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The repair of hemimandibulectomy defects involving the temporomandibular joint (TMJ) is challenging. This study compared the functional outcomes and reconstruction accuracy using a deep circumflex iliac artery (DCIA) flap with and without a virtually planned stock TMJ prosthesis (TMJP) after hemimandibulectomy. Ten patients were assessed: five with a TMJP (TMJP group) and five without (control group). A three-dimensional comparison revealed a mean deviation of 0.11 ± 0.04 mm between the planned and actual DCIA flap with TMJP. The planned and actual TMJP positions differed by 0.56 ± 0.57 mm in height, 0.33 ± 0.24 mm ventrally/dorsally, and 1.18 ± 0.42 mm medially/laterally. Mouth opening, laterotrusion, and midline deviation were significantly greater in the control group than in the TMJP group (P = 0.024, P = 0.008, P = 0.024). The deviation in ventral to dorsal translation for the DCIA flap was slightly higher than reported values in the literature, while height deviation was comparable. Lower deviations in the literature were due to the DCIA flap being used where both TMJs were intact. The in-house virtually planned DCIA flap with stock TMJP yielded results comparable to more expensive patient-specific prostheses. [ABSTRACT FROM AUTHOR]

The contributions of Laurent Princeteau (1858–1932) to anatomy and to the establishment of neurosurgery have largely gone unrecognized, perhaps because he was educated and practiced in a French city other than Paris at a time when Paris was one of the chief centers of medicine in Europe. After completing a thesis describing an iliac artery anomaly and obtaining the distinguished agrégé teaching degree, Princeteau began his surgical career at the University of Bordeaux. Within 10 years, he became chef de clinique and one of the busiest surgeons in Saint-André Hospital, as well as head of the anatomy institute and professor of anatomy at the dental school. In 1891, he achieved the rank of surgeon. In the field of general anatomy, he was recognized for novel cadaveric preparations and vascular perfusion techniques. In the neurosciences, he made important contributions to the anatomy of the trigeminal nerve and trigeminal neuralgia. In 1898, Princeteau supervised a thesis that addressed contemporary surgical approaches to the trigeminal complex. In the course of this effort, he identified a bony prominence near the petrous apex (the retrogasserian tubercle) that helped to locate the gasserian ganglion. The surgical significance of the retrogasserian tubercle was quickly acknowledged in the European neurosurgical community and was noted in French textbooks of anatomy. Thierry de Martel, a founding member of the French neurosurgical School, named the tubercle after Princeteau. To the rest of the world, however, it remained almost unknown. [ABSTRACT FROM AUTHOR]

• The prevalence of prenatal ectopic kidney is quite low. • The most common locations of ectopic kidneys are the iliac fossa and lateral pelvic areas, respectively. • In ectopic kidney cases, both kidneys are equally affected in both genders. • Blood supply to ectopic kidneys is most commonly provided by the iliac artery and then the aorta. • The most common extraurinary anomalies accompanying prenatally diagnosed ectopic kidney are cardiac anomalies. To assess the characteristics, additional structural anomalies and postnatal urinary outcome of the cases diagnosed with fetal ectopic kidneys in the prenatal period. Cases having fetal ectopic kidneys, detected from a total of 14,617 pregnant women examined by routine detailed (Group 1) or indicated (Group 2) obstetric ultrasonography (USG) in a tertiary perinatology unit were analyzed. The prevalence of the cases, time of the diagnosis, sidedness of the affected kidney, anatomical location, origins of blood supply, additional urinary or extraurinary anomalies, and urinary complications during the postnatal follow-up period were investigated. We have detected 33 fetuses with ectopic kidneys in our cohort. The prevalence of fetal ectopic kidney was 0.22 %, with a median (min.-max.) diagnosis time of 21.3 (17.6–34) weeks. In the group in whom indicated USG was performed, the time of diagnosis was later compared to routine detailed USG (p = 0.04) group. There was no difference in terms of gender [male, (n = 14), female (n = 19), p = 0.38] and the sidedness of the ectopic kidneys (p = 0.38). The location of ectopic kidneys was most frequent in the iliac fossa (n = 20, 60.6 %) and in the lateral pelvic areas (n = 13, 39.3 %). The blood supply origin of ectopic kidneys was the common iliac artery in 22 (66.6 %), whereas the aorta in 11 cases (33.3 %). There was an additional urinary anomaly in 8 cases (24 %), an extraurinary structural anomaly, most commonly cardiac, and/or a soft marker for aneuploidy were presented in 16 cases (48 %). The most common urinary complication in the postpartum period was vesicoureteral reflux (n = 5). Ectopic kidney in the prenatal period is a rare structural anomaly that can equally affect both genders and both kidneys. Prenatal diagnosis is important for the diagnosis of additional anomalies and follow-up of postnatal complications. [ABSTRACT FROM AUTHOR]

To assess the comparative safety and efficacy of covered stents (CS) and bare metal stents (BMS) in the endovascular treatment of aorto-iliac disease in patients with peripheral arterial disease. A systematic review was conducted adhering to the PRISMA 2020 and PRISMA for Individual Participant Data 2015 guidelines. A search of PubMed, Scopus, and Web of Science for articles published by December 2023 was performed. The primary endpoint was primary patency. Certainty of evidence was assessed via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eleven studies, comprising 1 896 patients and 2 092 lesions, were included. Of these, nine studies reported on patients' clinical status, with 35.5% classified as Rutherford 4 – 6. Overall primary patency for CS and BMS at 48 months was 91.2% (95% confidence interval [CI] 84.1 – 99.0%) (GRADE, moderate) and 83.5% (95% CI 70.9 – 98.3%) (GRADE, low). The one stage individual participant data meta-analyses indicated a significant risk reduction for primary patency loss favouring CS (hazard ratio [HR] 0.58, 95% CI 0.35 – 0.95) (GRADE, very low). The 48 month primary patency for CS and BMS when treating TransAtlantic Inter-Society Consensus (TASC) C and D lesions was 92.4% (95% CI 84.7 – 100%) (GRADE, moderate) and 80.8% (95% CI 64.5 – 100%) (GRADE, low), with CS displaying a decreased risk of patency loss (HR 0.39, 95% CI 0.27 – 0.57) (GRADE, moderate). While statistically non-significant differences were identified between CS and BMS regarding technical success, 30 day mortality rate, intra-operative and immediate post-operative procedure related complications, and major amputation, CS displayed a decreased re-intervention risk (risk ratio 0.59, 95% CI 0.40 – 0.87) (GRADE, low). This review has illustrated the improved patency of CS compared with BMS in the treatment of TASC C and D lesions. Caution is advised in interpreting overall primary patency outcomes given the substantial inclusion of TASC C and D lesions in the analysis. Ultimately, both stent types have demonstrated comparable safety profiles. [ABSTRACT FROM AUTHOR]

The deep circumflex iliac artery (DCIA) flap is one of the bone flaps commonly used for mandibular reconstruction. Observation of the skin paddle and Doppler ultrasound are methods that are usually used to monitor DCIA flaps after mandibular reconstruction surgery. The aim of this study was to introduce a novel DCIA flap with a perforator-supported external oblique abdominal muscle (EOAM) island for postoperative flap monitoring. This study included five patients who underwent mandibular reconstruction using this modified technique. The DCIA flap and the EOAM island supplied by the ascending branch of the DCIA were harvested during the surgery. After mandibular reconstruction, the EOAM island was placed in the submandibular region to monitor the blood supply to the DCIA flap after surgery. The blood supply to the DCIA flap was monitored by observing the colour, texture, and bleeding condition of the EOAM island. After the monitoring period, the EOAM was removed and the ascending branch of the DCIA was ligated. The outcome was successful in all patients. The EOAM island supported by the ascending branch of the DCIA is reliable and safe, thus providing a robust option to monitor the blood supply to the DCIA flap. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the role of intravascular ultrasound (IVUS) for the technical assessment of kissing stents (KSs) and covered endovascular reconstruction of the aortic bifurcation (CERAB) in the treatment of aortoiliac obstructive disease involving the aortic bifurcation. We conducted a single-center retrospective review of patients undergoing endovascular treatment of severe aorto-iliac obstructive disease (2019-2023). IVUS was performed in patients treated by KSs or CERAB according to preoperative indications, in cases of moderate/severe calcifications, mural thrombus, total occlusions, and lesion extension towards the proximity of renal or hypogastric arteries. Indications for IVUS-guided intraoperative revisions were residual stenosis or compression >30%, incomplete stent-to-wall apposition, or flow-limiting dissection at the landing site. Follow-up assessment was performed at 6 and 12 months, and then yearly. Thirty-day outcomes and 2-year patency rates were evaluated. Logistic regression was used to identify factors associated with significant technical defects detected by IVUS needing intraoperative revision. IVUS was used for the technical assessment of 102 patients treated by KSs (n = 57; 56%) or CERAB (n = 45; 44%) presenting with severe intermittent claudication (39%), rest pain (39%), or ischemic tissue loss (25%). Twenty-nine significant technical defects were identified by IVUS in 25 patients (25%) who then had successful intraoperative correction by additional ballooning (n = 23; 80%) or stenting (n = 6; 20%). Patients with a severely calcified chronic total occlusion (odds ratio, 1.85; 95% confidence interval, 1.01-5.27; P =.044) or severely calcified narrow aortic bifurcation with <12 mm diameter (odds ratio, 2.34; 95% confidence interval, 1.10-8.64; P =.032) were at increased risk for IVUS-guided intraoperative revision. There were no postoperative deaths and no major adverse events. Two-year primary patency was 100%. IVUS was used for the technical assessment of KSs/CERAB in a selected cohort of patients with severe aorto-iliac obstructive disease. This allowed the identification and intraoperative correction of a significant technical defect not detected by completion angiogram in one-quarter of patients, achieving optimal 2-year results. IVUS assessment of KSs/CERAB may be considered especially in patients with a calcified total occlusion or narrow aortic bifurcation. [ABSTRACT FROM AUTHOR]

To explore the possibility of a neural network-based method for quantifying calcifications of the abdominal aorta and its branches. In total, 58 computed tomography (CT) angiography volumes were selected from a dataset of 609 to represent different stages of sclerosis. The ground truth segmentations of the abdominal aorta, coeliac trunk, superior mesenteric artery, renal arteries, common iliac arteries, and their calcifications were delineated manually. Two V-Net ensemble models were trained, one for segmenting arteries of interest and another for calcifications. The branches of interest were shortened algorithmically. The volumes of calcification were then evaluated from the arteries of interest. The results indicate that automatic detection is possible with a high correlation to the ground truth. The scores for the ensemble calcification model were dice score of 0.69 and volumetric similarity (VS) of 0.80 and for the arteries of interest segmentations: aorta: dice 0.96, VS 0.98; aortic branches: dice 0.74, VS 0.87; and common iliac arteries: dice 0.72, VS 0.91. The presented neural network model is the first to be capable of automatically segmenting, in addition to calcification, both the aorta and its branches from contrast-enhanced CT angiography. This technology shows promise in addressing limitations inherent in earlier methods that relied solely on plain CT. • The method provides a clinical tool to detect the burden of atherosclerosis. • First NN models for auto-segmenting calcifications, aorta and its branches from CTA. • The method for measuring volumes of calcifications correlate with manual measurements. [ABSTRACT FROM AUTHOR]

Fournier's gangrene is a serious pathology with a high mortality rate. Treatment requires a large debridement of necrotized tissues, conducing to a skin loss, requiring a reconstruction, which may involve different surgical techniques, depending on the context as well as the size and location of the skin loss. The most common covering technique uses split-thickness skin grafting, which however presents a risk of contracture. Our 63 years old patient presented a Fournier's gangrene, leading to pubic and circular penile skin defects after multiple debridements. We decided to practice a right superficial circumflex iliac perforator (SCIP) pedicled flap to reconstruct the penile skin sheath. The flap was rotated 180 degrees and rolled around the penis. The inguinal pedicle flap is described for penile reconstruction, the SCIP flap for perineal reconstruction, and even bilateral SCIP flaps for performing phalloplasty, but SCIP pedicled flap is not already described for isolated penile skin sheath reconstruction. Skin loss in our patient was not extensive, permitting us to perform this surgical technique. To go further, note the possibility of carrying out this reconstruction by a super-thin SCIP flap, as a pure skin graft flap. The SCIP pedicled flap seems us to be a safe technique for penile skin reconstruction and a good alternative to the usual skin grafts, especially regarding the lower risk of contracture, and low donor-site morbidity. [ABSTRACT FROM AUTHOR]

La polyarthrite rhumatoïde (PR) est une maladie inflammatoire chronique polymorphe et fréquente dans la population générale responsable de la survenue de nodules rhumatoïdes sous-cutanés ou viscéraux. Leurs présentations et localisations cliniques typiques ne posent en général aucun problème diagnostique ni thérapeutique. Nous rapportons ici une présentation atypique fistulisée d'un nodule rhumatoïde de localisation iliaque inhabituelle chez une patiente de 65 ans. L'évolution a été favorable sans récidive à 6 mois après exérèse chirurgicale complète et antibiothérapie adaptée. Rheumatoid arthritis (RA) is a polymorphous chronic inflammatory disease that is common in general population and is responsible for the occurrence of subcutaneous or visceral rheumatoid nodules. Their typical clinical presentations and localizations do not generally pose any diagnostic or therapeutic problem. We report here an atypical fistulized presentation of an unusual iliac rheumatoid nodule in a 65-year-old female patient. The evolution was favorable without recurrence at 6 months after complete surgical resection and appropriate antibiotherapy. [ABSTRACT FROM AUTHOR]

Quality of life (QOL) has become a primary determinant of the treatment outcome. There is a poor evidence base regarding the QOL implications of free flap harvest from the various different osseous composite donor sites. This prospective study assessed the impact of free flap harvest on QOL and compared QOL morbidity between fibula, scapula, and iliac crest (deep circumflex iliac artery; DCIA) donor sites in head and neck reconstructive surgery. This was a single-site prospective cohort clinical research study. Fifty-nine patients were recruited between 2017 and 2021; 30 underwent fibula flap reconstructive surgery, 17 scapula flap, and 12 DCIA flap. The patients were assessed using the University of Washington Quality of Life Questionnaire version 4 (UW-QOL v4) preoperatively and again at >12 months postoperatively. The results showed no significant change in the mean global QOL score postoperatively when compared to the preoperative baseline in any of the donor site groups. However, the mean postoperative scores for the appearance domain were significantly lower than the preoperative scores in all of the donor site groups. In addition, fibula flap patients had significantly reduced physical activity and recreation QOL domain scores postoperatively when compared to the preoperative scores. [ABSTRACT FROM AUTHOR]

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Introduction: The Cattell-Braasch maneuver has been widely used to provide adequate exposure for aorto-caval space (ACS) since the 1960s. Given its requirement of complex visceral mobilization and significant physiological disturbance, we proposed a new alternative surgical technique to access ACS: the transabdominal inferior retroperitoneal approach (TIRA) with robotic assistance. Methods: Patients were placed in the Trendelenburg position, and the retroperitoneum was accessed from the iliac artery level and dissected toward the 3rd and 4th portion of the duodenum along the anterior surface of IVC and aorta. Results: TIRA has been used in 5 consecutive patients at our institution whose tumors were located in the ACS below the level of SMA origin. The tumor sizes ranged from 1.7 to 5.6 cm. The median OR time was 192 min with a median EBL of 5 ml. Four out of the five patients passed flatus before or on post operative day (POD) 1, and the other patient passed flatus at POD2. The shortest length of stay was < 24 h, and the longest was 8 days due to pre-existing pain (the median length of stay was 4). Conclusion: The proposed robotic-assisted TIRA procedure is designed for tumors in the inferior portion of ACS, specifically for the tumor involving D3, D4, para-aortic, para-caval, and kidney regions. Since this approach does not involve organ mobilization and all the dissections are following an avascular plane, it can be easily adapted to laparoscopic and/or open surgery setting. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the feasibility and accuracy of occlusion-driven maxillary reconstruction with the deep circumflex iliac artery (DCIA) flap, using computer-assisted design and manufacturing (CAD/CAM) technology and intraoral anastomosis. The data of 11 patients who underwent occlusion-driven maxillary reconstruction with this method between December 2018 and December 2020 in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were reviewed retrospectively. Postoperative complications and functional and aesthetic outcomes were recorded. The accuracy of the postoperative restoration was assessed using Geomagic Control 2014. Reconstruction was successful in nine patients; all were satisfied with their aesthetic and functional outcomes. One patient underwent extraoral anastomosis after failure of intraoral anastomosis. In another patient, the DCIA flap had to be removed after the operation because of flap failure. Among the 10 patients with DCIA flap success, colour map analysis showed a mean deviation of 0.40 ± 0.08 mm between the preoperative and postoperative craniomaxillary models. Thus, occlusion-driven maxillary reconstruction with the DCIA flap, using CAD/CAM technology and intraoral anastomosis, appears to be a feasible and accurate method for the repair of maxillary defects. [ABSTRACT FROM AUTHOR]

Sacral extradural arteriovenous fistula (SEAVF) is relatively rare, and its etiology is unknown. They are mostly fed by the lateral sacral artery (LSA). For endovascular treatment, both the stability of the guiding catheter and accessibility of the microcatheter to the fistula, distal to the LSA are required for sufficient embolization of the fistulous point. Cannulation of these vessels requires either crossover at the aortic bifurcation or retrograde cannulation using the transfemoral approach. However, atherosclerotic femoral and tortuous aortoiliac vessels can make the procedure technically difficult. Although the right transradial approach (TRA) can reduce this difficulty by straightening the access route, a potential risk remains for cerebral embolism because it passes the aortic arch. Herein, we present a case of successful embolization of a SEAVF using a left distal TRA. We report a case of a 47-year-old man with SEAVF treated with embolization using a left distal TRA. Lumbar spinal angiography showed a SEAVF with an intradural vein through the epidural venous plexus fed by the left LSA. A 6-French guiding sheath was cannulated into the internal iliac artery via the descending aorta using the left distal TRA. A microcatheter could be advanced into the extradural venous plexus over the fistula point from the intermediate catheter placed at the LSA. Embolization with coils and n-butyl cyanoacrylate was successfully performed. The SEAVF completely disappeared on neuroimaging, and the patient gradually recovered. Left distal TRA could be a useful, safe, and less invasive option for the embolization of SEAVF, especially for patients with high-risk factors for aortogenic embolism or puncture site complications. [ABSTRACT FROM AUTHOR]

To evaluate the functional efficacy of the superficial circumflex iliac artery perforator (SCIP) -lymphatic pedicled flap in the treatment of advanced male genital lymphedema. From February 2018 to January 2022, we treated 26 male patients with scrotal and penoscrotal advanced lymphedema using reconstructive lymphatic surgery. Isolated scrotal involvement was seen in 15 patients, and 11 patients had penoscrotal involvement. Excision of genital lymphedematous fibrotic tissue was followed by reconstruction utilizing the SCIP-lymphatic flap. Patient characteristics, intraoperative data, and postoperative results were evaluated. The mean patient age was 39 ± 4.6, and the mean follow-up time was 44.9 months. the SCIP-lymphatic flap was used to reconstruct partial (n = 11) or total (n = 15) scrotum and used to reconstruct total penile skin in 9 cases and partial in 2 cases. The flap survival rate was 100%. Cellulitis rates were dramatically reduced after reconstruction (P value <.001). The mean genital lymphedema score (GLS) after surgery was 0.05, which was significantly lower than the preoperative 1, 6.2 (P <.001). The median Glasgow Benefit Inventory (GBI) total score was +41, all 26 patients (100%) showed a degree of quality of life improvement. The pedicled SCIP lymphatic transfer approach in advanced male genital lymphedema can provide a durable complete functional lymphatic system that improves the appearance and genital lymphatic drainage. This leads to an improvement in quality of life as well as in sexual functions. [ABSTRACT FROM AUTHOR]

Supermicrosurgery involves the dissection and anastomosis of vessels<0.8 mm in diameter with minimal donor site morbidity. This study evaluated the feasibility and outcomes of free flaps using supermicrosurgery to repair oncological defects in the maxillofacial region. Forty-two patients were treated with supermicrosurgery to repair oncological defects in the maxillofacial region between December 2015 and February 2021. The supermicrosurgery technique was used for different types of free flap, including 24 superficial circumflex iliac artery perforator flaps, seven anterolateral thigh flaps, three peroneal artery perforator flaps, five medial femoral condyle osteo-adipofascial flaps, and three profunda artery perforator flaps. An artery-to-artery approach was used in 38 patients; venous grafts for anastomosis were used in four patients to resolve an arterial discrepancy. Forty-one flaps (97.6%) survived. Thirty-six patients (85.7%) healed without any complications; three flaps required revision surgery including one lost, one demonstrated wound dehiscence, and two demonstrated wound infection. Supermicrosurgery is a useful complement to conventional microsurgery in head and neck reconstruction. [ABSTRACT FROM AUTHOR]

Reconstruction and repair of multiple defects in the hand is a combination of function, sensation and aesthetics. The reconstruction using the superficial circumflex iliac artery perforator flap has become popular, which overcomes the inherent shortcomings of traditional inguinal flaps by preserving the deep fascia. In this report, we present our experience in the design and clinical application of the superficial circumflex iliac artery perforator flap, which we used to repair multiple defects in the hand. From January 2015 to December 2020, 41 patients received free superficial circumflex iliac artery perforator flap to repair multiple hand defects. All flaps were carefully designed according to the hand defect including 21 single and 20 bilobed flaps. The area of ​​the donor area is 2.5 cm × 3.0cm∼8.0 cm × 6.5 cm. We followed up all patients regularly and completed standardized assessments of outcomes based on post-reconstruction hand function and esthetic scores. 41 cases of flaps survived completely.3 cases of vascular crisis was relieved after surgical exploration, 1 case of mild distal necrosis was healed after dressing change, 1 case of pigmentation happened. There were 41 patients, 27 males and 14 females, with an average age of 40.5 years (4 to 59 years old). The defects included 20 cases opisthenars and 21 cases palms. The wounds were irregular, with exposed or damaged tendons, nerves or bones. All flaps were followed for a mean of 10.5 months (3 to 15 months). The functional and esthetic outcomes were satisfactory for all flaps without complications such as hand spasms, adhesions and scar contractures The superficial circumflex iliac artery perforator flap's donor site was concealed, relatively stable perforators, easy dissection. Recipient site condition was good and acceptable for the patients. It is a significant choice for multiple hand defects. [ABSTRACT FROM AUTHOR]

Our study aimed to identify the risk factors of magnetic resonance imaging (MRI) findings for predicting patient outcomes of placenta accreta spectrum (PAS) and placenta previa after prophylactic balloon occlusion of the internal iliac artery (PBOIIA). This retrospective analysis was performed using the clinical records of 46 patients diagnosed with PAS and placenta previa who underwent PBOIIA during caesarean section (CS). The possible clinical risk factors for adverse maternal outcomes were evaluated by consulting patients' clinical records. The inclusion criteria for the massive bleeding group were as follows: estimated blood loss (EBL) > 2500 mL, packed red blood cell (pRBC) transfusion (>4 units), and need for hysterectomy or transcatheter arterial embolization after delivery. The MRI features were compared between the massive and non-massive bleeding groups. Patients in the massive bleeding group (n = 22) had a significantly longer operation time (p < 0.001), more EBL (p < 0.001), more pRBC transfusions (p < 0.001), and a prolonged postoperative hospital stay (p < 0.05). MRI features showed a T2 dark bands, placenta bulge, and abnormal blood vessels in the placental bed more frequently in the massive bleeding group (p < 0.05). In the multiple logistic regression analysis, T2 dark bands (odds ratio 9.1, p = 0.048) and placental bulge (odds ratio 5.1, p = 0.014) remained statistically significant. T2 dark bands and placental bulges observed on an MRI can predict adverse maternal outcomes in patients with PAS and placenta previa undergoing PBOIIA. If these findings are observed on a preoperative MRI, effective management strategies should be prepared for the possibility of massive hemorrhage during CS. [ABSTRACT FROM AUTHOR]

This study analyzed the outcomes of bilateral internal iliac artery (IIA) ligation with preperitoneal pelvic packing (PPP) in hemodynamically unstable patients with major pelvic fractures. All-cause mortality was examined, periprocedural safety for critical circumstances was reviewed, and iliac artery ligation-related complications of the postoperative phase were evaluated. A total of 20 patients who suffered substantially from severe pelvic trauma with hemodynamic instability and subsequently underwent bilateral IIA ligation with PPP between January 1, 2017, and December 31, 2021, were enrolled in the study. The median participant age was 60.5 years, and 65.0% were male. The median systolic blood pressure was 68.5 mmHg on arrival. Increased lactate level (median, 11.05 mmol/L) suggested that the patients were in shock distinctly due to hypovolemia. It took approximately 1 h to complete the ligation of bilateral IIA to accomplish hemostasis (median, 65.5 min). The iliac vein was injured during dissection in three cases. During the ICU stay (median, 17.5 days), acute kidney injury was identified in 13 patients, likely due to volume depletion. The median ventilator-free days was 13.5; six patients were confirmed with ventilator-associated pneumonia. Moreover, 12 patients were diagnosed with acute respiratory distress syndrome. There was one case in which the lower extremity artery was acutely occluded. Anatomic hemostasis was achieved in 18 patients. The two patients for which anatomic hemostasis failed became two mortality cases from preperitoneal hemorrhage. Our analysis showed that bilateral IIA ligation with PPP was effective as a lifesaving procedure in hemodynamically unstable patients with a major pelvic fracture in terms of mortality due to fracture-related exsanguination. Moreover, the incidence of periprocedural complications was considered tolerable, making the procedure worth a try, especially in austere and underdeveloped healthcare settings. [ABSTRACT FROM AUTHOR]

The radial forearm free flap (RFFF) is widely used for oral reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap is an increasingly utilized alternative. The cases of 165 patients who received either an RFFF or SCIP flap for oral reconstruction at Chris O′Brien Lifehouse, Sydney were reviewed. The aim was to report on patient, pathology, treatment, and outcome variables and to compare these between the two flap groups. A RFFF was used in 126 patients and a SCIP flap in 39 patients. SCIP flap patients were younger (P < 0.001) and had shorter operative times (P < 0.001), shorter anaesthetic times (P < 0.001), and more frequent recipient site dehiscence (P = 0.005) when compared to RFFF patients. The SCIP flap was significantly less frequently used for composite resections including bone when compared to the RFFF (P < 0.001). The primary site distribution was more even for RFFF patients (P < 0.001). There were no SCIP flap failures; three RFFF failures occurred. SCIP flaps performed comparably in terms of operative and clinical outcomes. Most SCIP flaps were utilized in younger patients with partial glossectomy defects. [ABSTRACT FROM AUTHOR]

We evaluated the effectiveness of transarterial embolization (TAE) for intractable postpartum hemorrhage in patients with disseminated intravascular coagulation (DIC) despite emergency hysterectomy. We retrospectively assessed TAE performed after emergency hysterectomy in 15 patients between July 2008 and January 2022. Underlying condition, technical success, clinical success, angiographic findings, laboratory findings, pregnancy-modified DIC score (The International Society on Thrombosis and Haemostasis), blood transfusion, ICU (Intensive care unit) admission day, hospital day, in-hospital mortality, and long-term sequelae were evaluated. All patients were diagnosed with DIC before embolization, with a 43.9 mean DIC score. All patients showed positive angiographic findings for active bleeding. Thirty-eight bleeding arteries were confirmed. The remnant uterine artery (n=25) was the most common focus of persistent bleeding, followed by the cervicovaginal artery (n=6), pudendal artery (n=3), obturator artery (n=2), vesical artery (n=1), and unspecified artery from the internal iliac artery (n=1). Technical and clinical success rates were 100% (15/15) and 93.3% (14/15), respectively. Mean nadir hemoglobin (Hb) level before embolization was 4.9 g/dL. All patients underwent massive transfusion before embolization (mean 33.2 packs of RBC). Postoperatively, a smaller amount of blood was transfused than before the procedure (mean 10.6 packs of RBC). Mean nadir Hb level after embolization was 8.2 g/dL. There was one instance each of in-hospital death, hypoxic brain damage, and ischemic acute kidney injury. Despite hysterectomy for postpartum bleeding, there could be multiple residual or uncontrolled bleeding foci, especially in case of DIC, for which TAE could be an effective treatment. • Postpartum hemorrhage may persist even though a hysterectomy is performed. • Remnant uterine artery is the most common bleeding focus. • Embolization is safe and effective treatment for intractable postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

One under-investigated area of abdominal aortic aneurysm (AAA) research is how changes in iliac arteries flow alter infrarenal aortic hemodynamics and aneurysm expansion. Therefore, the aim of this study was to investigate the hemodynamics of iliac arteries in healthy volunteers and AAA patients, further exploring the occurrence of auxiliary aneurysm. Healthy volunteers and patients with abdominal aortic aneurysm were continuously included, and patients with other aortic diseases were excluded. All the subjects underwent MRI on a 3.0T MR scanner, and hemodynamic parameters, including total flow volume, peak velocity and wall shear stress (WSS) of left common iliac artery (LCIA) and right common iliac artery (RCIA) were recorded. Between December 2022 and May 2023, 16 volunteers (54.89±14.55 years) and 22 AAA patients (68.73±13.77 years) were included. There was no significant difference in flow volume between controls and AAA both in LCIA and RCIA. However, the WSS decreased in AAA patients both in LCIA (0.61±0.19 vs. 0.34±0.11, P =0.014) and RCIA (0.57±0.19 vs. 0.32±0.18, P =0.025). In healthy volunteers, there was good consistency of hemodynamic parameters between the left and right iliac artery. However, peak velocity between left and right common iliac arteries is significantly different in AAA (78.57±22.76 vs. 58.31±16.66, P =0.025). In this study, 4D flow MRI were used to evaluate the iliac arteries dynamics changes between healthy controls and AAA patients. In AAA patients, the WSS of both left and right iliac arteries was decreased, and the hemodynamic parameters between the left and right iliac arteries are asymmetrical. These changes are of great value for predicting the development of abdominal aortic aneurysms and even for predicting the occurrence and development of iliac aneurysms. [ABSTRACT FROM AUTHOR]

Allograft artery-infected pseudoaneurysm (PA) represents a rare but life-threatening complication of kidney transplantation (KT). A review of the literature, showed that nearly all these cases ended resulted in graft loss. We presented a case of post-KT-infected external iliac artery anastomotic PA successfully managed by endovascular stenting with graft preservation. Additionally, we reviewed the pertinent literature. In this article, we described a hypertensive, 47-year-old man who presented 1 month post-cadaveric KT with acute kidney injury and gram-negative bacteremia secondary to a large infectious anastomotic PA of the external iliac artery. Because of favorable anatomy, successful arterial angio-stent fixation of the main renal artery PA, sparing the lower polar artery, was performed after 1 week of antibiotic and fungal coverage. Patient was discharged after 2 weeks with functioning graft. Graft function was stable after 3 months. [ABSTRACT FROM AUTHOR]

Background: Thoracic endovascular aortic repair (TEVAR) can only promote 55-80% false lumen (FL) thrombosis when only the proximal primary tear is covered during the repair of type B aortic dissection (TBAD). This study evaluated the effectiveness and clinical outcome of tailored exclusion of the primary entry tear with TEVAR and distal fenestrations with ancillary devices in patients with subacute or chronic Crawford type III and IV aortic dissection aneurysm.Methods: All patients underwent either TEVAR for primary entry tear; subsequently, various ancillary devices were applied on each distal fenestration. These techniques included covered stent occlusion of detached visceral artery entry tears, TL stenting and FL occlusion with vascular plugs in the common iliac artery dissection, or TEVAR coverage for multiple fenestrations from segmental arteries. This case series included nine patients (seven men and two women; mean age: 63.4 years) during January 2013 to May 2019. Outcome analysis included the rates of technical success and procedure-related complications, completeness of FL occlusion, aortic remodeling, and midterm mortality at 2 years.Results: The mean follow-up duration was 37.7 months without in-hospital mortality. One patient was lost to follow-up at the second month, the rest of patients were all alive during the follow-up period. All patients achieved complete FL thrombosis, and six patients exhibited aneurysm diameter shrinkage.Conclusion: Tailored exclusion of visceral and iliac distal fenestrations with proximal primary tear coverage can promote FL thrombosis and aortic remodeling in the visceral aortic segment in patients with Crawford type III or IV aortic dissection aneurysm. [ABSTRACT FROM AUTHOR]

Aim: To assess improvement in arterial opacification by optimising the contrast medium dosing protocol for computed tomography (CT) prior to trans-catheter aortic valve implantation (TAVI).Materials and Methods: A wide variation in arterial opacification was observed in the initial CT TAVI protocol (standard protocol). The practice was optimised by considering the time required for the examination and optimising contrast medium flux. This became the optimised protocol with a 30-second contrast medium bolus of iodine flux 15-19 mg iodine/kg body weight/second (mg/kg/s). Attenuation (mean HU) in (a) the ascending aorta (gated systolic acquisition) and (b) the ascending, descending thoracic (at carina), infra-renal abdominal aorta, and right common iliac artery (non-gated acquisition) was measured. Thirty-one sequential optimised examinations were compared to 31 prior standard protocol examinations.Results: There was no difference between the standard and optimised groups regarding age, sex, weight, body mass index (BMI), or voltage. The mean bolus durations were 24.9±4.4 seconds for the standard and 30±0.3 seconds for the optimised protocols (p<0.001). Although there was no difference in the attenuation in the gated ascending aorta (p>0.99), there was improvement at all other anatomical points in the non-gated examinations of the optimised protocol (p<0.002).Conclusion: Optimising contrast medium flux and matching bolus duration to the CT technology dramatically improves the vascular access component of TAVI planning and provides a reliable method to achieve objectively enhanced arterial opacification. This work highlights how to obtain good arterial contrast medium opacification in haemodynamically fragile patients without excessive contrast medium volumes. [ABSTRACT FROM AUTHOR]

Background: Extensive soft-tissue defects around the ankle and foot pose a difficult challenge to surgeons. Considering that natural contour, the ideal solution should match a thin and pliable skin flap to allow shoe fitting and provide a functional move. As the conjoined flaps were increasingly utilized in covering various defects, we present our experience using the bipedicle conjoined flap on the lower abdomen and groin site.Methods: From May 2018 to September 2020, 36 patients (27 male and 9 female) with a mean age of 32 years (ranged, 21-54 years) underwent the one-stage coverage of ankle and foot defects with the bipedicle conjoined flap. A suitable "Y" bifurcation was dissected to enlarge vessel size or participated in intra-flap anastomosis. The mean dimension of the defect was 30 × 12 cm2 (ranged, 20 × 8 cm2 to 38 × 16 cm2). Primary donor-site closure was accomplished in all patients.Results: Thirty-six flaps survived completely without significant complications, and mild venous congestion was observed in one flap. The average flap size was 35 × 15 cm2 (ranged, 22 × 10 cm2 to 42 × 18 cm2). All flaps were available for a mean follow-up of 18 months (ranged, 12 to 24 months). Natural shape and walking function were successfully achieved with restored protective sensation.Conclusions: Bipedicle conjoined flap harvested from the lower abdomen and groin is a great alternative, in selected patients seeking one-stage coverage for the exposed ankle and foot. Compared to single-pedicle flaps, the increased skin allows the wider coverage for the large defect with less morbidity and better outcomes. [ABSTRACT FROM AUTHOR]

The natural history of isolated common iliac artery aneurysms (CIAAs) has not been well-studied. The optimal size threshold for elective repair of isolated CIAAs is also not well-defined. We sought to determine the natural history and growth rates of isolated CIAAs to justify a surveillance protocol and size for elective repair. Isolated CIAAs (>2 cm) identified from January 1, 2008, through February 29, 2020, at a single center were reviewed. Patient demographics, comorbidities, and details of CIAA operative repairs were retrospectively collected. All available duplex ultrasound and computed tomography scans were reviewed from time of CIAA identification through June 2020. There were 244 isolated CIAAs found in 167 patients. The cohort was 94% male with an average age of 68.1 ± 8.8 years at the time of CIAA detection. CIAAs were identified with ultrasound examination 69% of the time with a mean CIAA diameter of 2.3 cm. Operative repair of a CIAA was performed in 11.4% of the cohort at an average diameter of 3.30 ± 1.02 cm. The majority of these repairs were performed via an endovascular approach (73.7%; n = 14). There were no symptomatic or ruptured isolated CIAAs. Concurrent aortic growth that led to an abdominal aortic aneurysm with diameter of at least 3 cm occurred in 10.6% (n = 26) of isolated CIAAs. The average length of time from CIAA diagnosis to repair was 65.7 ± 47.1 months. The overall CIAA growth rate was 0.4 mm/y. A subgroup analysis based on CIAA size demonstrated a growth rate of 0.2 mm/y fore CIAAs 2.00 to 2.49 cm, 0.3 mm/y for CIAAs 2.50 to 2.99cm, and 1.3 mm/y for CIAAs 3.0 cm or larger. There were two CIAAs greater than 3.0 cm with extreme growth, which significantly impacted the CIAA growth rate on sensitivity analysis. After excluding those two CIAAs from the model, the overall CIAA growth rate was 0.3 mm/y. The subgroup analysis then demonstrated a growth rate of 0.2 mm/y for CIAAs 2.00 to 2.49cm, 0.3 mm/y for CIAAs 2.50 to 2.99cm, and 0.5 mm/y for CIAAs 3 cm or larger. Isolated CIAAs are typically slow growing aneurysms that expectedly grow faster as they enlarge. Given the rare occurrence of rapid isolated CIAA growth, we recommend surveillance at 3 years for 2.00 to 2.49 cm isolated CIAAs, 2 years for 2.50 to 2.99 cm isolated CIAAs, and yearly for isolated CIAAs greater than 3.0 cm. The lack of symptomatic or ruptured isolated CIAAs in this study supports delaying elective repair until an isolated CIAA diameter reaches at least 3.5 cm. These recommendations should be considered for isolated CIAA practice guidelines. [Display omitted] [ABSTRACT FROM AUTHOR]

To evaluate agreement with central systemic arterial pressure of an oscillometer and two cuff widths placed on the thoracic or pelvic limbs. Prospective experimental study. A group of nine New Zealand White rabbits weighing 3.5 ± 0.3 kg. Rabbits were sedated with dexmedetomidine and midazolam, then anesthetized with ketamine and sevoflurane. The femoral artery was surgically exposed and a 20 gauge, 5 cm catheter inserted to measure systolic (SAP), mean (MAP) and diastolic (DAP) blood pressure at the iliac artery and caudal aorta junction. Adjustments of vaporizer dial and dobutamine infusion provided a range of invasive blood pressure (IBP). Two measurements of IBP were recorded during the oscillometer cycling phase, and the mean value was used in analyses. Oscillometer cuffs of bladder width 2.0 cm (S1) and 2.5 cm (S2) were placed proximal to the carpus and tarsus. Cuff width to circumference ratio was calculated. Oscillometer SAP, MAP and DAP were paired with corresponding IBP values. Agreement was assessed using linear mixed models (p < 0.05). Cuff ratios for both limbs were 41% (S1 cuff) and 50% (S2 cuff) and 122–139 paired observations were obtained. There was significant limb × cuff interaction with SAP and MAP. The oscillometer overestimated SAP and MAP on the pelvic limb and underestimated SAP and MAP on the thoracic limb. For SAP, the oscillometer overestimated by constant bias (–19 ± 2 mmHg) and proportional bias (0.28 ± 0.02 mmHg per 1 mmHg increase). For MAP, the oscillometer underestimated by constant bias (4 ± 2 mmHg) and was worse with S2 on the thoracic limb. Overestimation was similar between cuffs on the pelvic limb. For DAP, the oscillometer underestimated by constant bias (15 ± 2 mmHg). Cuff S1 on the thoracic limb provided best estimation of MAP. [ABSTRACT FROM AUTHOR]

• Aortic dissection is a rare and infrequently reported event before transplantation. • Transplant surgeons must consider whether the flow from the true lumen imposes adequate blood flow. • A vascular clamp close to the internal iliac artery can be used for aortic dissection. Aortoiliac lesions can influence the results of kidney transplantation and increase technical difficulties during surgery. Aortic dissection (AD) is a rare and infrequently reported event before transplantation, whereas immediate optimal perfusion is paramount for kidney transplantation. Thus, adequate blood flow imposed by the flow from the true lumen must be considered when choosing a target inflow vessel. A 67-year-old man on dialysis with end-stage renal disease caused by immunoglobulin A nephropathy was referred for kidney transplantation. He had successfully undergone conventional Stanford type A AD surgery 3 years ago. Pretransplant contrast-enhanced computed tomography angiography revealed termination of the distal intimal flaps within the common iliac arteries. Dilation of the descending aorta was also observed. Based on the meticulous vascular assessment, including consultation with the cardiovascular surgery department, the right internal iliac artery (IIA) was considered usable for anastomosis. He underwent living unrelated kidney transplantation from his 66-year-old wife. The patency and blood flow in the right IIA were also verified using intraoperative findings. Without any special procedure, we used a side-to-end arterial anastomosis between the donor renal artery and recipient IIA. After vascular clamp removal, the allograft was perfused homogeneously and immediately functioned. Patients receiving previous surgery for type A AD can successfully undergo kidney transplantation if the patency of the iliac arteries from the true lumen is confirmed by perioperative evaluation, and the artery can be carefully clamped to avoid possible further dissection. [ABSTRACT FROM AUTHOR]

• Autosomal dominant polycystic kidney disease is related to cardiovascular disorders. • Kidney transplantation performed after repair for aortic dissection is challenging. • A vascular clamp close to the internal iliac artery can be used for aortic dissection. Autosomal dominant polycystic kidney disease (ADPKD) is associated with several cardiovascular disorders, including aortic dissection, which preferentially occurs at the thoracic or abdominal level. Because there are few case reports describing surgical repair for aortic dissection followed by renal transplantation in patients with ADPKD, kidney transplantation performed after repair for aortic dissection remains challenging. A 34-year-old Japanese man with end-stage renal disease secondary to ADPKD underwent thoracic endovascular aortic repair for complicated acute type B aortic dissection 12 months earlier. A contrast computed tomography scan before transplantation revealed an aortic dissection involving the descending aorta proximal to the common iliac arteries and confirmed multiple large bilateral renal cysts. After simultaneous right native nephrectomy, the patient underwent preemptive living-donor kidney transplantation obtained from his mother. Intraoperatively, we noted that dissection of the external iliac vessels was difficult because of dense adhesions. Arterial clamping was performed immediately below the bifurcation of the internal iliac artery to prevent further aortic dissection of the external iliac artery. After end-to-end anastomosis to the internal iliac artery was completed and the vascular clamp was released, the kidney began to produce urine immediately. This case suggests that kidney transplantation in patients undergoing endovascular aortic repair for aortic dissection can be performed by adequately applying a vascular clamp proximal to the internal iliac artery during vascular anastomosis. [ABSTRACT FROM AUTHOR]

• The number of kidney transplant recipients with peripheral arterial disease (PAD) has increased and is expected to continue to increase. • More peripheral sites can be anastomosed without changing allograft kidney height with an upside-down kidney transplant. • Upside-down kidney transplantation is safe in patients with severe atherosclerosis. Recently, the number of patients with significant arteriosclerosis has been increasing owing to the aging of kidney transplant patients, an increase in the number of patients with kidney failure with diabetes as the primary disease, and an increase in the number of patients undergoing long-term dialysis. Severe atherosclerosis in kidney transplant recipients makes it difficult to determine the site of vascular anastomosis and increases the technical difficulty of the surgical procedure. This study presents a case of upside-down kidney transplantation in a recipient with severe arteriosclerosis. The patient was a 58-year-old male with diabetic nephropathy. He received an ABO-compatible living donor kidney transplant from his wife. Preoperative computed tomography revealed a mild calcification of the external iliac artery. However, during surgery, more than half of the external iliac artery was found to be calcified, making vascular anastomosis difficult. The peripheral side of the external iliac artery showed mild atherosclerosis. Therefore, the vessel could be anastomosed to the peripheral side of the external iliac artery by turning the kidney graft upside-down for use as the anastomosis site. The postoperative course was uneventful, and the kidney function was good at the last follow-up. Upside-down kidney transplantation is safe in patients with severe arteriosclerosis. [ABSTRACT FROM AUTHOR]

• Relapses occur in up to 50% of GCA patients. • To stratify the treatment strategy on the risk of relapse is an unmeet need in GCA. • FDG uptake in limb arteries at diagnosis is associated with relapse in newly diagnosed GCA. • The value of FDG/PET CT for tailoring treatment in GCA patients needs to be further evaluated. Steroids and anti-IL6 biotherapy are highly effective in obtaining remission in patients with giant cell arteritis (GCA) but the risk of relapses remains high. We aimed to identify predictors of relapse in GCA. All consecutive patients admitted with a new diagnosis of GCA – according to the 2022 American College of Rheumatology/EULAR (ACR/EULAR) classification criteria – between May 2011 and May 2022 were eligible for this study. The primary outcome was the GCA relapse rate over the 36-months follow up. Factors associated with the primary outcome and time to first relapse were analyzed. One hundred and eight patients (74 [69–81] years, 64.8% women) with a new diagnosis of GCA were studied. GCA was biopsy-proven in 65 (60.2%) cases. Ninety-eight (90.7%) FDG/PET CT scans performed at diagnosis were available for review. All patients received steroids given for 21.0 [18.0–28.5] months, associated with methotrexate (n = 1, 0.9%) or tocilizumab (n = 2, 1.9%). During a median follow-up of 27.5 [11.4–35.0] months, relapse occurred in 40 (37%) patients. Multivariable Cox regression model, including general signs, gender, aortic wall thickness, FDG uptake in arterial wall and IV steroid pulse as covariates, showed that both general signs (HR 2.0 [1.0–4.0, P < 0.05) and FDG uptake in limb arteries (HR 2.7 [1.3–5.5], P < 0.01) at diagnosis were associated with GCA relapse. FDG uptake in limb arteries at diagnosis is a predictor of relapse in newly diagnosed GCA. [ABSTRACT FROM AUTHOR]

The pre-operative planning and intra-operative navigation of the endovascular aneurysm repair (EVAR) procedure are currently challenged by the aortic deformations that occur due to the insertion of a stiff guidewire. Hence, a fast and accurate predictive tool may help clinicians in the decision-making process and during surgical navigation, potentially reducing the radiations and contrast dose. To this aim, we generated a reduced order model (ROM) trained on parametric finite element simulations of the aortic wall-guidewire interaction. A Design of Experiments (DOE) consisting of 300 scenarios was created spanning over seven parameters. Radial basis functions were used to achieve a morphological parametrization of the aortic geometry. The ROM was built using 200 scenarios for training and the remaining 100 for validation. The developed ROM estimated the displacement of aortic nodes with a relative error below 5.5% for all the considered validation cases. From a preliminary analysis, the aortic elasticity, the stiffness of the guidewire and the tortuosity of the cannulated iliac artery proved to be the most influential parameters. Once built, the ROM provided almost real-time and accurate estimations of the guidewire-induced aortic displacement field, thus potentially being a promising pre- and intra-operative tool for clinicians. • A methodology for a reduced order model (ROM) to estimate the guidewire-induced displacement of abdominal aorta during EVAR is obtained. • The workflow to obtain the ROM from CT images can be executed within 3 hours and 15 minutes, given access to HPC resources. • The obtained ROM allows to explore with sufficient accuracy different scenarios, varying seven parameters of interest. [ABSTRACT FROM AUTHOR]

Iliac artery aneurysms are rare, with isolated iliac artery aneurysms responsible for only 2 % of all aneurysmal diseases. External iliac artery (EIA) aneurysms are extremely rare, and the exact cause is unknown. In this case, we report a giant aneurysm without any risk factor presented with rupture and managed by open repair. An 85-year-old man presented to the emergency department with sudden onset right lower quadrant abdominal pain and vague right lower limb pain. After a complete physical examination, an abdominopelvic CT scan revealed an 80 mm EIA aneurysm containing thrombosis and active leakage. The patient underwent open repair of an aneurysm using a graft between the Aorta and EIA. The surgery was uneventful. Later in the ICU, the patient experienced a cardiac arrest and unfortunately could not recover from it. In this case, a patient with a relatively large aneurysm presented with abdominal pain and lower limb discomfort. Although endovascular surgery is recommended for the repair of iliac aneurysms, open repair is common for ruptured aneurysms. Endovascular repair is less invasive but may lead to contrast-induced renal dysfunction. Open repair may induce complications such as sexual dysfunctions, graft infection, and pelvic ischemic conditions. EIA aneurysms are exceedingly rare. They may present with a Rupture that puts the patient in critical condition, such as in this case. Due to the hemodynamic instability, open repair is considered one of the main approaches for repairing the aneurysm. • Iliac artery aneurysms specifically external iliac artery aneurysms are exceedingly incidence. • The presentation of an external iliac artery aneurysm can vary, and the method of repair depends on its presentation. • Open repair is the preferred choice for hemodynamically unstable patients with external iliac artery aneurysms. [ABSTRACT FROM AUTHOR]

• Iliac flap is more suitable for repairing Brown class b and c defects of maxilla. • Fibular free flap is longer and better for Brown class d defect reconstruction. • Iliac flap is thicker, wider and can provide sufficient bone for implantation. • Reconstruction method should be based on the defect type and implantation demands. The deep circumflex iliac artery flap (DCIA) and vascularized fibular free flap (FFF) are mainstay flaps for maxillary defect reconstruction. This study compared the functional outcomes and success rates of these flaps to provide midface reconstruction strategies. Maxillary defects reconstructed with DCIA or FFF at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology between May 2016 and May 2023 were retrospectively analyzed. The length, width, and height of the grafted bone segments; intermaxillary distance; buttress reconstruction rate (BRR); dental arch reconstruction rate (DAR); success rate; and dental implantation rate were compared. The DCIA and FFF groups had 33 and 27 patients, respectively. Success rate in the DCIA group was 93.94 % and 100 % in the FFF group. The DCIA length was less than that of FFF; however, the width and height were significantly larger. 87.10 % of cases in the DCIA group were classified as Brown class b and c, 51.85 % of cases in the FFF group were classified as Brown class d. The average BRR in the DCIA group was 69.89 % ± 16.05 %, which was significantly higher than that in the FFF group. A total of 38.7 % and 11.1 % patients in the DCIA and FFF groups, respectively, had completed implantation. DCIA has a greater width and height, and is more suitable for repairing Brown class b and c defects, providing sufficient bone for implantation, while the FFF is longer and more suitable for Brown class d defect reconstruction. [ABSTRACT FROM AUTHOR]

Iliac arteries play a crucial role in peripheral blood circulation. They are susceptible to various diseases, including aneurysms and atherosclerosis. Structure, material properties, and biomechanical forces acting on different regions of the iliac vasculature may contribute to the localization and progression of these pathologies. We examined 33 arterial specimens from common iliac (CI), external iliac (EI), and internal iliac (II) arteries obtained from 11 human donors (62 ± 12 years). We conducted morphometric, mechanical, and structural analyses using planar biaxial tests, constitutive modeling, and bi-directional histology on transverse and axial sections. The iliac arteries exhibited increased tortuosity and varying disease distribution with age. CI and II arteries displayed non-uniform age-related disease progression around their circumference, while EI remained healthy even in older individuals. Trends in load-free and stress-free thickness varied along the iliac vasculature. Longitudinally, EI exhibited the highest compliance compared to other iliac vessels. In contrast, CI was stiffest longitudinally, and EI was the stiffest circumferentially. Material parameters for all iliac vessels are reported for four common constitutive relations. Elastin near the internal elastic lamina displayed greater waviness in EI and II compared to CI. Also, EI had the least glycosaminoglycans (GAGs) and the highest elastin content. Our findings highlight variations in the morphological, mechanical, and structural properties of iliac arteries along their length. This data can inform vascular disease development and computational studies, and guide the development of biomimetic repair materials and devices tailored to specific iliac locations, improving vascular repair strategies. [ABSTRACT FROM AUTHOR]

• Patients after simultaneous pancreas-kidney transplant are a group of patients with an increased risk of vascular complications. • The endovascular approach is recommended in stable patients, but it requires an experienced and multidisciplinary team. • Patients after pancreas transplantation must be under the constant care of transplant centers, where all complications can be effectively assessed and treated. A 51-year-old patient with type I diabetes and end-stage renal disease was qualified for a simultaneous kidney and pancreas transplant. The procedure was performed in a typical manner: arterial anastomosis to the right common iliac artery, the graft's portal vein with inferior vena cava, and side-to-side duodenal intestinal anastomosis. The kidney was implanted retroperitoneally. Six months after the transplant, the patient reported pain in the right lower abdomen, and imaging examinations revealed arterial anastomosis. Reconstruction of the right common iliac artery was performed with a Gore-Tex prosthesis and the pancreatic artery reanastomosed to the right external iliac artery. After the surgery, the function of the transplanted pancreas deteriorated, the level of C-peptide was decreased, and the patient required low doses of insulin. After another 8 months, the imaging studies revealed an aneurysm located in the bifurcation of the aorta up to the anastomosis of the pancreatic graft artery with the iliac artery. The patient was qualified for the implantation of an endovascular of 2 prosthesis, which improved the graft's function. After another 2 months, the presence of an aneurysm at the endovascular prosthesis was found again. The patient was requalified for endovascular prosthesis implantation. Currently, there is no aneurysm but the function of the pancreas graft is impaired, though the kidney graft function is good. Patients after simultaneous kidney and pancreas transplant are a group of patients with an increased risk of vascular complications. Treatment should take place in a multidisciplinary center. [ABSTRACT FROM AUTHOR]

• Solid organ transplantation is a well-recognized risk factor for aspergillosis. • Diagnosis is often challenging, especially in the comorbid patient. • Voriconazole is the first-line antifungal agent. • Prompt therapy and removal of infected tissue where possible are essential. • The prognosis for invasive Aspergillus is extremely poor. A renal transplant recipient aged 68 years experienced multiple complications after an initial good graft function from a deceased donor transplant. Late in the first week, the patient was oliguric with hematuria; the graft failed in week 2 after the development of a hematoma from a rupture of a renal artery aneurysm. He had a recurrent bleed from the internal iliac graft site and subsequently developed painful dark patches on his leg, distal to where the transplant had been. Histology from the explanted graft and skin biopsies demonstrated Aspergillus flavus; this was also grown in the culture of the external iliac artery tissue. Systemic aspergillosis is rare but well recognized, especially in the immunocompromised. Presentations include mycotic aneurysms and secondary cutaneous aspergillosis from hematogenous spread. Diagnosis requires confirmation by histology or direct culture, but a high β-glucan concentration and positive galactomannan antigen can suggest invasive fungal infection in the early stages of the disease. Cases should be managed with systemic antifungals and involvement of local microbiology services; unfortunately, the prognosis is poor. [ABSTRACT FROM AUTHOR]

Concerns about potential risks of using contrast media in patients with chronic renal insufficiency limit the utilization of CT angiography in this population. To evaluate the feasibility of abdominopelvic CTA with very low volumes of contrast media. In this retrospective study, 20 patients with chronic renal insufficiency underwent high-pitch abdominopelvic (AP) CTA on a third-generation dual-source CT scanner with 30 mL of nonionic iodinated contrast. The homogeneity of intravascular attenuation at the suprarenal aorta, infrarenal aorta, and the right common iliac artery was measured. Image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were used to assess objective image quality. Subjective image quality was evaluated on a 5-point scale (1 = unacceptable; 5 = excellent). Twelve male and eight female patients underwent CTA of the abdomen and pelvis at 80 kVp. Five CTAs also included the chest (CAP). The mean scan duration was 0.78 ± 0.19 s for AP and 0.96 ± 0.06 s for CAP CTAs. The mean ± SD of attenuation at suprarenal aorta, infrarenal aorta, and right common iliac artery were 235.1 ± 68.0, 249.2 ± 61.3, and 254.4 ± 67.7 HU, respectively. The attenuation was homogeneous across vascular levels (P = 0.06). All scans had diagnostic subjective image quality with the median (IQR) of 3.5 (1.75). CNR and SNR were homogeneous across vascular levels (P = 0.08 and P = 0.14, respectively). Sub-second, high-pitch abdominopelvic CTA with a low volume of contrast in patients with chronic renal insufficiency is technically and clinically feasible with good diagnostic image quality and homogenous attenuation across vascular levels. • CT angiography (CTA) can be performed with significantly lower volume of intravenous contrast material • Vascular opacification can be maximized using high-pitch, low tube voltage, abdominopelvic CTA • Subsecond CTA was achieved by using dual source CT scanner [ABSTRACT FROM AUTHOR]

Aim: To evaluate the computed tomography (CT) attenuation values, background noise, arterial depiction, and image quality in whole-body dual-energy CT angiography (DECTA) at 40 keV with a reduced iodine dose using deep-learning image reconstruction (DLIR) and compare them with hybrid iterative reconstruction (IR).Material and Methods: Whole-body DECTA with a reduced iodine dose (200 mg iodine/kg) was performed in 22 patients, and DECTA data at 1.25-mm section thickness with 50% overlap were reconstructed at 40 keV using 40% adaptive statistical iterative reconstruction with Veo (hybrid-IR group), and DLIR at medium and high levels (DLIR-M and DLIR-H groups). The CT attenuation values of the thoracic and abdominal aortas and iliac artery and background noise were measured. Arterial depiction and image quality on axial, multiplanar reformatted (MPR), and volume-rendered (VR) images were assessed by two readers. Quantitative and qualitative parameters were compared between the hybrid-IR, DLIR-M, and DLIR-H groups.Results: The vascular CT attenuation values were almost comparable between the three groups (p=0.013-0.97), but the background noise was significantly lower in the DLIR-H group than in the hybrid-IR and DLIR-M groups (p<0.001). The arterial depictions on axial and MPR images and in almost all arteries on VR images were comparable (p=0.14-1). The image quality of axial, MPR, and VR images was significantly better in the DLIR-H group (p<0.001-0.015).Conclusion: DLIR significantly reduced background noise and improved image quality in DECTA at 40 keV compared with hybrid-IR, while maintaining the arterial depiction in almost all arteries. [ABSTRACT FROM AUTHOR]

The optimal endovascular treatment for common iliac artery in stent re-stenosis has yet to be assessed. Treatment options include, among others, angioplasty alone and repeated stenting with covered stents. This study retrospectively compared patency and target lesion revascularisation of these treatments. All patients who underwent endovascular treatment of common iliac artery in stent re-stenosis between 2007 and 2017 were included retrospectively. The primary end point was freedom from re-stenosis. Secondary endpoints were target lesion revascularisation rate (TLR) and freedom from occlusion during follow up. Seventy-four interventions were included, consisting of 37 angioplasties and 37 covered stent placements in 57 patients. Freedom from re-stenosis at four years was 72.6% (95% confidence interval [CI] 51.8% – 88.7%) in the covered stent group vs. 43.5% (95% CI 25.9% – 59.8%) in the percutaneous transluminal angioplasty (PTA) group (p =.003). The target lesion revascularisation (TLR) rate was 16.4% (95% CI 7.1% – 35.6%) and 43.6% (95% CI 28.0% – 63.2%) respectively (p =.020). There was no difference in freedom from occlusion; this was 90.8% (95% CI 73.9% – 97.0%) in the covered stent group and 79.1% (95% CI 58.4% – 90.3%) in the PTA group (p =.49). The difference in freedom from re-stenosis and TLR remained significant after sensitivity and multivariable analyses. Covered stents offer better outcomes for common iliac artery in stent re-stenosis than angioplasty alone. [ABSTRACT FROM AUTHOR]

The deep circumflex iliac artery perforator flap with iliac crest (DCIAPF) is considered a favourable single-flap option for oromandibular reconstruction. The aim of this study was to evaluate the effectiveness of venous superdrainage using the superficial circumflex iliac vein (SCIV) in the DCIAPF for oromandibular reconstruction. The data of 22 patients (12 female, 10 male) aged 10–76 years (median 53 years) who underwent simultaneous oromandibular reconstruction with a DCIAPF were reviewed retrospectively. Eleven patients received the DCIAPF with SCIV for superdrainage (group A) and another 11 patients received the conventional single-pedicled DCIAPF flap (group B). No flap loss occurred in either group. Venous congestion due to relative venous insufficiency was significantly more frequent in group B (P = 0.045). There was no significant difference in the incidence of partial flap necrosis and wound dehiscence, or in the total operation time between the two groups. Superdrainage using the SCIV has the potential to reduce the incidence of venous congestion due to relative venous insufficiency in DCIAPF used for oromandibular reconstruction. [ABSTRACT FROM AUTHOR]

• Use of a surgical microscope to create an arterial anastomosis provides better results. • Kidney graft function was better than that achieved with two separate anastomoses. • Use of a surgical microscope should become routine in kidney transplantation. • This technique would decrease complication rates and increase the life of the graft. In this study, we compared the outcomes of three different surgical microscope–assisted end-to-side anastomosis techniques between the dominant and accessory renal arteries during living donor kidney transplant. The demographics, serum creatinine levels, warm and cold ischemia times, rate of complications, and incidence of delayed graft function of 135 kidney recipients were analyzed according to the type of arterial anastomosis. Group A (n = 98) had one dominant renal artery (DRA) with one end-to-side anastomosis to the external iliac artery (EIA) using a surgical microscope. Group B (n = 17) had one DRA plus one accessory renal artery (ARA) with two separate end-to-side anastomoses to the EIA using a surgical microscope. Group C (n = 20) had one DRA with end-to-side anastomosis to the EIA and one ARA with an ex vivo on-bench end-to-side anastomosis to the DRA using a surgical microscope. Compared with groups A and B, the cold ischemia time and the rate of delayed graft function were significantly higher in group C (P ≤.001). At 6 months after transplant, group B demonstrated a higher creatinine value (2.40 ± 3.41 mg/dL) than group A and group B (P =.032). Also, the decrease in creatinine at postoperative month 6 was limited in group B as compared with groups A and C. An end-to-side anastomosis between ARA (group B) and DRA (group A) of the kidney graft using a surgical microscope on the bench ex vivo results in superior outcomes. Single arterial anastomosis techniques are associated with a better function in a 6-month follow-up than two separate arterial anastomoses. [ABSTRACT FROM AUTHOR]

• Lymphatic vessel ligation is a critical step in kidney transplantation. • LigaSure is an electrothermal bipolar vessel-sealing device for effective lymphatic ligation. • LigaSure was similar to conventional lymphatic ligation in kidney transplantation across postoperative outcomes. • Considering the additional advantages, LigaSure is superior for lymphatic ligation compared with conventional ties. Iliac vessel lymphatic ligation is critical in kidney transplantation, because it is associated with the occurrence of lymphocele. Lymphocele can also affect the renal graft. This study aimed to evaluate the efficacy of lymphatic sealing using LigaSure (an electrothermal bipolar sealing device) in kidney transplantation as compared with conventional silk-tie ligation. This retrospective study included 100 consecutive patients from a prospectively registered database who underwent kidney transplantation at Seoul St. Mary's Hospital, South Korea, between December 1, 2019 and November 12, 2020. Comorbidities, primary renal disease, transplantation variables, surgical variables, and posttransplantation outcomes were compared between conventional and LigaSure lymphatic ligations. Subgroup analyses were performed by anastomosis pattern. The mean age of patients was 47.4 ± 12.40 (range, 24-73) years. The LigaSure and conventional groups comprised 50 (50%) patients. Hypertension history, number of anastomosed renal arteries, and anastomosis patterns differed significantly between groups (P <. 05). No significant difference was found in postoperative outcomes. In the subgroup analysis, greater drain volume was found at postoperative day 1 in the end-to-end internal iliac artery–renal artery anastomosis group (P =. 001) because the internal iliac artery dissection results in longer lymphatic ligation. Nevertheless, no differences in drain removal time (P =.528) or lymphocele incidence were found between subgroups. LigaSure is expected to benefit from surgery time and will be identified in subsequent studies. LigaSure can be safely and comfortably used for iliac lymphatic ligation in kidney transplantation. In conclusion, LigaSure lymphatic ligation is superior to conventional lymphatic ligation in kidney transplantation. [ABSTRACT FROM AUTHOR]

Transfemoral (TF) access for transcatheter aortic valve implantation (TAVI) is the most commonly used site, however its use may be limited by prohibitive peripheral arterial disease. Although a number of alternative access techniques have been well described, each has been shown to be associated with increased risks when compared to a TF approach. Recently, planned treatment of iliofemoral artery disease using intravascular lithotripsy (IVL) has emerged as a means of preserving TF access. Ipsilateral or contralateral femoral artery access has been routinely used to perform IVL but its use may be limited in certain conditions. Here we describe the novel technique of using percutaneous axillary artery access to perform IVL of iliofemoral artery to facilitate its use for large bore access. We present a 78-year-old high surgical risk female with severe aortic stenosis who was found to have a prior stent in the contralateral iliac artery protruding into the aorta which limited a traditional 'up and over' approach, and thus axillary artery access was used to perform IVL. This is the first case in literature to describe the use of percutaneous axillary access to perform IVL of the iliac and common femoral artery to facilitate TF TAVI. Based on our previous experience we feel this technique holds promise for a routine use when use of other access sites is limited. [ABSTRACT FROM AUTHOR]

The everolimus-eluting stent (EES), one of the effective stents for in-stent restenosis (ISR), has a lower incidence of stent thrombosis; however, the underlying mechanism remains unknown. This study aimed to identify the effects of everolimus on vascular metabolism and thrombogenicity and examine their mechanistic link. EESs and bare-metal stents were implanted in rabbit iliac arteries with smooth muscle cell (SMC)-rich neointima induced by endothelial denudation. Four weeks after stent implantation, the stented arteries were examined for histological analysis and metabolomics. Additionally, everolimus effects in coronary artery SMCs metabolism, tissue factor (TF) expression, and procoagulant activity were assessed in vitro. EES-implanted arteries showed decreased neointima formation, less SMCs infiltration, and reduced TF expression. Concomitantly, they were metabolically characterized by increased levels of metabolites in amino acids, such as glutamine. Similarly, everolimus increased intracellular glutamine levels, decreased TF expression, and reduced procoagulant activity in SMCs in vitro. On the contrary, exogenous glutamine administration also increased intracellular glutamine level, decreased TF expression, and reduced procoagulant activity despite enhanced mammalian target of rapamycin (mTOR) activity. Intracellular glutamine level is likely to determine vascular SMC-related thrombogenicity regardless of mTOR pathway activity. Therefore, increased intracellular glutamine level might contribute partially to the beneficial effect of EES use on stent thrombosis. [Display omitted] • Everolimus-eluting stents (EESs) have low thrombosis rate, with unknown mechanism. • Metabolomics identified EES-implanted arteries as amino acid (glutamine) enriched. • Everolimus downregulates vascular smooth muscle cell-derived thrombogenicity. • Increasing intracellular glutamine level possibly has anti-thrombotic effect. [ABSTRACT FROM AUTHOR]

Background: Bypass grafting is the standard of care for chronic aorto-iliac occlusive disease (AIOD, aka Leriche Syndrome) but is associated with mortality rates of up to 25% if surgical re-intervention is necessary. Despite a recent shift towards an endovascular-first strategy for TransAtlantic InterSociety Consensus II ("TASC II") C and D lesions, reports from Leriche Syndrome are still limited.Patients and Methods: 15 high-risk patients (11 male, 4 female), mean age of 60.6 years, with chronic aorto-iliac occlusive disease were retrospectively reviewed. Retrograde approaches via the bilateral femoral arteries for aortic occlusion less than 4 cm in length and/or antegrade fashion from the brachial artery for juxtarenal type lesions were made. For the latter, thrombolysis prior to angioplasty was also performed. Intraluminal or if necessary, subintimal angioplasty was performed with deployment of either bare metal stents or stentgrafts in a kissing-stent fashion.Results: A total of 28 iliac arteries and 14 occluded abdominal aorta were treated with 100% technical success, of which 25% success were achieved by using subintimal technique. Two minor complications occurred, including vascular rupture and distal emboli in one patient apiece, which were successfully managed via endovascular fashion. There were no complications of renal artery emboli. Primary and secondary patency rates at 1, 3 and 5 years were 92.3% and 100%; 83.9% and 100%; and 83.9% and 100%, respectively.Conclusion: Endovascular therapy for chronic aorto-iliac occlusion has a high technical success rate, with good short- and mid-term primary and secondary patency rates and may provide a valid alternative to surgery for high-risk patients. [ABSTRACT FROM AUTHOR]

The diagnosis of aortic dissection is often challenging due to its various presentations and the frequent absence of classic findings. This high morbidity and high-mortality condition may present with different presentations and aortic dissections also are strongly associated with hypertension and are related to other underlying causes. A 45-year-old woman, was a case of Marfan's syndrome, presented to the GYN OPD for evaluation of low abdominal pain for 2 days. The pain was persisting and radiated to her pelvis. A bedside ultrasound was performed to assess for evidence of aortic dissection (Fig 1a,b). An axial CT angiogram (CTA) of the chest, abdomen, and pelvis was then performed immediately at ER, which demonstrated that the aortic dissection actually extended from the aortic arch all the way down the abdominal aorta and into the left common iliac artery, external iliac artery, and the internal iliac artery (Fig 2a,b). The patient had a sudden hypotension attack while at the pre-operation room, and succumbed. Aortic dissection has always to be aware of in Marfan's syndrome. Point-of-care ultrasound is a useful bedside tool for the rapid diagnosis of aortic dissection not only in the ER but also in gynecology field. [ABSTRACT FROM AUTHOR]

As a fundamental instrument in vascular interventional surgery, guidewires inherently face limitations when navigating through complex curved blood vessel bifurcations due to their deflection and the constraints of external pushing and twisting operations. To address this issue, this study proposes a micro magnetically guided helical robot comprising a cylindrical permanent magnet, a helical casing, a soft structure, and an interventional guidewire. The soft structure is employed to enhance the steering capability of the guidewire by reducing resistance caused by its deflection during steering. Furthermore, an additional helical casing with a permanent magnet is added at the head of the guidewire to enable active movement. The effectiveness of the experimental platform was validated using a T-shaped magnet, with a maximum error of less than 3°. A prototype of the magnetically guided robot was fabricated, and basic experiments were conducted in various liquid environments. Steering tests were performed in a 2D plane, demonstrating that with the assistance of the soft structure, the robot achieved an additional 32° of bending beyond the maximum initial bending degree, resulting in a maximum bending of 90°. Moreover, the active locomotion and steering capabilities of the magnetically guided robot were validated in various in vitro simulated blood vessels. The study effectively demonstrated the successful execution of selective steering motion, continuous steering motion, and large-angle bending motion by the robot, utilizing a variety of glycerin-filled tubing configurations, such as Y-shaped, Ω-shaped, and U-shaped tubing, as representative models to simulate iliac artery, aortic arch, and distal coronary arteries encountered in the femoral artery intervention pathway. These experiments confirmed the effectiveness of the proposed robot in enabling the guidewire to navigate through curved blood vessels. [Display omitted] • A micro magnetically guided helical robot with active and steering motion for guidewires was developed. • The robot comprises a permanent magnet, a helical casing, a soft structure, and a guidewire. • The robot achieved an additional 32° of bending beyond the maximum initial degree of the guidewire. • The active locomotion and steering capability of the proposed robot were validated. • The robot assists in enabling the guidewire to navigate through curved blood vessels. [ABSTRACT FROM AUTHOR]