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Objective: The aim of our study was to investigate whether temporary clamping of the bilateral common iliac artery (BCIA) has a role in reducing intraoperative blood loss in patients with segmentally resected anterior placenta percreta or not. Methods: This prospective observational study included patients with anterior placenta percreta who underwent cesarean segmental resection either with BCIA temporary clamping or without clamping between October 2022 and September 2023. Results: A comparison of demographic, obstetric, and surgical parameters and the need for transfusion (except for postoperative erythrocyte suspension transfusion) between the two groups revealed no significant difference (P > 0.05). In contrast, the amount of intraoperative blood loss (P = 0.001) (1974 ± 749 mL vs 2702 ± 615 mL) and postoperative erythrocyte suspension transfusion (P = 0.046) in patients who underwent BCIA temporary clamping were significantly lower than in those who did not undergo BCIA temporary clamping. Conclusion: Temporary clamping of BCIA plays a significant favorable role both in reducing blood loss and the need for postoperative transfusion in patients with placenta percreta who underwent segmental uterine resection. Synopsis: Temporary clamping of BCIA plays a positive role in reducing blood loss in patients with placenta percreta who underwent segmental uterine resection. [ABSTRACT FROM AUTHOR]

Objective: The study aims to evaluate the long‐term impact of internal iliac artery ligation (IIAL) on ovarian hormonal and functional changes in women. The procedure is often used for postpartum hemorrhage and is considered uterus‐sparing. However, its effects on ovarian reserve and fertility preservation remain controversial. Methods: This is a retrospective, case–control study involving consecutive female patients aged 17–47 years. These patients underwent successful bilateral IIAL due to severe postpartum hemorrhage between January 2022 and December 2022. The control group included women of matching age, parity, and body mass index (BMI) who did not undergo IIAL. Both groups were followed for 6 months to measure follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) levels, antral follicle counts, and ovarian volume. Results: The study comprised 62 patients in the IIAL group and 86 in the control group. No significant differences were found in FSH and LH levels between the two groups (P > 0.05). However, the numbers of antral follicles in both the right and left ovaries were significantly lower in the IIAL group than in the control group (P < 0.05). Ovarian volume did not show a significant difference between the groups (P > 0.05). Conclusion: The findings suggest that IIAL leads to a significant decrease in the number of ovarian follicles at 6 months post‐operation. However, it does not significantly impact FSH and LH levels or ovarian volume. Synopsis: The study reveals that IIAL significantly decreases ovarian follicle counts at 6 months but does not impact FSH, LH levels, or ovarian volume. [ABSTRACT FROM AUTHOR]

Key Clinical Message: LMS of IVC needs a multidisciplinary approach. Surgical excision with free margin is the cornerstone of management. Upon case‐by‐case selection, adjuvant chemotherapy may play a role in better oncologic outcome. Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare form of mesenchymal origin malignancy with less than 400 cases reported to date. Surgery is the mainstay of management but it requires vast experience in vascular and visceral surgery to attain a free tumor margin. Subsequent adjuvant treatment with chemotherapy and radiation remains as an area of gray zone. We report the case of a 61‐year‐old man with an 8‐month history of abdominal pain. Upon physical examination, an ill‐defined mass over the right side of the lower abdomen and bilateral lower extremity edema were detected. Abdominal ultrasound with Doppler revealed a right‐side retroperitoneal mass invading the IVC with extensive venous thrombosis for which anticoagulation was initiated. Computed Tomography of the abdomen revealed a huge heterogeneously enhancing mass involving the whole length of the infrarenal IVC obstructing the IVC lumen with collateral veins draining through the paralumbar veins and inferior epigastric veins bilaterally. With a top differential of primary IVC LMS, a midline longitudinal laparotomy was performed with an intraoperative finding of a tumor arising from the infra‐renal IVC which was excised. Gore‐Tex graft was used to reconstruct the IVC. There was an injury to the right common iliac artery and it was repaired by end‐to‐end anastomosis. Histopathology confirmed a high‐grade LMS of the IVC and surgical margin status was unknown. He was given adjuvant Chemotherapy consisting of Doxorubicin and Dacarbazine. He has been on follow‐up at the Oncology side with a good performance status. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Level of evidence Extramammary Paget's disease (EMPD) is a rare intra‐epidermal adenocarcinoma, and reconstruction of the penoscrotal region remains a clinical challenge. The superficial circumflex iliac artery perforator (SCIP) flap has been successfully used as a free flap, while its application as a propeller flap in the reconstruction of penoscrotal EMPD defect is rarely reported. The objective was to evaluate the safety and efficacy of the SCIP propeller flap in the reconstruction of penoscrotal defects in EMPD.Between September 2010 and August 2022, consecutive patients diagnosed with penoscrotal EMPD were enrolled. All patients underwent penoscrotal EMPD excision and reconstruction with SCIP propeller flap combined with other flaps or skin grafts on individual defects. Demographic information, surgical parameters, postoperative complications, patient satisfaction, and recurrence rates were analyzed.Twenty‐four patients (mean age, 73 ± 8.8 years; mean BMI, 23.98 ± 3.62 kg/m2) with 33 SCIP propeller flaps (mean size 120.1 cm2; range, 24–208 cm2) were included, and the mean defect size was 67.4 cm2 (range, 12–255 cm2). The mean operative duration was 385.4 ± 146.8 min. Fifteen patients received autologous full‐thickness skin grafts, and four received other flaps simultaneously. All flaps survived without total or partial loss, and all donor sites achieved primary closure, though local hematoma (one case) and limited skin graft necrosis (two cases) were observed. All patients experienced complete wound healing and maintained penoscrotal morphology and function without recurrent lesions over a mean follow‐up of 59 months.The SCIP propeller flap seems a safe and effective reconstructive method for penoscrotal EMPD.IV. [ABSTRACT FROM AUTHOR]

Arterio–ureteral fistulas (AUFs), which are relatively rare but potentially life‐threatening, require prompt diagnosis and treatment. We reported a case of AUFs following robot‐assisted laparoscopic radical cystectomy (RARC) with extended pelvic lymph node dissection and ileal conduit urinary diversion for muscle‐invasive bladder cancer, which resulted in massive hemorrhage. Urine leaked from the anastomosis between the ureter, and the end of the ileal conduit was infected, which resulted in an AUF between the pseudoaneurysm of the right common iliac artery and the ureter. The AUF was managed successfully by vascular intervention with an arterial stent graft. [ABSTRACT FROM AUTHOR]

Key clinical message: This was the first report of a pseudoaneurysm in a vaginal artery after hysterectomy, unlike other published studies that were of pseudoaneurysms in uterine or vaginal arteries after delivery. A 51‐year‐old woman presented with massive vaginal bleeding 7 days after a hysterectomy, which caused hemoglobin to drop. The patient was suspicious of having a vaginal artery pseudoaneurysm according to the sonography. Her bleeding was stopped after the ligation of her left internal iliac artery. [ABSTRACT FROM AUTHOR]

Drug‐coated balloons (DCBs), serving as a superior alternative to stents, are at the cutting edge of clinical innovations in atherosclerosis management. Nevertheless, the prevalent high flow rates in arterial vascular result in short drug residence times, significantly compromising DCBs' therapeutic effectiveness. Drawing inspiration from the mechanisms of vascular calcification, a rapamycin‐loaded calcium phosphate nanoparticle (CaP@Rapa) coating for balloons is pioneered. This coating functions as a potent drug anchor in arteries, facilitating the adhesion of rapamycin to plaques and thereby enhancing the local concentration of the rapamycin. To evaluate its therapeutic efficacy in vivo, the rabbit iliac artery atherosclerosis model is innovatively developed, which authentically mirrors the pathological progression of atherosclerosis in humans. The enhanced localized rapamycin retention, along with its pH‐sensitive sustained release characteristics, culminate in substantial reductions in plaque volume, a decrease in intimal hyperplasia, and mitigation of local inflammation in model rabbits. To further substantiate the translational potential of CaP@Rapa balloons, the research on the pig coronary atherosclerosis model is expanded, which yielded results solidifying the clinical promise of CaP@Rapa balloons. In summary, this research not only offers a more effective and reliable alternative to traditional DCB but also paves the way for further clinical trials. [ABSTRACT FROM AUTHOR]

Background: Head and neck tissue defects after ablative surgery often require complex and composite reconstructions. The superficial circumflex iliac artery perforator (SCIP) flap is an extremely versatile perforator‐based flap with minimal donor site morbidity, which may represent the optimal procedure in this setting. Over the last 5 years, we collected a large base of experience, including both simple and chimeric SCIP‐based reconstruction, making this flap our first choice for head and neck reconstructions. Patients and Methods: Seventy‐three patients undergoing ablative head and neck surgery for oncologic pathologies were treated by means of a SCIP flap reconstruction. Patients' mean age was 67 years old (range 37–89), 51 were males and 22 were females. Fifty‐eight flaps were simple and 15 were chimeric reconstruction patterns. Indocyanine green perfusion imaging was performed in all cases. Results: All the patients were successfully treated with no flap losses were encountered. Twelve patients encountered postoperative complications: in four cases revision surgery was required for venous congestion, while the remaining cases were managed conservatively (four wound dehiscence and three infections). No patients showed donor site complications. The mean follow‐up period was 11 months (range 3–24). Conclusions: Our case series demonstrates the reliability and versatility of the SCIP flap for different kinds of head and neck reconstructions. The chimeric options combined with bone, double skin paddle, and muscle offer a broad variety of functional reconstructive solutions for complex head and neck surgeries. Intraoperative indocyanine green perfusion examination provides a valuable tool to assess and ascertain proper vascularization and post‐anastomosis vessel patency in complex microvascular flap‐based reconstructions. [ABSTRACT FROM AUTHOR]

The article discusses a case of an 8-day-old neonate with a near-occlusive ductal thrombus extending to the abdominal aorta, leading to severe left ventricular dysfunction and absent femoral pulses. The patient underwent emergent heparinisation and thrombectomy to restore aortic patency and reduce the risk of mortality, limb-tissue necrosis, and end-organ damage. The management of acute, symptomatic thromboses in large arteries in neonates remains controversial, with surgical thrombectomy reported as safe and effective in reducing occlusion and risk of complications. Further research is needed to establish clear treatment guidelines for cases of aortic thrombosis. [Extracted from the article]

Key Clinical Message: Arterial rupture is one of the rare but known and devastating complications of the angiogram, which can ultimately lead to loss of limb and life. Therefore, it is recommended that this complication be included in the consent form and that the operator and the logistics team be prepared for this scenario. Moreover, categorizing the patients based on risk factors to be more cautious during the procedure for high‐risk patients can be considered a reasonable strategy. One of the rare but lethal complications of femoral artery catheterization for coronary angiography is arterial rupture, which can cause a range of negligible to massive retroperitoneal hemorrhage. This case presents a woman with unstable angina who underwent coronary catheterization. After arterial sheath placement, extravasation of blood from the right common iliac and lateral sacral arteries was seen, a diagnosis that has been reported rarely before. The bleeding was controlled with balloon inflation in the lateral sacral artery and a stent graft implantation in the right common iliac artery. The patient remained asymptomatic during the procedure and the short‐ and long‐term follow‐up. Interventional cardiologists and radiologists who access the femoral artery for any procedure should be aware of this possible event. Sometimes, this situation manifests with nonspecific symptoms such as weakness, lethargy, and pallor. Moreover, more logistical preparation and training are needed to overcome these unexpected conditions. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to compare prophylactic common iliac artery (CIA) temporary clamping and preoperative balloon occlusion for managing placenta accreta spectrum (PAS) disorders. Study Design: Between January 2019 and June 2020, 46 patients with PAS disorders were included. Of them, 26 patients were offered CIA balloon occlusion (Group A), while temporary CIA clamping was done for the other 20 patients (Group B). Primary outcomes were procedure‐related complications, and secondary outcomes included intraoperative and postoperative complications, reoperation rates, total procedure time, blood loss, and amount of blood transfusion. Results: Blood loss was statistically non‐significant higher in group B than in group A (p‐value = 0.143). Only one patient in group A and three in group B needed reoperation. The bleeding continued for a mean of 1.6 days in group A and 1.7 days in group B, with non‐significant statistical differences between both groups p value = 0.71. Nine patients in group A (34.6%) and four in group B (20%) required ICU admission. The mean Apgar score was 7 and 6.6 in babies of group A and group B patients, respectively. The median number of allogeneic blood transfusions performed was two in patients in group A and 1 in group B (p‐value = 0.001). Conclusion: Both techniques offer good choices for patients with PAS to decrease mortality and morbidity rates. The selection of a better technique depends on institutional references and physicians' experience. [ABSTRACT FROM AUTHOR]

This article discusses a case of laparoscopic assisted dissection for a large trans-obturator tumor. The procedure was performed on a 38-year-old male patient with a solid mass located in the right pelvic space. The tumor was carefully dissected to preserve important structures such as the ureter, iliac vessels, obturator nerve, and spermatic cord. The surgery was successful, and the patient had an uneventful postoperative course. The authors suggest that laparoscopic assisted dissection can be performed safely by experienced surgeons, and for large tumors, a combination of laparoscopic and open approaches may be recommended. [Extracted from the article]

Background: Microsurgical bone reconstruction is challenging in cases of anterior maxillary defects because of the presence of residual teeth. The study analyzed the method and feasibility of using vascularized bone flaps to reconstruct anterior maxillary defects. Methods: We retrospectively analyzed 15 patients treated at the Department of Oral and Maxillofacial Surgery, Peking University School, and Hospital of Stomatology between November 2017 and January 2023. Results: A total of 14 patients were successfully reconstructed using the digital technique: 6 deep circumflex iliac artery (DCIA) flaps and 8 fibular free flaps. Palatal and buccal pedicle paths were used in 4 and 10 cases, respectively, for vascular anastomosis. The implant coverage rates of the DCIA and fibular free flaps were 87.2% and 92.6%, respectively (p > 0.05). Conclusion: Anterior maxillary defects reconstructed with the DCIA and fibular free flaps are reliable methods. Furthermore, the palatal and buccal paths are recommended for vascular anastomosis. [ABSTRACT FROM AUTHOR]

Late gestational supine positioning reduces maternal cardiac output due to inferior vena caval (IVC) compression, despite increased collateral venous return. However, little is known about the impact of maternal position on oxygen (O2) delivery and consumption of the gravid uterus, fetus, placenta and lower limbs. We studied the effects of maternal positioning on these parameters in 20 healthy pregnant subjects at 36 ± 2 weeks using magnetic resonance imaging (MRI); a follow‐up MRI was performed 6‐months postpartum (n = 16/20). MRI techniques included phase‐contrast and T1/T2 relaxometry for blood flow and oximetry imaging, respectively. O2 transport was measured in the following vessels (bilateral where appropriate): maternal abdominal descending aorta (DAoabdo), IVC, ovarian, paraspinal veins (PSV), uterine artery (UtA) and external iliacs, and umbilical. Maternal cardiac output was measured by summing DAothoracic and superior vena cava flows. Supine mothers (n = 6) had lower cardiac output and O2 delivery in the DAoabdo, UtA and external iliac arteries, and higher PSV flow than those in either the left (n = 8) or right (n = 6) lateral positions during MRI. However, O2 consumption in the gravid uterus, fetus, placenta and lower limbs was unaffected by maternal positioning. The ratio of IVC/PSV flow decreased in supine mothers while ovarian venous flow and O2 saturation were unaltered, suggesting a major route of pelvic venous return unaffected by maternal position. Placental–fetal O2 transport and consumption were similar between left and right lateral maternal positions. In comparison to non‐pregnant findings, DAoabdo and UtA O2 delivery and pelvic O2 consumption increased, while lower‐limb consumption remained constant , despite reduced external iliac artery O2 delivery in late gestation. Key points: Though sleeping supine during the third trimester is associated with an increased risk of antepartum stillbirth, the underlying biological mechanisms are not fully understood.Maternal cardiac output and uteroplacental flow are reduced in supine mothers due to inferior vena caval compression from the weight of the gravid uterus.This MRI study provides a comprehensive circulatory assessment, demonstrating reduced maternal cardiac output and O2 delivery (uteroplacental, lower body) in supine compared to lateral positioning; however, O2 consumption (gravid uterus, fetus, placenta, lower limbs) was preserved.Unlike other mammalian species, the ovarian veins conduct substantial venous return from the human pregnant uterus that is unaffected by maternal positioning. Lumbar paraspinal venous flow increased in supine mothers. These observations may have important considerations during major pelvic surgery in pregnancy (i.e. placenta percreta).Future studies should address the importance of maternal positioning as a potential tool to deliver improved perinatal outcomes in pregnancies with compromised uteroplacental O2 delivery. [ABSTRACT FROM AUTHOR]

This article discusses the potential association between neutrophilic dermatoses (ND), a group of inflammatory skin diseases, and arterial aneurysms. The authors present a case study of a 47-year-old male with neutrophilic eccrine hidradenitis (NEH) who was found to have an aneurysm of the left common iliac artery. The authors also review the existing literature and compile a case series of 10 patients with ND and arterial aneurysms. They suggest that clinicians should be aware of the potential for systemic cardiovascular manifestations in ND and consider screening for arterial aneurysms, particularly in children and young adults. However, further research is needed to determine if these vascular complications are a true manifestation of ND. [Extracted from the article]

Key Clinical Message: A combination of long large‐bore sheath and balloon‐expandable stent‐graft can be effective to challenging access route in transfemoral transcatheter aortic valve replacement. An 88‐year‐old female with symptomatic severe aortic stenosis underwent transcatheter aortic valve replacement (TAVR). Multidetector computed tomography demonstrated a small aortic annulus, shaggy aorta, and significant stenosis with heavily calcified atherosclerotic lesions in the bilateral common iliac arteries (CIAs). TAVR with Evolut™ Pro+ via alternative approach was considered; however, our heart team concluded that the patient was unsuitable for the procedure due to anatomical reasons, patient frailty, and medication history. Finally, transfemoral TAVR with endovascular therapy (EVT) and 18Fr‐65 cm‐Dryseal was adopted for the site. Following EVT with VIABAHN® VBX balloon‐expandable stent‐graft (VBX) implantation to the right ostial CIA lesion, 18Fr‐65 cm‐Dryseal was advanced to the ascending aorta through VBX, and Evolut™ Pro+26 mm was successfully implanted without any complication. At the 2‐month follow‐up, the patient reported a significant improvement in shortness of breath and did not present any evidence of atheroembolism. Transfemoral TAVR with 18Fr‐65 cm‐Dryseal to shaggy aorta can be feasible depending on the plaque distribution, and VBX implantation to a heavily calcified ostial CIA lesion was safe and effective for obtaining enough lumen for a large‐bore sheath. [ABSTRACT FROM AUTHOR]

Background: Takayasu arteritis (TA) is a chronic inflammatory arteritis affecting large vessels, predominantly the aorta and its main branches. Diagnosis is usually delayed in most patients owing to the absence of typical clinical manifestations in the acute phase until the development of substantial arterial symptoms. The purpose of this case report is to describe abdominal pain being an uncommon symptom in TA. Learning Objective: The clinical presentation of TA can be non‐specific and can have serious consequences if the diagnosis is delayed, helping the clinicians who can treat with such patients (emergency medicine, cardiologist, or medical personnel). [ABSTRACT FROM AUTHOR]

Herein, we describe our surgical technique and outcome of a kidney transplant in a patient with failing vascular access. A right donor kidney was transplanted into the right iliac fossa with an end‐to‐side arterial anastomosis to the ipsilateral right common iliac artery and end‐to‐side venous anastomosis to the contralateral left common iliac vein. The possibility of performing an ipsilateral arterial and contralateral venous anastomosis has been shown here to be successful. No post‐operative surgical complications were encountered. [ABSTRACT FROM AUTHOR]

Effective treatment, but also proper diagnosis of cardiovascular diseases, remains a major challenge in everyday practice. A quick, safe, and economically acceptable non‐invasive procedure should play a leading role in cardiovascular risk assessment before invasive diagnostics is performed. The staging of subclinical atherosclerosis may help in further clinical decisions. Safe, widely available, and relatively inexpensive, ultrasonography is a promising examination that should find wider application in clinical practice. The latest ESC guidelines emphasize the usefulness of carotid ultrasound in the diagnosis of coronary artery disease (CAD) and subclinical assessment of atherosclerosis, which help to determine the level of cardiovascular risk. Ultrasound examination of peripheral arteries, especially superficial vessels such as the femoral arteries, is quite easy, quick, and accurate. Other vascular beds, such as iliac and renal, are more demanding to examine, but can also provide valuable information. This review summarizes important studies comparing the severity of atherosclerosis in ultrasound‐visible vascular beds in patients with established CAD. We especially emphasize the benefits of the combined assessment of atherosclerosis features, which were characterized by high sensitivity and specificity in the diagnosis of CAD and other serious cardiovascular diseases. [ABSTRACT FROM AUTHOR]

The Pfizer‐BioNTech mRNA vaccine is a US Food and Drug Administration‐approved coronavirus disease 2019 (COVID‐19) vaccine. Although it is reported to be safe and effective, immune dysregulation leading to autoimmunity has become an area of concern. Retroperitoneal fibrosis (RPF) is an immune‐mediated fibroinflammatory disease characterized by the deposition of fibrous tissues, primarily around the abdominal aorta and iliac arteries. Herein, we report a case of RPF following Pfizer BioNTech COVID‐19 mRNA vaccination. To the best of our knowledge, there have been no published reports on RPF after COVID‐19 mRNA vaccination. A 58‐year‐old woman with no history of autoimmune diseases presented with acute onset of epigastric pain 5 weeks after the second dose of the Pfizer‐BioNTech vaccine. She had been diagnosed with stage I breast cancer 9 years ago and was in complete remission on admission. Abdominal computed tomography showed preaortic soft‐tissue infiltration around the origin of the superior mesenteric artery but no evidence of breast cancer recurrence. Considering the temporal relationship between current symptoms and vaccination and the absence of other possible causes, she was diagnosed with RPF secondary to Pfizer‐BioNTech vaccine‐induced autoimmunity. This case may raise awareness of the possibility of RPF development following COVID‐19 mRNA vaccination. [ABSTRACT FROM AUTHOR]

Background: Anterolateral thigh (ALT) and Radial forearm free flaps (RFFF) are historically the most common methods of oral reconstruction. The Superficial circumflex iliac artery perforator flap (SCIP) is an alternative providing a donor site that can be readily closed primarily with improved cosmesis in younger patients, due to its concealability. Methods: We reviewed 135 patients who received ALT, RFFF or SCIP flaps for oral reconstruction in our institution. Our aim was to compare operative and perioperative outcomes between each cohort. ANOVA and χ2 test were used for statistical analysis. Results: There were 37 ALT, 64 RFFF and 35 SCIP reconstructions. Patients reconstructed with SCIP flaps had smaller resection volumes (P < 0.001) and earlier T and N classifications (P = 0.001, P = 0.008), and consequently reduced tracheostomy rates (P < 0.001), reduced need for enteral feeding at discharge (P < 0.001) and shorter length of stay and perioperative times (P < 0.001). SCIP flaps were more common in younger patients (P < 0.01). ALT flaps were used for more advanced disease (P = 0.001) and had larger resection volumes (P < 0.001) and increased need for assisted enteral feeding (P < 0.001). There were no significant differences in flap or donor site outcomes. There were two flap failures, both RFFF. Conclusion: Each flap plays an important role in the reconstruction of oral defects, with larger defects preferentially reconstructed with ALT flaps. SCIP appears to be a reliable alternative in small defects with excellent perioperative and postoperative outcomes. [ABSTRACT FROM AUTHOR]

Poststent restenosis is caused by insufficient endothelialization and is one of the most serious clinical complications of stenting. We observed a rapid endothelialization rate and increased fibrin deposition on the surfaces of the corroded iron stents. Thus, we hypothesized that corroded iron stents would promote endothelialization by increasing fibrin deposition on rough surfaces. To verify this hypothesis, we conducted an arteriovenous shunt experiment to analyze fibrin deposition in the corroded iron stents. We implanted a corroded iron stent in both the carotid and iliac artery bifurcations to elucidate the effects of fibrin deposition on endothelialization. Co‐culture experiments were conducted under dynamic flow conditions to explore the relationship between fibrin deposition and rapid endothelialization. Our findings indicate that, from the generation of corrosion pits, the surface of the corroded iron stent was rough, and numerous fibrils were deposited in the corroded iron stent. Fibrin deposition in corroded iron stents facilitates endothelial cell adhesion and proliferation, which, in turn, promotes endothelialization after stenting. Our study is the first to elucidate the role of iron stent corrosion in endothelialization, pointing to a new direction for preventing clinical complications caused by insufficient endothelialization. [ABSTRACT FROM AUTHOR]

Key clinical message: This is the first reported case of a pelvic gunshot wound with a bladder injury masking a coinciding left external iliac artery injury. A high index of suspicion for an acute and traumatic ilio‐vesical fistula should be raised in the presence of the following triad: bright red hematuria, bladder distension from clot retention, hemodynamic instability after bladder decompression "Mukendi's triad." Iliac artery injury from gunshot wounds is very rare and a lethal injury associated with high mortality rate. Concurrent ballistic external iliac artery and bladder injuries resulting in an acute ilio‐vesical shunt or fistula and discovered at the time of presentation are extremely rare. In this report, we present an unprecedented case of multiple pelvic gunshot wounds presented with a distended injured bladder full of clots concealing a left external iliac injury by tamponade effect. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of internal iliac artery intraoperative vascular clamp temporary occlusion in the treatment of abnormally invasive placenta. Method: This retrospective study enrolled 153 patients diagnosed with abnormally invasive placenta between January 2018 and December 2021. The patients were divided into a study group (n = 88, undergoing cesarean section followed by internal iliac artery vascular clamp temporary occlusion) and a control group (n = 65, receiving routine cesarean section). The general situation, intraoperative conditions, postoperative complications, and neonatal outcomes were compared between the two groups. Results: The hysterectomy rate in the study group was significantly lower than that in the control group. However, there were no significant differences in intraoperative blood loss, blood transfusion, postoperative intensive care unit transfer rate, or neonatal outcome between the groups. Further subgrouping showed that in patients with placenta increta, the hysterectomy rate and intraoperative bleeding amount were significantly lower in the occlusion group. Nevertheless, these advantages were not significantly different between the groups in patients with placenta percreta. Conclusion: Vascular clamp temporary occlusion of internal iliac artery is an effective method for controlling hemorrhage and decreasing the incidence of hysterectomy in patients with placenta increta. For patients with placenta percreta, the benefit is limited. Synopsis: Vascular clamp temporary occlusion of internal iliac artery is an effective method to manage placenta increta, but it provides limited benefit for placenta percreta. [ABSTRACT FROM AUTHOR]

Objective: The repair of great toe donor site defect after wrap‐around flap transfer is still controversial. The bilobed superficial circumflex iliac artery perforator (SCIP) flap can improve the aesthetics of the great toe while maintaining its function. Thus, this study aimed to report our experience in the reconstruction of big toe donor site defects with the bilobed SCIP flap and describe the clinical outcomes. Methods: This study was a retrospective trial. From May 2017 to May 2020, 13 patients with the great toe donor site defect after wrap‐around flap transfer were included in this study. The average age of the patients was 44 years (range, 23–60 years). All patients received free bilobed SCIP flaps to reconstruct the donor site defect of the great toe. Relevant clinical features were recorded preoperatively. The thickness and design of the SCIP flap and the harvesting layer of the flap were measured during the operation. The survival rate of flaps and skin grafts and the incidence of infection were recorded after operation. At follow‐up, donor site complications and postoperative outcomes were evaluated. Results: In all cases, the SCIP flap covering the donor site of the great toe survived. All patients were followed up for 24–40 months (mean, 30.5 months). The average thickness of the SCIP flap was 0.38cm. All SCIP flaps were harvested from the superficial fascial layer except for three obese patients. The thin SCIP flap had a bilobed design with no further defatting procedures. Postoperatively, the great toe‐nail flap donor site regained its original appearance without bloating or flap necrosis. There was a hidden linear scar in the groin donor site, which did not affect hip joint movement. All patients were satisfied with the aesthetics of the surgical site. Conclusion: The SCIP flap with bilobed design for repairing the donor defect of the great toe after wrap‐around flap transfer is a kind of surgical method with excellent contour, meeting the requirements of function and aesthetics. [ABSTRACT FROM AUTHOR]

Background: Preperitoneal packing (PPP) has been widely accepted as a damage control technique for severe bleeding from pelvic fractures. It is supposed to work by direct compression and tamponade of the bleeding source in the pelvis and it has been suggested to be effective for both venous and arterial bleeding. However, there is little evidence to support its efficacy or the ability to place the laparotomy pads in proximity of the desired location. Methods: Bilateral PPP was performed on 10 fresh human cadavers, followed by laparotomy and measurements of resultant pad placement in relation to critical anatomic structures. Results: A total of 20 assessments of laparotomy pad placement were performed. Following completion of PPP, a midline laparotomy was performed to determine proximity and closest distance of the laparotomy pads to sites of potential bleeding in pelvic fractures. In almost all cases, the pad placement was not contiguous with the key anatomic structure with mean placement 3.9 + 1.1 cm from the sacroiliac joint, 3.5 + 1.6 cm from the common iliac artery, 1.1 + 1.2 cm from the external iliac artery, 2.8 + 0.8 cm from the internal iliac artery, and 2.3 + 1.2 cm from the iliac bifurcation. Surgeon experience resulted in improved placement relative to the sacroiliac joint, however the pads still did not directly contact the target point. Conclusion: This human cadaver study has shown that PPP, even in experienced hands, may not be placed in significant proximity of anatomical structures of interest. The role of PPP needs to be revisited with better clinical or human cadaver studies. [ABSTRACT FROM AUTHOR]

Retained products of conception (RPOC) is a condition in which trophoblastic tissue remains in the uterus after pregnancy, causing massive hemorrhage in some cases. Though RPOC is commonly treated by intrauterine curettage or hysteroscopic resection uterine artery embolization or hysterectomy may be performed in case of massive bleeding. We experienced two cases of RPOC after surgery for missed abortion that failed to respond to conservative treatment and required surgical treatment. They were treated by hysteroscopic resection with temporary balloon catheter occlusion of bilateral internal iliac arteries for fertility preservation. After the balloon catheters were inflated, the reduction of blood flow to RPOC was observed under transvaginal ultrasound. In both cases, good visualization was maintained throughout the surgery with minimal bleeding. They were discharged the next day and resumed menstruation 1 month after surgery. This paper demonstrates the usefulness of this procedure as a minimally invasive and fertility‐preserving surgery. [ABSTRACT FROM AUTHOR]

Background: Fournier’s gangrene is a form of necrotising fasciitis involving perineoscrotal skin. It is treated with radical debridement, infection control and often leaves a large anatomical defect that is challenging to reconstruct. The anatomical location of the defect leads to faecal contamination, difficulties when mobilizing, and negative psychological impact. Traditional approaches for managing such defects have relied on either healing by secondary intention or skin grafting. There are few reported cases in the literature to cover such defects with a flap. Methods: Pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) flap reconstruction was performed in three patients who had perineo-scrotal defects following debridement for Fournier’s gangrene. Results: All flaps survived with no significant postoperative complications and good functional and aesthetic outcomes were achieved. The mean age of patient was 52 years and the largest defect measured 22 ( 10 cm. Conclusion: The reconstruction of perineo-scrotal defects is difficult despite a range of reconstructive options. The pedicled SCIP flap offers many advantages over standard techniques. This flap is thin, pliable, and has a consistent anatomy. With continued experience, we feel that this flap could be considered the gold standard of treatment for such defects. [ABSTRACT FROM AUTHOR]

Background: Kawasaki disease (KD) is a systemic vasculitis; systemic arteries other than the coronary arteries should therefore also be evaluated. This study investigated the feasibility of evaluating coronary aneurysms, systemic artery aneurysms (SAAs), and cerebrovascular diseases in patients with KD using non‐contrast magnetic resonance angiography (NC‐MRA). Methods: Coronary artery protocols, including coronary magnetic resonance angiography (MRA) and vessel wall imaging, were performed in 57 examinations of 28 patients. Systemic artery protocol, including SAA scans and head MRA, along with coronary artery protocol, were performed in 42 examinations of 42 patients. The image quality of the SAAs was evaluated on a 4‐point scale. Examination time and sedation dosage were compared between the protocols. The presence of SAAs and cerebrovascular disease was also evaluated. Results: The image quality score of SAAs was 4 (interquartile range [IQR]: 4–4) for the aorta, 4 (IQR: 3–4) for the subclavian artery, 4 (IQR: 3–4) for the renal artery, and 3 (IQR: 3–4) for the iliac artery. No differences were found between examination time (47.0 [IQR: 43.0–61.0] min vs. 51.0 [IQR: 45.0–60.0] min, p = 0.48) and sedative dose (4.63 [IQR: 3.93–5.79] mg/kg vs. 4.21 [IQR: 3.56–5.71] mg/kg, p = 0.37) between the protocols. Systemic artery protocol detected SAAs in three patients (7.1%), and cerebrovascular disease was not detected. Conclusions: Evaluating the coronary and systemic arteries in patients with KD using NC‐MRA on a single examination was possible without compromising examination time or sedation dose. The systemic artery protocol was useful in finding SAAs. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the accuracy of computer‐assisted surgery (CAS)–driven DCIA (deep circumflex iliac artery) flap mandibular reconstruction by traditional morphometric methods and geometric morphometric methods (GMM). Methods: Reconstruction accuracy was evaluated by measuring distances and angles between bilateral anatomical landmarks. Additionally, the average length of displacements vectors between landmarks was computed to evaluate factors assumed to influence reconstruction accuracy. Principal component analysis (PCA) was applied to unveil main modes of dislocation. Results: High reconstruction accuracy could be demonstrated for a sample consisting of 26 patients. The effect of the number of segments and length of defect on reconstruction accuracy were close to the commonly used significance threshold (p = 0.062/0.060). PCA demonstrated displacement to result mainly from sagittal and transversal shifts. Conclusions: CAS is a viable approach to achieve high accuracy in mandibular reconstruction and GMM can facilitate the evaluation of factors influencing reconstruction accuracy and unveil main modes of dislocation in this context. [ABSTRACT FROM AUTHOR]

This article, published in the journal "Ultrasound in Obstetrics & Gynecology," presents a step-by-step technique for identifying the proximal ureter using transvaginal ultrasound (TVS). The authors note that there are currently no published descriptions of how to visualize and describe the proximal ureter above the crossing of the uterine artery. The article provides a 5-step guide with accompanying images and videos to visually present the technique, including examples of normal and abnormal proximal ureters. The authors propose that this standardized approach will allow clinicians to diagnose hydroureter and ureter endometriosis more accurately. [Extracted from the article]

The obturator lymph nodes and surrounding adipose tissue were dissected, protecting the obturator nerve and internal and external iliac arteries and veins. After completing this stage, the bladder, obturator lymph nodes, umbilical artery and nerves to the bladder were exposed and served as the lateral boundary of the dissection. This is the case of a 40-year-old male patient with rectal cancer identified 1 year previously who had undergone neoadjuvant therapy (six cycles of FOLFOX + radiotherapy elsewhere - precise details unknown at referral) without significant change in the tumour. [Extracted from the article]

Microsurgery 2022; 42: 512 - 9. 8 Song C, Bhogesha S, Song C. Review of the superficial circumflex iliac artery perforator flap: recommendations to the approach of a groin perforator flap. The pedicled groin flap is a well-established reconstructive technique described initially for hand defect coverage by McGregor and Jackson in 1972. A reoperation rate of 6.2% was reported due to wound complications in the vulvo-perineal and inguinal areas with SCIP flaps compared with 69% for gluteal thigh flaps and 25% with VY flaps respectively.[5] Donor site mortality is also greatly reduced in SCIP flaps compared to alternatives such as DIEP and TRAM flaps.[2] In keeping with the literature, our patient had an uncomplicated post-operative course with no flap or donor site wound healing issues. [Extracted from the article]

Summary: Presented here is a very rare and potentially life‐threatening complication of a very common procedure. Vascular injury with traumatic pseudoaneurysm following BMAT in a paediatric patient has only been reported once in the literature to the best of our knowledge. Presented here is a second case, with pathognomonic imaging findings on CT that underwent successful coil embolisation. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate whether the cause of uremia is associated with degree of calcification, and to report the proportion excluded from kidney transplantation due to iliac artery calcification. Method: We enrolled 306 patients with a pre‐transplant computed tomography scan who went through the comprehensive assessment program in 2013–2015. Calcification score was measured for each iliac artery segment and patient records viewed for a variety of variables. Interobserver variation was assessed for 135 paired observations. Results: The patients' mean age was 55.5 years. Of the 306 patients, 133 did not undergo transplantation, and for 21 of these, heavy calcification was the primary explanation for this. External iliac artery calcification was positively associated with male sex, age, systolic blood pressure, diabetes and cardiovascular disease, and differed significantly among the causes of uremia subgroups; the least calcification was seen in patients with autoimmune causes, and the highest in those with diabetic causes. Similarly, the proportion of patients who underwent renal transplantation differed significantly with regard to causes of uremia (ranging from 72.3% for autoimmune disease to 40.6% for diabetic nephropathy). Conclusion: The degree of iliac artery calcification differs according to the cause of uremia and influences the likelihood of receiving a kidney transplantation. [ABSTRACT FROM AUTHOR]

The ankle‐brachial index is an accurate tool for detecting claudication in atherosclerotic patients. However, this technique fails to identify subtle flow limitations of the iliac arteries (FLIA) in endurance athletes. Near‐infrared spectroscopy (NIRS) is a noninvasive technique that measures skeletal muscle tissue oxygenation status. The aim of the present study is to examine the absolute and relative test–retest reliability of NIRS and evaluate its potential as a diagnostic tool in FLIA. NIRS‐derived exercise variables were analyzed during exercise and recovery in FLIA 17 patients and 19 healthy controls. The relative reliability of absolute variables (such as the maximal value) were slight to yet predominantly substantial (intraclass correlation coefficient [ICC], ICC range: 0.06–0.76) with good to excellent absolute reliability (absolute limits of agreement [ALoA], ALoA range: 0.8 ± 10.2 to 0.7 ± 13.1; coefficient of variation [CV], CV range: 5%–11%). Absolute values encompassing signal amplitudes showed moderate to almost perfect relative reliability (ICC range: 0.51–0.89) and poor to good absolute reliability (ALoA range: −1.3 ± 7.0 to −2.5 ± 15.7; CV range: 15%–32%). Kinetic variables showed moderate to almost perfect relative reliability for most recovery kinetics variables (ICC range: 0.54–0.86) with fair to good absolute reliability (ALoA range: 0.4 ± 12.2 to 3.9 ± 37.9; CV range: 18%–27%). Particularly, kinetic variables showed significant differences between patients and healthy subjects. NIRS is found to be a reliable method for examining muscle tissue oxygenation variables. Given the significant differences in especially recovery kinetics between normal subjects and patients, NIRS may contribute to diagnosing FLIA in endurance athletes. [ABSTRACT FROM AUTHOR]

Background: To evaluate patients undergoing a new procedure, iliac vascular transposition, in pancreas transplantation regarding the risk of thrombosis and graft survival without heparin-based anticoagulation therapy. Methods: Iliac vascular transposition (IVT) involves changing the positions of the external iliac artery and vein relative to each other. In this study, this technique was evaluated in patients undergoing the procedure compared with patients not undergoing the procedure (iliac vascular parallel (IVP) group). Results: No patients received prophylactic heparin therapy. Two patients in the IVP group (n = 26) developed complete thrombosis and six developed partial thrombosis, compared with no patients with complete thrombosis and one with partial thrombosis in the IVT group (n = 29). The cumulative incidence of thrombosis was significantly higher in the IVP group (p < 0.01). Cox regression revealed that not receiving iliac vascular transposition was the only significant risk factor for thrombosis (odds ratio: 10.1, 95% confidence interval: 1.27–81.2; p = 0.03). One-year graft survival was significantly better in the IVT group vs IVP group (p = 0.03). Conclusions: IVT in pancreas transplantation is a simple technique that results in a lower thrombosis risk and better graft survival rates without heparin-based anticoagulation therapy. [ABSTRACT FROM AUTHOR]

Immunoglobulin G4‐related disease (IgG4‐RD) is a fibro‐inflammatory condition that can affect many organs, either simultaneously or metachronously. In recent years, IgG4‐related vascular complications of larger arteries such as the aorta and iliac arteries have been increasingly identified. Among vascular complications, coronary artery involvement in the forms of either periarteritis or coronary artery aneurysms (CAAs) has also been reported; however, are very rare in comparison. This case report presents a rare case of a sudden death due to occlusive thrombosis of IgG4‐related giant CAAs measuring up to 10 cm in diameter, demonstrates their possible clinical progression, and shows how they can distort normal anatomy which may then pose challenges in the interpretation of postmortem‐computed tomography scans. It also briefly discusses the diagnosis of IgG4‐RD in arteries, both clinically and in the postmortem setting. [ABSTRACT FROM AUTHOR]

Objective: To analyze and classify arterial supply and venous drainage of postcatheterization femoral arteriovenous fistulas (AVFs). Methods: A review of extremity Doppler reports identified 77 femoral AVFs in 75 patients. Doppler exams were reviewed retrospectively. Fistulas were classified as above or below the common femoral artery bifurcation and subclassified based on the location of arterial inflow and venous outflow. Results: Arterial inflow originated above the femoral bifurcation in 32 cases. The communication was between the common femoral artery and the superficial circumflex iliac vein in 25 of 32 cases and between a branch of the common femoral or external iliac artery and the common femoral or external iliac vein in 4 of 32 cases. In 3 of 32 cases, AVFs arose from the common femoral artery, but the venous outflow was not determined. Arterial inflow originated from the superficial femoral artery in 23 cases. Venous outflow originated from the common femoral vein in 10 of 23 cases, the femoral vein in 7 of 23 cases, and the lateral circumflex femoral vein in 6 of 23 cases. Arterial inflow originated from the deep femoral artery in 12 cases. Venous outflow originated from the common femoral vein in 6 of 12 cases and from the lateral circumflex femoral vein 6 of 12 cases. In 8 cases, the AVF originated below the bifurcation, but the arterial inflow was not classified. In 2 cases, it was impossible to determine if the AVF originated above or below the bifurcation. Conclusions: Iatrogenic femoral AVFs arise above the femoral bifurcation more often than previously recognized. Classification based on the arterial inflow and venous outflow provides a straightforward means of describing these fistulas. [ABSTRACT FROM AUTHOR]

Computational Fluid Dynamics (CFD) and time‐resolved phase‐contrast magnetic resonance imaging (PC‐MRI) are potential non‐invasive methods for the assessment of the severity of arterial stenoses. Fractional flow reserve (FFR) is the current "gold standard" for determining stenosis severity in the coronary arteries but is an invasive method requiring insertion of a pressure wire. CFD derived FFR (vFFR) is an alternative to traditional catheter derived FFR now available commercially for coronary artery assessment, however, it can potentially be applied to a wider range of vulnerable vessels such as the iliac arteries. In this study CFD simulations are used to assess the ability of vFFR in predicting the stenosis severity in a patient with a stenosis of 77% area reduction (>50% diameter reduction) in the right iliac artery. Variations of vFFR, overall pressure drop and flow split between the vessels were observed by using different boundary conditions. Correlations between boundary condition parameters and resulting flow variables are presented. The study concludes that vFFR has good potential to characterise iliac artery stenotic disease. [ABSTRACT FROM AUTHOR]

Background: Internal iliac artery aneurysms (IIAA) are uncommon. Open repair is technically challenging and has been associated with increased morbidity and mortality compared with repair of abdominal aortic aneurysms. The aim of this study is to assess the outcomes of endovascular treatment of IIAA and incidence of postoperative pelvic ischaemia. Methods: A single-centre retrospective analysis was performed for IIAAs treated with endovascular repair between January 2005 and December 2017. Aneurysm morphology, mode of presentation and operative technique were evaluated. Primary outcomes were 30-day mortality and incidence of pelvic ischaemia. Secondary outcomes were technical success, major complications and reintervention. Results: Twenty-nine IIAAs were treated in 23 patients with a mean age of 74 */- 9 years. Six patients had isolated IIAAs (26%); the remaining 17 patients had aortoiliac aneurysms. Five patients (22%) required emergent repair for ruptured IIAAs. Mean IIAA size was 4.1 cm */- 1.8 and ruptures occurred at mean 6.1 cm */- 2.6. Endovascular techniques used: stent graft occlusion of the internal iliac artery (IIA) ostium (n = 16), deployment of iliac branch device (n = 9), and other endovascular techniques (n = 4). The 30-day mortality was zero. Three patients (13%) experienced post-operative pelvic ischemia which were all minor chronic gluteal claudication after IIA occlusion. Primary technical success was achieved in 27 repairs (93%). There was one late reintervention (3%). Conclusion: IIAAs are often asymptomatic and diagnosed incidentally, however, a significant proportion present emergently. Endovascular treatment is feasible for both ruptured and non-ruptured aneurysms with low perioperative morbidity, mortality and reintervention rates. [ABSTRACT FROM AUTHOR]

Introduction: The transfusion rate in hysterectomies for benign pathology is almost 3%. However, despite the strong interest in reducing intraoperative bleeding, limited evidence is available regarding the technical aspects concerning uterine vessel management during a total laparoscopic hysterectomy (TLH). Uterine artery (UA) closure in TLH can be performed at the origin from the internal iliac artery or at the uterus level (UL). However, low‐quality evidence is available regarding the superiority of one method over the other. Material and methods: We performed a single‐blind randomized (1:1) controlled trial (NCT04156932) between December 2019 and August 2020. One hundred and eighty women undergoing TLH for benign gynecological diseases were randomized to TLH with UA closure at the origin from the internal iliac artery (n = 90), performed at the beginning of the procedure by putting two clips per side at the origin, vs closure at the UL (n = 90). Intraoperative blood loss estimated from suction devices was the primary outcome. Secondary end points were perioperative outcomes, the conversion rate from one technique to the other, and complication rates with 4 months of follow up. Results: Uterine artery closure at the origin was completed in all 90 patients (0%), whereas closure at the UL was converted to closure at the origin in 11 cases (12.2%; p < 0.001); failures were mainly associated with the presence of endometriosis (81.8% [9/11] vs 10.1% [8/79]; p < 0.001). In the intention‐to‐treat analysis, the intraoperative blood loss was higher in the group assigned to the closure at the UL (108.5 mL) than in the group with closure at the origin (69.3 mL); the mean difference was 39.2 mL (95% CI 13.47–64.93 mL; p = 0.003). Other perioperative outcomes and complications rates did not differ. Conclusions: Uterine artery closure at the origin reduces intraoperative blood loss during a TLH and appears to be more reproducible than closure at the UL without higher complication rates. However, the absent translation in clinical benefits impedes the support of a clinical superiority in all women. Closure at the origin may provide clinical advantages in the presence of severe preoperative anemia or pelvic anatomic distortion. [ABSTRACT FROM AUTHOR]

Non‐contrast pelvic computed tomography (CT) can detect severe iliac artery calcifications that present technical contraindications to kidney transplantation (TCT). We screened 454 asymptomatic patients with a history of any of the following: hemodialysis >10 years, diabetes mellitus >20 years, coronary artery disease (CAD) with percutaneous or surgical interventions, carotid disease, diabetes with below‐/above‐knee amputations, and heart‐kidney transplantation candidacy. Patients with normal dorsalis pedis and/or tibialis posterior pulses were not screened. A total of 8.4% had severe calcifications with TCT; CT determined laterality for implantation in 13.9%. No patients with the following characteristics were classified as TCT: age <40 years, hemodialysis >10 years, carotid arterial disease, prior lower extremity amputation, or heart‐kidney transplantation candidacy. CAD was associated with TCT in univariate though not multivariate analysis. Limiting screening to patients >40 years, with DM >20 years, or with CAD, 9.8% had a TCT and CT determined transplant laterality in 14.2%. Screening for severe iliac artery calcifications is useful for selected kidney transplantation candidates over age 40. It can assist with laterality choice or surgeon determination of TCT. Cost and radiation exposure risks should be weighed against the morbidity risks from unnecessary surgery. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present paper was to evaluate the safety and clinical efficacy of mini‐open retroperitoneal oblique lumbar interbody fusion (OLIF) for the treatment of lumbar spinal tuberculosis. Methods: A total of 115 patients who suffered from lumbar spinal tuberculosis from June 2014 to December 2017 were included in this research. A total of 59 patients underwent OLIF and percutaneous pedicle screw fixation (OLIF group) and 56 patients underwent the anterior‐only approach (anterior‐only group). All patients were followed up for at least 24 months. Operation time, blood loss, and rate of complications were used to assess the safety of these two techniques. The visual analog scale (VAS) and the Oswestry disability index (ODI) were used to evaluate the relief of neurological and functional symptoms. The erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP) were measured to investigate the activity and recurrence of spinal tuberculosis. The Cobb angle, the sagittal vertical axis of the spine (SVA), the pelvic tilt (PT), the sacral slope (SS), the pelvic incidence (PI), and postoperative Frankel classification were also used to assess the efficiency of the spine deformity correction and the recovery of long‐term neurological function. Results: Most patients were successfully treated with OLIF and the anterior‐only technique and attained satisfactory clinical efficiency during the 24‐month follow‐up period. In the perioperative period, the mean operative time (154.68 ± 23.64 min, P < 0.001), the mean blood loss (110.57 ± 87.67 mL, P < 0.001), and the mean hospital stay (9.55 ± 3.62 days, P < 0.001) of the OLIF group were all significantly lower than in the anterior‐only group (172.49 ± 25.67 min, 458.56 ± 114.89 mL, and 14.89 ± 3.89 days, respectively). A total of 10 patients (16.95%) experienced complications in the OLIF group, including neurological injury, segmental artery and iliac vein lacerations, peritoneal injury, instrument failure, and infection of incisions; this rate of complications was lower than in the anterior‐only group (37.50%, P = 0.013). Regard to spinal deformity correction, the Cobb angle (9.42° ± 1.72°, P = 0.032), the SVA (2.23 ± 1.07 cm, P = 0.041), the PT (14.26° ± 2.37°, P = 0.037), and the SS (39.49° ± 2.17°, P = 0.042) of the OLIF group at last follow‐up were all significantly different when compared to the anterior‐only group (14.75° ± 2.13°, 3.48 ± 0.76 cm, 18.58° ± 1.45°, and 36.78° ± 1.96°, respectively). The VAS and the ODI of the OLIF group at 1 week postoperatively (3.15 ± 0.48, 21.85 ± 3.78, P = 0.032, 0.037) and at the last follow‐up (2.12 ± 0.35, 16.70 ± 5.25, P = 0.043, 0.035) were both lower than for the anterior‐only group (5.18 ± 0.56, 29.83 ± 5.42 and 3.67 ± 0.62, 20.68 ± 6.23). The Frankel classification was improved for both OLIF and anterior‐only patients; however, there were 35 cases (59.32%) classified as Frankel grade E in the OLIF group and 22 cases (39.29%, P = 0.021) in the anterior‐only group Conclusion: The OLIF surgical technique for single lumbar (L2–L5) spinal tuberculosis is less invasive, has lower complication rates, and is more efficient than the anterior‐only approach. However, the long‐term effects of this surgical technique still need to be explored. [ABSTRACT FROM AUTHOR]

We theorize that the ruptured angioplasty balloon has migrated distally from the right common iliac artery to the bifurcation of the right common femoral artery, or the separation event has occurred at the right common femoral artery as the angioplasty balloon has been removed from the patient. A longitudinal arteriotomy of the right common femoral artery was performed, revealing occlusive thrombus surrounding a ruptured angioplasty balloon (Fig. A 74-year-old man presented to the vascular surgery outpatient clinic with worsening right leg claudication, rest pain and paraesthesia 4 months post bilateral external iliac angioplasty, and stenting using a BIOTRONIK Passeo-35 9/40/80 angioplasty balloon was performed by our interventional radiology department (Fig. [Extracted from the article]

Introduction: Placenta accreta spectrum (PAS) carries a high burden of adverse maternal outcomes, especially significant blood loss, which can be life-threatening. Different management strategies have been proposed but the association of clinical risk factors and surgical management options during cesarean delivery with high blood loss is not clear.Material and Methods: In this international multicenter study, 338 women with PAS undergoing cesarean delivery were included. Fourteen European and one non-European center (USA) provided cases treated retrospectively between 2008 and 2014 and prospectively from 2014 to 2019. Peripartum blood loss was estimated visually and/or by weighing and measuring of volume. Participants were grouped based on blood loss above or below the 75th percentile (>3500 ml) and the 90th percentile (>5500 ml).Results: Placenta percreta was found in 58% of cases. Median blood loss was 2000 ml (range: 150-20 000 ml). Unplanned hysterectomy was associated with an increased risk of blood loss >3500 ml when compared with planned hysterectomy (adjusted OR [aOR] 3.7 [1.5-9.4], p = 0.01). Focal resection was associated with blood loss comparable to that of planned hysterectomy (crude OR 0.7 [0.2-2.1], p = 0.49). Blood loss >3500 ml was less common in patients undergoing successful conservative management (placenta left in situ, aOR 0.1 [0.0-0.6], p = 0.02) but was more common in patients who required delayed hysterectomy (aOR 6.5 [1.7-24.4], p = 0.001). Arterial occlusion methods (uterine or iliac artery ligation, embolization or intravascular balloons), application of uterotonic medication or tranexamic acid showed no significant effect on blood loss >3500 ml. Patients delivered by surgeons without experience in PAS were more likely to experience blood loss >3500 ml (aOR 3.0 [1.4-6.4], p = 0.01).Conclusions: In pregnant women with PAS, the likelihood of blood loss >3500 ml was reduced in planned vs unplanned cesarean delivery, and when the surgery was performed by a specialist experienced in the management of PAS. This reinforces the necessity of delivery by an expert team. Conservative management was also associated with less blood loss, but only if successful. Therefore, careful patient selection is of great importance. Our study showed no consistent benefit of other adjunct measures such as arterial occlusion techniques, uterotonics or tranexamic acid. [ABSTRACT FROM AUTHOR]

A 37‐year‐old pregnant woman who had undergone three previous cesarean sections was diagnosed as having placenta percreta. We decided to perform cesarean hysterectomy with bilateral common iliac artery balloon occlusion (CIABO). The duration of surgery was 2 h and 2 min and total estimated blood loss was 2600 mL. Surgery was completed without any surgical complications, but the pulse oximeter waveform of the left leg became undetectable during surgery. We immediately performed angiography after closure of laparotomy and found abnormal pooling of contrast media at the left common iliac artery in the region in which the balloon was positioned. We made a diagnosis of left common iliac artery dissection caused by CIABO. We performed emergent revascularization by intravascular stenting. We conclude that CIABO can cause common iliac artery dissection by mechanical stimulation of the inflated balloon. Careful intraoperative evaluation of limb ischemia and preparation of intravascular treatment is needed for a safe procedure. [ABSTRACT FROM AUTHOR]