutrophil sequestration, respectively. Bronchoalveolar lavage protein concentration was measured by the bicinclinoic acid method as a measure of capillary-alveolar protein leak. The alveolar-arterial gradient was measured; a large gradient indicated impaired oxygen transport and hence lung injury. Bilateral hind limb I/R injury increased significantly intestinal mucosal acidosis, intestinal permeability, portal endotoxemia, plasma IL-6 concentrations, circulating phagocytic cell priming and pulmonary leukosequestration, edema, capillary-alveolar protein leak, and impaired gas exchange. Conversely, pigs treated with rBPI21 2 mg/kg at the onset of reperfusion had significantly reduced intestinal mucosal acidosis, portal endotoxin concentrations, and circulating phagocytic cell priming and had significantly less pulmonary edema, leukosequestration, and respiratory failure. Endotoxin transmigration across a hyperpermeable gut barrier, phagocytic cell priming, and cytokinemia are key events of I/R injury, sepsis, and pulmonary dysfunction. This study shows that rBPI21 ameliorates these adverse effects and may provide a novel therapeutic approach for prevention of I/R-associated sepsis syndrome.

Ischaemic preconditioning before lower limb ischaemia–reperfusion protects against acute lung injury

Abstract Background Ischaemic preconditioning (IPC) of skeletal muscle, by exposing it to repeated brief periods of ischaemia and reperfusion (I-R) before a subsequent longer ischaemic period, protects against local damage on reperfusion. In a large animal model of hindlimb I-R it was hypothesized that hindlimb IPC would attenuate the systemic inflammatory response syndrome and prevent acute lung injury associated with limb reperfusion injury. Methods Anaesthetized ventilated swine (six per group) were used throughout. After midline laparotomy, animals were randomized to the following three groups: bilateral external iliac artery occlusion for 120 min, followed by reperfusion for 180 min (I-R group); IPC (three cycles of 5 min ischaemia, then 5 min reperfusion of both external iliac arteries) followed by bilateral external iliac artery occlusion for 120 min and reperfusion for 180 min (I-R + IPC group); or laparotomy alone (control group). Acute lung injury was assessed by invasive pulmonary artery pressure (PAP) measurement, arterial to alveolar (A-a) oxygen gradient, lung tissue wet: dry weight ratio, and lung myeloperoxidase (MPO) concentration. Results Conclusion Lower limb I-R induces systemic inflammation and acutely impairs oxygen transport associated with lung neutrophil sequestration. IPC attenuates acute pulmonary hypertension, impairment of oxygen transport, oedema and leucosequestration in planned lower limb I-R.

Seltene Manifestation einer Großgefäßvaskulitis bei systemischem Lupus erythematodes

Case-reports from two female patients with an occlusion of the right external iliac artery and femoral artery are presented due to a large-vessel vasculitis. Both patients suffered from systemic lupus erythematosus This rare manifestation occurred within the first few years of the disease and was important for prognosis and further treatment. Other manifestations of the disease were general symptoms and polyarthritis. In one case the vasculitis was confirmed by histology. A fibrous thickening of the intima and a vasculitis of small vessels within the adventitia were the prominent feature. This observation supports the idea of small vessel vasculitis as the characteristic manifestation in lupus erythematosus.

Percutaneous treatment of acute iliac artery injury after intraaortic balloon counterpulsation

We report on a novel approach to correcting iliac artery occlusions caused by aortic counterpulsation. Two patients who had leg ischemia after retrieval of an intraaortic balloon pump underwent angiograms that showed occlusion of the right external iliac artery because of dissection (one case) or thrombosis (one case). Percutaneous self-expandable stents were implanted in the occluded vessels, and they fully restored normal iliac patency with no complications and satisfactory midterm follow-up results. We conclude that iliac artery occlusion induced by aortic counterpulsation can be safely treated by implanting self-expandable stents in cases of acute iatrogenic dissection.