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Transposition of the iliac arteries is a simple procedure which permits correction of renal transplant artery stenosis without use of a graft and with minimal ischemic risk for the transplant.
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Transcatheter arterial embolization was attempted for external iliac artery (EIA) hemorrhage in five patients with wound infection after pelvic malignant tumor surgery. To prevent distal migration of coils and to preserve distal branches of the EIA, the entire weakened artery was occluded with use of coils via a bilateral femoral artery approach with balloon occlusion of the distal side. The success rate was 100%. No limb loss was observed immediately after embolization. This method can prevent distal migration of coils and preserve branches that can be collaterals to the femoral artery, and as such it can be used to embolize an adequate portion of the affected artery.
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Vascular injuries from blunt trauma are rare in children. This report concerns traumatic occlusion of the common iliac artery with limb-threatening ischemia in a 6-year-old boy sustained while wearing a lap belt. Associated injuries included fracture of the third lumbar vertebra, perforation of the sigmoid colon, and disruption of the anterior abdominal wall musculature. Because of fecal contamination from the colon perforation, revascularization using a subcutaneous prosthetic femorofemoral artery bypass was performed and proved successful in limb salvage. As improved prosthetic vascular conduits of smaller caliber are developed, applications in small children with vascular injuries may increase.
PURPOSE: To evaluate whether the presence of type 2 endoleak after internal iliac artery (IIA) coil embolization in patients with residual antegrade flow through the coils is more frequent than in patients who presented with total occlusion of the IIA after embolization. MATERIALS AND METHODS: Records were reviewed of 45 patients who underwent unilateral (n = 37) or bilateral (n = 8) IIA coil embolization between 1998 and 2004 for endovascular repair of aortoiliac aneurysms (n = 32), iliac artery aneurysms (n = 12), pseudoaneurysm (n = 1), or distal type 1 endoleak after placement of an aortoiliac stent-graft (n = 8). A total of 53 IIAs were embolized by means of coils and/or microcoils. Computed tomography (CT) was used for follow-up in 40 patients, angiography was used in three, and color Doppler ultrasonography was used in three. RESULTS: At the end of the embolization procedure, 23 IIAs were occluded and 30 IIAs demonstrated residual antegrade flow through the coils. Control CT demonstrated two type 2 endoleaks after endovascular stent-graft placement resulting from retrograde blood flow into the left IIA main branch via a patent iliolumbar artery. One of these two patients showed residual antegrade flow through the coils at the end of the IIA embolization procedure, and the other patient underwent complete coil embolization of the ostia of the anterior and posterior division but not of the main trunk of an aneurysmal IIA. CONCLUSION: IIA coil embolization with residual antegrade flow through the coils causes no greater incidence of type 2 endoleak after aortoiliac or iliac stent-graft placement. However, care must be taken in case of a proximal postostial origin of the iliolumbar artery on the IIA, which may cause type 2 endoleak if not embolized.
A case of aneurysm of persistent sciatic artery with ruptured aneurysm of the internal iliac artery is reported. A 62-year-old man was admitted to our hospital in emergency because of abdominal severe pain. Abdominal CT and angiography showed aneurysm of the infrarenal aortic aorta and left internal iliac artery and left persistent sciatic artery. The persistent sciatic artery aneurysm was coursed down the left thigh. Left superficial femoral artery was supplying blood to the popliteal artery as normal connection. Emergency operation was performed. The left internal iliac aneurysm was ruptured to a retroperitoneal space. The aneurysm was replaced by a Y-shaped dacron double velour graft from the infrarenal abdominal aorta to right common iliac and left external iliac arteries, which was followed by a ligation at the origin of left persistent sciatic aneurysm. The pulsation of the left lower extremity was good and additional bypass procedure to the popliteal artery was not performed. The post-operative course of the patient was excellent and post-operative angiography showed normal anatomy of the left lower extremity. Optimal management of ruptured abdominal aneurysm thus requires not only an emergency operation but detailed observation of preoperative CT and angiography in order to scrutinize the associated vascular anomalies.
A case is reported of bilateral internal iliac artery ligation during cesarean delivery for intractable hemorrhage. Uterine artery Doppler flow velocity waveforms were documented before and after the procedure. After the ligation the uterine arteries could still be visualized in the appropriate anatomic location, and no changes in Doppler flow velocity waveforms were documented.
PURPOSE: Iliac artery occlusions that are more than a few centimeters in length are normally treated with surgical bypass grafting. The aim of this study was to evaluate the results of primary stent implantation after Excimer laser-assisted recanalization of iliac artery occlusions. SUBJECTS AND METHODS: We studied 212 consecutive patients with chronic unilateral iliac artery occlusions (mean [+/- SD] length 8.9 +/- 3.9 cm) who were treated with Excimer laser-assisted recanalization and stent implantation. Based on the criteria of the Society of Cardiovascular and Interventional Radiology, lesions were graded as class III occlusions (<5 cm) in 46 patients and as class IV (> or =5 cm) in 166 patients. A total of 527 stents (Palmaz stent, 346; Wallstent, 94; Strecker stent, 38; covered stents, 49) were implanted. RESULTS: Technical success was achieved in 190 (90%) patients. There was a clinical improvement of three grades in 112 (53%) patients and of two grades in 67 (32%) patients. The rate of major complications was 1.4%, which included arterial rupture (1) and embolic events (2). Primary patency rates were 84% at 1 year, 81% at 2 years, 78% at 3 years, and 76% at 4 years. Secondary patency rates were 88% at 1 year, 88% at 2 years, 86% at 3 years, and 85% at 4 years. CONCLUSION: Stent-supported angioplasty is an effective treatment for iliac artery occlusions, with less morbidity and mortality than is associated with surgery. However, reported long-term patency rates after bypass surgery are greater than those we observed with interventional treatment. The value of primary stenting as compared with angioplasty alone should be evaluated in a randomized trial.
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Isolated iliac artery aneurysms comprise less than 1% of all arteriosclerotic aneurysms. Spontaneous iliac arteriovenous fistula is a rare complication of these aneurysms with only 16 cases previously described. The diagnosis depends on a strong clinical suspicion and usually requires angiography for confirmation. We report a case in which CT with contrast medium showed clear findings of a spontaneous iliac arteriovenous fistula complicating rupture of an isolated iliac artery aneurysm. CT findings included: (1) iliac artery aneurysm, (2) vena caval dilatation, (3) rapid flow of contrast medium from the arterial side into the dilated inferior vena cava on dynamic scanning, (4) increased density of the inferior vena cava similar to that of the aorta caused by entry through the fistula of blood with a high concentration of iodinated contrast medium, and (5) the actual fistula connecting the two vessels.
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Chemotherapy with combined administration of 5-FU and l-Leucovorin has been reported to be effective for advanced rectal cancer. A 61-year-old woman with a huge, locally extended advanced rectal cancer was treated with intra-arterial infusion therapy via internal iliac artery. Catheters were inserted from the bilateral femoral arteries to the opposite internal iliac arteries and the bilateral upper and lower gluteal arteries and lateral sacral artery were embolized with a metallic coil. The port was positioned under the skin of her lower abdominal wall. The chemotherapy regimen was 5-FU (500 mg/body) and l-Leucovorin (250 mg/m2), administered over 5 hours once weekly to bilateral reservoirs through an infuser pump. After 5 sessions of the chemotherapy, the perineal pain decreased and the patient no longer needed morphine. Following 34 administrations (at 10 months) of this regimen, reductions of tumor size on pelvic CT and CEA level were confirmed. Side effects of the intra-arterial infusion chemotherapy were pygal dermatitis, leg desensitization, infection of circumferential reservoir and obstruction of the catheter due to flection were observed. Local intra-arterial infusion chemotherapy via the internal iliac artery appears to be effective for local advanced rectal cancer.
69 balloon-expandable vascular endoprostheses (Palmaz stents) were placed in 65 iliac arteries of 57 patients. The indications for stent placement were total occlusions (n = 15), restenosis after PTA (n = 13), dissections (n = 4), post-operative strictures (n = 3) or others (n = 30). The peak systolic pressure gradient dropped from 43.9 to 2.9, the mean pressure gradient to 1.9 mmHg after stent placement. This was significantly lower than conventional PTA (residual peak systolic pressure gradient: 5.8). Complications occurred in 7.7% of all interventions. 78.4% of the patients showed no limiting claudication after stent placement. Angiographic controls after 47 weeks demonstrated an average intima proliferation of 0.4 mm, not leading to significant restenosis. Cumulative patency after 16 months was 96%. Iliac stents became an effective and in certain situations indispensable adjuvant to PTA.
OBJECTIVE: To evaluate the incidence and angiographic findings of the collateral pathway involving the internal thoracic artery in patients with chronic aortoiliac occlusive disease. MATERIALS AND METHODS: Between March 2000 and Februrary 2001, 124 patients at our hospital underwent angiographic evaluation of chronic aortoiliac occlusive disease, and in 15 of these complete obstruction or severe stenosis of the aortoiliac artery was identified. The aortograms and collateral arteriograms obtained, including internal thoracic arteriograms, as well as the medical records of the patients involved, were evaluated. RESULTS: In nine patients there was complete occlusion of the infrarenal aorta, or diffuse stenosis of 75% or more in the descending thoracic aorta, and in the other six, a patent aorta but complete occlusion or stenosis of 75% or more of the common iliac artery was demonstrated. Collateral perfusion via hypertrophied internal thoracic arteries and rich anastomoses between the superior and inferior epigastric arteries, reconstituting the external iliac artery, were noted in all fifteen patients, regardless of symptom duration, which ranged from six months to twelve years. CONCLUSION: In patients with chronic aortoiliac occlusive disease, the internal thoracic artery, along with visceral collaterals and those from the contralateral side, is one of the major parietal collateral pathways.
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Internal iliac artery aneurysm is a rare cause of lower gastro-intestinal tract (GIT) haemorrhage. A fifty-four year old male patient presented with massive rectal bleeding. Sigmoidoscopy was not conclusive and pelvic angiography revealed an aneurysm from a branch off the main trunk of the anterior division of the right internal iliac artery that was located in juxtaposition to the sigmoid colon. The aneurysm was successfully obliterated by transcatheter arterial embolotherapy with acrylic glue. A high index of suspicion of internal iliac artery aneurysm as a possible cause of lower GIT haemorrhage is of paramount importance. Pelvic angiography is essential for the diagnosis, and embolotherapy with acrylic glue was an effective treatment method in this patient.