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Traditional open surgery of the abdominal aorta and iliac segment is a surgical intervention with a relatively high risk and well-studied perioperative mortality. Over the last decade, there has been a constantly growing trend to reduce surgical trauma in the treatment of vascular diseases. The right choice of a vascular approach is crucial for the success of every open aorto-iliac vascular reconstruction. The mini-invasive vascular approaches offer significant advantages over classic surgery and are associated with better perioperative results. [ABSTRACT FROM AUTHOR]

Background: The management of pediatric trauma with trans-arterial embolization is uncommon, even in level 1 trauma centers; hence, there is a dearth of literature on this subject compared to the adult experience. Objective: To describe a single-center, level 1 trauma center experience with arterial embolization for pediatric trauma. Materials and methods: A retrospective review was performed to identify demographics, transfusion requirements, pre-procedure imaging, procedural details, adverse events, and arterial embolization outcomes over a 19-year period. Twenty children (age 4.5 months to 17 years, median 13.5 years; weight 3.6 to 108 kg, median 53 kg) were included. Technical success was defined as angiographic resolution of the bleeding-related abnormality on post-embolization angiography or successful empiric embolization in the absence of an angiographic finding. Clinical success was defined as not requiring additional intervention after embolization. Results: Seventy-five percent (n=15/20) of patients required red blood cell transfusions prior to embolization with a mean volume replacement 64 ml/kg (range 12–166 ml/kg) and the median time from injury to intervention was 3 days (range 0–16 days). Technical success was achieved in 100% (20/20) of children while clinical success was achieved in 80% (n=16/20). For the 4 children (20%) with continued bleeding following initial embolization, 2 underwent repeat embolization, 1 underwent surgery, and 1 underwent repeat embolization and surgery. Mortality prior to discharge was 15% (n=3). A post-embolization mild adverse event included one groin hematoma, while a severe adverse event included one common iliac artery pseudoaneurysm requiring open surgical ligation. Conclusions: In this single-center experience, arterial embolization for hemorrhage control in children after trauma is feasible but can be challenging and the clinical failure rate of 20% in this series reflects this complexity. Standardization of pre-embolization trauma assessment parameters and embolic techniques may improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: Endovascular aneurysm repair is well established as the gold standard in treating abdominal aortic aneurysms. Generally, endovascular repair is performed using a bi or trimodular stent graft, requiring placement of a contralateral iliac limb. Deployment of the contralateral iliac limb requires retrograde gate cannulation of the endograft main body contralateral limb. This step represents the crucial point of a standard endovascular repair procedure and can become challenging, especially in the case of high iliac tortuosity. This study compares the procedural times between the retrograde gate cannulation and the contralateral snare cannulation to demonstrate the possibility of directly performing the contralateral snare cannulation in the case of a complex iliac anatomy assessed by the iliac tortuosity index. Methods: One hundred and forty-eight patients with infrarenal abdominal aortic aneurysms who underwent endovascular aneurysm repair from 2017 to 2022 were analyzed retrospectively. Cannulation times between retrograde gate cannulation and contralateral snare cannulation were compared for each degree of iliac tortuosity. The degree of iliac tortuosity was assessed through the iliac tortuosity index. Cannulation times were detected from inserting the wire into the introducer to passing through the radio-opaque gate markers. Results: The cannulation times were 2.94 min for the retrograde gate cannulation group and 3.15 min for the contralateral snare cannulation group, respectively, with no statistically significant differences (p = 0.33). Overall cannulation times were 2.98 min. For the iliac tortuosity index grade 0, the cannulation times were 2.71 min for the retrograde gate cannulation group and 3.85 min for the contralateral snare cannulation group, respectively, with a significant difference in favor of the retrograde gate cannulation group (p < 0.0001). For the iliac tortuosity index grade 1, the cannulation times were 2.74 min for the retrograde gate cannulation group and 2.8 min for the contralateral snare cannulation group, respectively, with no statistically significant differences (p = 0.63). Regarding the iliac tortuosity index grades 2 and 3, the cannulation times were 3.01 and 4.93 min for the retrograde gate cannulation group and 2.71 and 3.28 min for the contralateral snare cannulation group, respectively. The first group's times were significantly higher than the second group's (p = 0.01 and p = 0.0001). Conclusions: In patients with infrarenal abdominal aortic aneurysms undergoing endovascular aortic repair, the gate cannulation times were significantly shorter for the contralateral snare cannulation method than the retrograde gate cannulation method in the iliac tortuosity index grades 2 and 3. Therefore, performing the contralateral snare cannulation method would be appropriate. [ABSTRACT FROM AUTHOR]

Background: The increased life expectancy and accompanying comorbidities of elderly patients is in- creasing the need for composite soft tissue defect reconstruction. Since its introduction in 2004, the superficial circumflex iliac artery perforator (SCIP) flap has become popular among reconstructive surgeons for its various advantages. We describe our experience of free SCIP flap reconstruction in geriatric patients and examine its versatility in a literature review. Methods: Between 2018 and 2022, 19 geriatric patients (12 males, 7 females; 65--82 years old) under- went free SCIP flap transfer for reconstruction. The locations of the defects were all over the body area, from the trunk to the extremities. Patient perioperative demographic data are listed, along with surgical outcomes and complications. Results: In our experience, only one of 19 free SCIP flaps failed (total skin flap necrosis), presenting an overall flap survival rate of 94.7%. Partial flap loss was noted in 2 cases, which could be managed by other minor operations. Over at least 6 months of follow-up, all surviving flaps showed good contour and minimal donor site morbidity. Conclusion: The success rate was high and remained stable over time in geriatric patients managed with free SCIP flap reconstruction. The appearance of recipient and donor sites was optimal. With reduced donor site morbidity, we believe that the free SCIP flap will become a popular option for composite soft tissue defect coverage in the elderly. [ABSTRACT FROM AUTHOR]

Background In its normal anatomical relationship, the inferior vena cava is located on the right side of the abdominal aorta. Iliac vein compression syndrome (IVCS) is a pathological condition in which a blood clot is formed due to blood flow obstruction when the left common iliac vein is compressed between the right common iliac artery and the vertebral body. Therefore, right-sided IVCS (RIVCS) is rare. The effectiveness of treatment for RIVCS has not been sufficiently investigated. Case summary A 51-year-old man developed deep vein thrombosis in the right lower extremity and non-massive pulmonary embolism during steroid treatment for IgA nephropathy. Magnetic resonance angiography (MRA) suggested iliac compression syndrome. Symptoms improved with the use of direct oral anticoagulants and compression stockings. At the 8-month follow-up, the clinical course was uneventful. Discussion The causes of RIVCS in this case are believed to be the effects of steroids, prolonged sitting, and compression of the right external iliac vein. However, considering that deep vein thrombosis did not form in the left lower limb where there was no venous compression, it can be considered that the compression of the right external iliac vein had a significant impact. This case has been followed up for 8 months with anticoagulants and is progressing well. This is the first case to report the course of RIVCS treated conservatively with anticoagulant therapy for 8 months. This case suggested that conservative treatment is effective for RIVCS. [ABSTRACT FROM AUTHOR]

Purpose: To report technical feasibility and clinical efficacy of iliac vein stent placement in adolescent patients with May–Thurner Syndrome (MTS). Materials and Methods: Single-institution retrospective review of the medical record between 2014 and 2021 found 63 symptomatic patients (F = 40/63; mean age 16.1 years, 12–20 years) who underwent left common iliac vein (LCIV) stent placement for treatment of LCIV compression from an overriding right common iliac artery, or equivalent (n = 1, left IVC). 32/63 (50.7%) patients presented with non-thrombotic iliac vein lesions (NIVL). 31/63 (49.2%) patients presented with deep vein thrombosis of the lower extremity and required catheter-directed thrombolysis after stent placement (tMTS). Outcomes include technically successful stent placement with resolution of anatomic compression and symptom improvement. Stent patency was monitored with Kaplan–Meier analysis at 3, 6, 12, 24, and 36 months. Anticoagulation and antiplatelet (AC/AP) regimens were reported. Results: Technical success rate was 98.4%. 74 bare-metal self-expanding stents were placed in 63 patients. Primary patency at 12, and 24-months was 93.5%, and 88.9% for the NIVL group and 84.4% and 84.4% for the tMTS group for the same period. Overall patency for the same time intervals was 100%, and 95.4% for the NIVL group and 96.9%, and 96.9% for the tMTS group. Procedural complication rate was 3.2% (2/63) with no thrombolysis-related bleeding complications. Clinical success was achieved in 30/32 (93.8%) and 29/31 (93.5%) patients with tMTS and NIVL groups, respectively. Conclusion: CIV stent placement in the setting of tMTS and NIVL is technically feasible and clinically efficacious in young patients with excellent patency rates and a favorable safety profile. [ABSTRACT FROM AUTHOR]

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Background. Aortic dissection (AD) is a rare but serious medical emergency where the aorta's inner layer tears. Females are less likely to develop it than males, and AD cases with unusual symptoms can be hard to diagnose. Diagnosing AD can be further complicated as its symptoms and electrocardiogram (ECG) changes can mimic acute coronary syndrome, and it is challenging to distinguish it without risk factors. Case Report. This case report describes a 60-year-old female patient who presented with unusual symptoms, including pain in her chest, neck, left arm, and lower extremities. An electrocardiogram (ECG) revealed ST elevation in leads aVR and V1, as well as severe ST depression and T wave inversion in the inferior and lateral leads, which can mimic acute coronary syndrome. Despite initial treatment with nitroglycerin, the patient's pain worsened, and a CT angiography revealed type A aortic dissection extending from the aortic root to the right external iliac artery. Immediate surgery was recommended, which significantly improved the patient's condition. Conclusions. Be aware of aortic dissection and its symptoms, even if there are no risk factors or recognizable symptoms. Consider aortic dissection as a potential diagnosis if ECG changes are present. Ongoing education can help decrease mortality and increase awareness. [ABSTRACT FROM AUTHOR]

Leiomyosarcoma (LMS) is an uncommon and aggressive form of cancer that originates in the smooth muscles. It possesses the capacity for rapid growth and often manifests with general, nonspecific symptoms arising from the displacement of nearby structures rather than direct invasion. In this particular instance, an 81-year-old woman presented with right lower abdominal pain, leading to the discovery of a mass adjacent to the right external iliac artery. In this case, the patient was misdiagnosed initially because of her nonspecific and poorly distinguished clinical symptoms. The laboratory results were within normal ranges. A well-defined tumor was detected through laparoscopic operation and subsequently surgically excised. The histopathological analysis of the tumor revealed the presence of malignant spindle cells, nuclear pleomorphism, and tumor giant cells. Immunohistochemistry tests indicated positive results for CD34 and Desmin, while CD117 and DOG1 showed adverse effects. It is worth noting that LMS of the right external iliac artery is an infrequent occurrence, potentially resulting in delayed diagnosis and misidentification. To enhance our comprehension of this uncommon cancer, more cases with detailed information are essential. [ABSTRACT FROM AUTHOR]

Quantum pharmacology introduces theoretical models to describe the possibility of ultra-high dilutions to produce biological effects, which may help to explain the placebo effect observed in hypertensive clinical trials. To determine this within physiology and to evaluate novel ARBs, we tested the ability of known angiotensin II receptor blockers (ARBs) (candesartan and telmisartan) used to treat hypertension and other cardiovascular diseases, as well as novel ARBs (benzimidazole-N-biphenyl tetrazole (ACC519T), benzimidazole-bis-N,N′-biphenyl tetrazole (ACC519T(2)) and 4-butyl-N,N0-bis[[20-2Htetrazol-5-yl)biphenyl-4-yl]methyl)imidazolium bromide (BV6(K+)2), and nirmatrelvir (the active ingredient in Paxlovid) to modulate vascular contraction in iliac rings from healthy male New Zealand White rabbits in responses to various vasopressors (angiotensin A, angiotensin II and phenylephrine). Additionally, the hemodynamic effect of ACC519T and telmisartan on mean arterial pressure in conscious rabbits was determined, while the ex vivo ability of BV6(K+)2 to activate angiotensin-converting enzyme-2 (ACE2) was also investigated. We show that commercially available and novel ARBs can modulate contraction responses at ultra-high dilutions to different vasopressors. ACC519T produced a dose-dependent reduction in rabbit mean arterial pressure while BV6(K+)2 significantly increased ACE2 metabolism. The ability of ARBs to inhibit contraction responses even at ultra-low concentrations provides evidence of the existence of quantum pharmacology. Furthermore, the ability of ACC519T and BV6(K+)2 to modulate blood pressure and ACE2 activity, respectively, indicates their therapeutic potential against hypertension. [ABSTRACT FROM AUTHOR]

Background: The anterolateral thigh (ALT) free flap is commonly used for complex lower limb reconstruction. Recently, other thin perforator flaps—such as the thin-ALT flap and the superficial circumflex iliac artery perforator (SCIP) flap—have become increasingly utilized in this indication. There is limited evidence examining the performance of these thin suprafascial flaps to the standard ALT flap. We aim to systematically review the literature, assessing the survival and complication rates of the standard ALT, thin-ALT, and SCIP flaps in lower limb reconstruction. Methods: Following PRISMA guidelines, we systematically searched BIOSIS®, PubMed®, Cochrane Library®, Embase®, MEDLINE®, and Web of Science® on Jan. 27, 2021. Only primary English studies published in peer-reviewed scientific journals and that explored lower limb reconstruction were included. Results: We included 68 studies, comprising 1652 standard ALT, 187 thin-ALT, and 129 SCIP flaps. Thin-ALT flaps demonstrated significantly lower rates of full flap failure (0.6%, N = 1/187) compared to standard ALT flaps (3.9%, N = 64/1652). Thin-ALT and SCIP flaps have been more frequently used in foot reconstruction (47.6%, N = 50/105; 82.9%, N = 29/35 respectively), whereas standard ALT flaps have been more frequently used in leg (43.0%, N = 182/423) and trauma-related reconstructions (84.3%, N = 334/396). Thin-ALT and SCIP flaps have a smaller mean surface area, as well as significantly lower rates of thinning (6.2%, N = 5/80; 4.5%, N = 5/112, respectively) compared to standard ALT flaps (26.1%, N = 43/165). Conclusions: Thin-ALT and SCIP flaps demonstrate low rates of flap failure and secondary complications that are comparable to standard ALT flaps. Thin-ALT and SCIP flaps are viable options for complex lower extremity reconstruction. Level of evidence: Not gradable [ABSTRACT FROM AUTHOR]

Background: The superficial circumflex iliac artery (SCIA) perforator flap needs meticulous dissection because of anatomical variations. These variations of the SCIA allow the flap to be used in different parts of the body for different purposes. The aim of this study is to evaluate the versatility of using the SCIP flap in the reconstruction of composite defects in the upper and lower extremities. Methods: Between 2017 and 2021, twenty-nine patients who had undergone reconstruction with SCIP flap and whose defects were located in the lower and upper extremities were included. Results: The location of the defect was in the lower extremity in nine of the patients, and the upper extremity in twenty of the patients. The flap was raised from the superficial branch in thirteen of the patients, the deep branch in five of the patients, and the main trunk in eleven of the patients. The chimeric flap concept included both fascia and bone tissue other than the skin. Complications occurred in seven of the patients. Bone tissue loss occurred in one patient due to a perforator kink. Partial necrosis was encountered in four flaps, with two flaps failing, so the survival rate was 93.1%. Conclusions: Although the SCIA has numerous anatomical variations, bringing certain difficulties, these variations can become an advantage when the anatomy of this region and microsurgical techniques are mastered. With the proximal to distal freestyle technique, the branch with sufficient calibration and pulsation can be safely selected from the superficial branch or deep branch. Level of evidence: Level IV, Therapeutic [ABSTRACT FROM AUTHOR]

Oncovascular surgery (the removal of major blood vessels infiltrated by cancer) is challenging but can be key to achieve complete cytoreduction in patient with advanced ovarian cancer. The aim of this study was to review the literature on oncovascular surgery in ovarian cancer and to report the details of all the cases performed at our institution. We retrospectively reviewed the database of ovarian cancer patients who underwent debulking surgery at the Department of Obstetrics and Gynecology of Verona University between January 2021 and 2023. Patients with at least one major vessel resection during cytoreduction were identified. We then systematically review the literature searching Pubmed and Embase from inception to January 2023 to report all cases of surgery for ovarian cancer with concomitant major vessel resection. Five patients with advanced/recurrent ovarian cancer underwent major vascular resection at our institution. Vascular involvement was preoperatively identified in all cases and no case of vascular resection was performed after accidental injury. The major vessels removed were the inferior vena cava (n = 2), the common iliac veins (n = 2), the external iliac arteries (n = 2), the left common iliac artery (n = 1), and the left external iliac vein (n = 1). All patients underwent other non-gynecological cytoreductive procedures prior to vessel removal and had R0 obtained. Three (60%) patients experienced one or more postoperative complications. The literature search identified a total of seven cases of major vessels resection in ovarian cancer surgery. A single or multiple major vessels were removed in two (28.6%) and five (72.4%) cases, respectively. All the seven patients underwent vascular reconstruction. Four (57.1%) patients reported postoperative complications. Overall, 66.7% of the 12 total identified patients were free from disease at the last follow-up [median 15.5 months (range 5–25)]. Oncovascular surgery is feasible in selected patients with ovarian cancer, provided that a multidisciplinary approach with customized care is available. • Oncovascular surgery is the removal of major blood vessels infiltrated by cancer. • It can be key to achieve complete cytoreduction in advanced ovarian cancer. • It seems to be feasible when performed by a multidisciplinary team of experts. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of an anomalous common iliac artery (CIA) arising from the aorta as the fourth lumbar artery (4th LA) and following a retro-psoas course as the continuation of the 4th LA. Methods: Contrast-enhanced abdominopelvic computed tomography (CT) findings of an incidentally detected anomalous CIA are described in an 8-year-old girl. Case report: CT showed that the right CIA originated from the distal aorta at the L3–L4 level with an acute angle and continued posteriorly in the course of the 4th LA. The right CIA descended into the iliac fossa as a single artery, lying posterior to the psoas muscle. It gave off the internal iliac artery (IIA) low in the iliac fossa and continued as the external iliac artery (EIA). The median sacral artery (MSA) originated from the left proximal CIA and joined the posterior division of the right IIA. Discussion: Fourth LA continuation of the CIA is a rare vascular anomaly with a few published reports to date. The anomaly occurs far more on the right side than the left and is mostly asymptomatic. An abnormal connection between the umbilical artery and the distal aorta probably results in this anomaly, as well as in another group of CIA anomalies that are characterized by the absence of one or two CIAs with trifurcation or quadrifurcation of the distal aorta. Conclusion: Although the vascular anomaly is mostly asymptomatic, knowledge of it is important in the interventions of the area to prevent complications. [ABSTRACT FROM AUTHOR]

Simple Summary: Near-infrared indocyanine green (ICG)-enhanced fluorescence has been advocated as a reliable real-time technique to assess bowel perfusion during anastomosis formation in colorectal surgery. However, to date, no standardized protocols nor a quantitative imaging assessment are available. The aim of this study was to evaluate the timing of fluorescence as a reproducible, cost-effective parameter and its efficacy in predicting anastomotic leakage. The authors confirmed that patients with a longer perfusion timing, identified as delta timing, are at risk of developing anastomotic leakages. Furthermore, a real-time evaluation of a delta-timing/heart rate interaction provided a sensitive cut-off value to predict anastomotic leakage. The analysis of the timing of fluorescence can be easily applied during intraoperative ICG-enhanced fluorescence and may be used as a quantitative, objective parameter to guide surgical decision making. Background: To date, no standardized protocols nor a quantitative assessment of the near-infrared fluorescence angiography with indocyanine green (NIR-ICG) are available. The aim of this study was to evaluate the timing of fluorescence as a reproducible parameter and its efficacy in predicting anastomotic leakage (AL) in colorectal surgery. Methods: A consecutive cohort of 108 patients undergoing minimally invasive elective procedures for colorectal cancer was prospectively enrolled. The difference between macro and microperfusion (ΔT) was obtained by calculating the timing of fluorescence at the level of iliac artery division and colonic wall, respectively. Results: Subjects with a ΔT ≥ 15.5± 0.5 s had a higher tendency to develop an AL (p < 0.01). The ΔT/heart rate interaction was found to predict AL with an odds ratio of 1.02 (p < 0.01); a cut-off threshold of 832 was identified (sensitivity 0.86, specificity 0.77). Perfusion parameters were also associated with a faster bowel motility resumption and a reduced length of hospital stay. Conclusions: The analysis of the timing of fluorescence provides a quantitative, easy evaluation of tissue perfusion. A ΔT/HR interaction ≥832 may be used as a real-time parameter to guide surgical decision making in colorectal surgery. [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]

A 28-day-old Holstein calf with astasia (i.e., right hind limb flaccid paralysis) was referred to Large Animal Veterinary Educational Center. Thoracic radiographs showed an alveolar pattern and air bronchograms indicating pneumonia, whereas skeletal radiography showed muscle atrophy of the right hind limb but no abnormalities in the coxofemoral and stifle joints. Contrastenhanced computed tomography revealed the pulmonary abscess in the right cranial pulmonary lobe and a thrombus (5 × 5 × 20 mm) in the right external iliac artery distal to the bifurcation of the abdominal aorta. These findings were confirmed via pathological examination. Streptococcus bovis/equinus complex colonies were isolated from the thrombus and pulmonary abscess. Thus, the pulmonary abscess was considered the infectious source of the thromboembolism in the right external iliac artery. Arterial thromboembolism should be included in the differential diagnoses in calves with astasia but without radiographic skeletal abnormalities. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the biomechanical behavior of three-dimensionally (3D)-printed surgical plates used for mandibular defect reconstruction, compare them with conventional surgical plates, and provide experimental evidence for their clinical application. Three-dimensional models were created for the normal mandible and for mandibular body defects reconstructed using free fibula and deep circumflex iliac artery flaps. Three-dimensional finite element models of reconstructed mandibles fixed using 3D-printed and conventional surgical plates were established. Vertical occlusal forces were applied to the remaining teeth and the displacement and Von Mises stress distributions were studied using finite element analysis. The normal and reconstructed mandibles had similar biomechanical behaviors. The displacement distributions for the surgical plates were similar, and the maximum total deformation occurred at the screw hole of the anterior segment of the surgical plates. However, there were differences in the Von Mises stress distributions for the surgical plates. In reconstructed mandibles fixed using 3D-printed surgical plates, the maximum equivalent Von Mises stress occurred at the screw hole of the posterior segment, while in those fixed using conventional surgical plates, the maximum equivalent Von Mises stress was at the screw hole of the anterior segment. In the mandible models reconstructed with the same free flap but fixed with different surgical plates, the plates had similar biomechanical behaviors. The biomechanical behavior of 3D-printed surgical plates was similar to conventional surgical plates, suggesting that 3D-printed surgical plates used to reconstruct mandibular body defects with vascularized autogenous bone grafts could lead to secure and stable fixation. [ABSTRACT FROM AUTHOR]

The present study was conducted to create reference values of common iliac arteries (CIA) for the diagnosis of vascular diseases such as aneurysm and atherosclerosis and to contribute to preoperative evaluation and the literature for open or endovascular interventions. Abdominal computed tomography angiography (CTA) images of 299 (156 F, 143 M) patients which were taken for various reasons at Gaziantep University Faculty of Medicine Hospital between 2015 and 2023 and which met the criteria were selected. The mean age of the patients included in the study was 49.85±18.74 years. Diameter measurements were made on two-dimensional images, while length and angle measurements were made on three-dimensional images. As a result of the analysis, the mean right CIA (RCIA) anteroposterior diameter was 1.12±0.66 cm and the mean transverse diameter was 1.21±0.74 cm; while the mean left CIA (LCIA) value was 1.12±0.68 cm in the anteroposterior axis and 1.13±0.73 cm in the transverse axis. In terms of length measurements, the mean right common iliac artery (RCIA) was found as 5.63±1.61 cm and the mean LCIA was found as 6.19±1.65 cm; in angle measurements of right and left CIA with the abdominal aorta (AA), mean RCIA was found as 23.3±9.84° and mean LCIA was found as 19.66±9.18°. While a significant difference was found between genders in terms of diameter values (p<0.05), no difference was found in length and angle values (p>0.05). In terms of correlations with age, correlation was found in diameter values of both sides and RCIA angle. It is thought that morphometric measurements of the common iliac arteries will contribute to interventional radiologists, vascular surgeons and the literature. [ABSTRACT FROM AUTHOR]

We present a case of deep vein thrombosis of the left lower limb secondary to May-Thurner syndrome in a 91-year-old woman. The diagnosis was made by computed tomography, which showed the focal, mildly dilated, distal right common iliac artery with eccentric mural thrombus compressing the proximal left common iliac vein. The patient was treated with oral rivaroxaban and subcutaneous therapeutic low molecular weight heparin. Invasive vascular intervention was deemed to be of limited value, as the patient was minimally symptomatic, of advanced age, with comorbidities, and with features of chronicity of the condition. [ABSTRACT FROM AUTHOR]

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. Abstract 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.

Successful endovascular aneurysm repair can be achieved with favorable aortic and iliac arterial anatomies. However, patients with challenging iliac anatomy, such as stenotic, calcified, tortuous arteries, or concomitant iliac artery aneurysms, are commonly encountered. Such a hostile iliac anatomy increases the risk of intraprocedural complications and worsens long-term outcomes. This review addresses various technical options for treating patients with a hostile iliac anatomy, including innovative endovascular solutions, physician-modified endografts, and hybrid procedures. These considerations demonstrate the wide scope of therapies that may be offered to patients with an unfavorable iliac anatomy.

Although uncommon, iatrogenic vascular injury (IVI) is a serious complication of laparoscopic surgery. We present a case review involving a laceration of the right common iliac artery (RCIA) during an elective laparoscopic gynecological procedure. We provide a detailed account of the diagnostic and therapeutic processes carried out by our team, culminating in a synthesis of recommendations based on the most recent evidence.

External iliac artery dissection is a rare and reversible but serious complication of renal transplant that may ultimately lead to loss of kidney and lower limb. The exact cause of dissection is not known but atherosclerosis, imperfect suturing techniques, and clamp trauma are associated with increased risk. Here, we report three successful cases of vascular repair of external iliac artery dissection during renal transplant by Dacron interposition graft and reanastomosis. [ABSTRACT FROM AUTHOR]

Stroke is one of the leading causes of mortality and morbidity. Aortic dissection is a highly mortal medical condition without treatment as well. Aortic dissection can present with different clinical signs and symptoms, one of which is stroke. Treatments of ischemic stroke and aortic dissection are different from each other. Because of that, early diagnosis and treatment of ischemic stroke due to aortic dissection is important. In this case, we aimed to explain a young male patient with a large ischemic stroke as a result of painless dissection and thrombus of the carotid arteries and painless dissection of the ascending and descending aorta, arcus aorta, and iliac artery. [ABSTRACT FROM AUTHOR]

Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate maternal outcome in placenta accrete spectrum with bilateral internal iliac artery ligation before and after obstetric hysterectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Kharian Pakistan, from Oct 2022 to Sep 2023. Methodology: Seventy patients enrolled in the study underwent peripartum hysterectomy. Bilateral Internal Iliac Ligation was performed before obstetrical hysterectomy in 40 patients of Group -1, whereas it was done after hysterectomy in 37 patients of Group-2. In all cases, the baby was delivered via classical caesarean section, with the placenta left in situ, followed by the closure of the uterine incision. The number of blood transfusions, Intensive care unit stay, post-operative haemoglobin level, post- operative recovery events, and duration of hospital stay, along with demographic details, were noted. Results: Out of 77 patients, the mean age of patients was 28.79±3.05. Most patients (n=36, 46.8%) had the previous three scars. Fifty-four cases (70.1%) had bladder injury involving mucosa. 22(28.6%) females had post- operative haemoglobin ≤7g/dl. Our study revealed statistically significant differences in the type of bladder injury (p=0.024) and post- operative severe anaemia, i.e. Hb≤7g/dl (p=0.006) among the two groups. Conclusion: Bilateral internal iliac artery ligation prior to obstetrical hysterectomy leads to a reduction in post-operative severe anaemia and mucosal involvement in bladder injury.

Purpose: Aortoiliac occlusive disease (AIOD) is widely prevalent and leads to severe claudication or chronic limb-threatening ischemia. Stent placement for AIOD demonstrated excellent outcomes in terms of long-term patency. However, iliac artery rupture is the most fearful complication during the aortoiliac stenting (AIS). This study aimed to evaluate the incidence and risk factors of iliac artery rupture during AIS. Materials and Methods: A retrospective review of consecutive patients with AIOD treated with AIS from 2009 to 2021 was completed. We excluded patients with instent restenosis. All types of stents, including self-expanding stent (SES), balloon-expandable stent (BES), or balloon-expandable covered stent (CS), were used. Angiographic characteristics and procedural outcomes were analyzed. Procedural success was defined as the residual stenosis

Background: Treating an abdominal aortoiliac aneurysm (AAIA) with endovascular methods can be challenging when the internal iliac artery (IIA) is involved. Embolizing the IIA and extending the limb to the external iliac artery (IIAE + EE) to prevent a type 2 endoleak may lead to pelvic ischemic complications. To avoid these complications, strategies that preserve the IIA, such as the bell-bottom technique (BBT) and the iliac branch device (IBD), have been proposed. This study aims to compare the outcomes of these three endovascular approaches for AAIA. Methods: Between January 2010 and December 2019, 174 patients with asymptomatic AAIA were enrolled in this retrospective analysis. They were divided into two groups: 81 patients underwent non-IIAE procedures, and 93 patients underwent IIAE procedures. The iliac limb study group consisted of 106 limbs treated with the BBT, 113 limbs treated with the IIAE + EE, and 32 limbs treated with the IBD. The primary outcomes included the 30-day mortality rate and intraoperative limb complications. The secondary outcomes included postoperative pelvic ischemia, freedom from reintervention, and the overall 10-year survival rate. Results: There was no significant difference in the perioperative mortality rate between the non-IIAE group (0%) and the IIAE group (2.1%), p = 0.500. The intraoperative limb complications did not differ significantly between the BBT limbs (7.5%), the IIAE + EE limbs (3.5%), and the IBD limbs (3.1%) groups, p = 0.349. The incidence of buttock claudication was significantly greater in the bilateral IIAE + EE group compared to the unilateral IIAE + EE and non-IIAE groups (25%, 11%, and 2.5%, p-value < 0.004), and was similar to the incidence of buttock rest pain with skin necrosis (15%, 0%, and 0%, p < 0.001). During the 10-year follow-up, the BBT limbs group had a significantly lower rate of iliac limb reintervention free time than the IIAE + EE limbs and the IBD limbs groups (88.7%, 98.2%, and 93.8%, p = 0.016). There was no significant difference in the overall 10-year survival rate between the non-IIAE and IIAE groups (51.4% vs. 55.9%, p = 0.703). Conclusions: The early and late mortality rates were similar between the non-IIAE and IIAE groups. Preserving the IIA is recommended to avoid pelvic ischemic complications. Considering the higher rate of reintervention in the BBT group, the IBD strategy may be preferred for AAIA. [ABSTRACT FROM AUTHOR]

Surgical repair of a common iliac artery aneurysm (CIA) after previous open aortic reconstruction is associated with significant morbidity and mortality. Endovascular repair is considered less invasive than surgery. However, if preservation of the internal iliac artery (IIA) is required, the applicability of endovascular techniques may represent a challenge and a limitation to the use of standard aortic endografts or iliac branch devices. In these cases, the off-label use of endovascular devices may be an effective alternative. Herein, we report a successful hybrid approach to treat CIA using a reversed iliac limb endograft coupled with a double-barrel technique with femoro-femoral crossover bypass in a patient who had previously undergone open aortic reconstruction. [ABSTRACT FROM AUTHOR]

This case report presents the management of a 69-year-old man with an extensive history of peripheral vascular disease including 2 previous failed right femoral to distal bypasses and a left above-the-knee amputation who presented with right lower extremity rest pain and non-healing shin ulcers. A redo bypass was performed for limb salvage via the obturator foramen to avoid his extensively scarred femoral region. The postoperative course was uneventful and the bypass remained patent in the early period. This case demonstrates the usefulness of the obturator bypass to provide revascularization and avoid amputation in a patient with chronic limb-threatening ischemia and multiple failed bypasses. [ABSTRACT FROM AUTHOR]

Retroperitoneal liposarcoma (RPLS) is a rare but challenging neoplasm, which is frequently associated with iliac vessel invasion. We describe how we used a two-step arterial reconstruction technique to perform en bloc resection of a large RPLS involving the iliac arteries in three patients. A temporal long in situ graft bypass was established using a prosthetic vascular graft during dissection of the tumor. This bypass provided an unobscured surgical field, while maintaining blood flow in the lower limb during the operation. After removal of the tumor and washing out the abdominal cavity, the new prosthetic vascular graft of a suitable length was placed. No graft-related complications, including vascular graft infection or graft occlusion, occurred during the follow-up period. This novel technique appears to provide a safe and effective way to remove large RPLSs involving the retroperitoneal major vessels. [ABSTRACT FROM AUTHOR]

Objective : This retrospective study investigated the factors that affect cage obliquity angle despite orthogonal maneuvers performed during oblique lateral interbody fusion (OLIF) and assessed the relationship between cage obliquity angle and radiological outcomes post-surgery. Methods : Twenty-nine males who underwent L4-L5 OLIF for lumbar degenerative disease between 2019 and 2021 with a followup duration greater than 12 months were analyzed. Radiological parameters were measured including psoas muscle volume, total psoas area index (total psoas muscle area [cm2]/height squared [m2]), distance from the iliac artery to the origin of the psoas muscle (DIAPM), angle between the origin of the psoas muscle and the center of the vertebral disc (APCVD), iliac crest height, disc height, lumbar flexibility (lumbar flexion angle minus extension angle), cage location ratio, cage-induced segmental lumbar lordosis (LL) (postoperative index level segmental LL minus used cage angle), foraminal height changes, fusion grade. Results : DIAPM, APCVD, iliac crest height, postoperative index level segmental LL, and cage-induced segmental LL were significantly correlated with OLIF cage obliquity angle. However, other radiological parameters did not correlate with cage obliquity. Based on multiple regression analysis, the predictive equation for the OLIF cage obliquity angle was 13.062--0.318xDIAPM+0.325xA PCVD+0.174xiliac crest height. The greater the cage obliquity, the smaller the segmental LL compared to the cage angle used. Conclusion : At the L4-L5 level, OLIF cage obliquity was affected by DIAPM, APCVD, and iliac crest height, and as the cage obliquity angle increases, LL agnle achievable by the used cage could not be obtained. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the feasibility of a non-contrast time-of-flight magnetic resonance angiography (TOF-MRA) protocol for the pre-procedural access route assessment of transcatheter aortic valve implantation (TAVI) in comparison with contrast-enhanced cardiac dual-source computed tomography angiography (CTA). Methods and Results: In total, 51 consecutive patients (mean age: 82.69 ± 5.69 years) who had undergone a pre-TAVI cardiac CTA received TOF-MRA for a pre-procedural access route assessment. The MRA image quality was rated as very good (median of 5 [IQR 4–5] on a five-point Likert scale), with only four examinations rated as non-diagnostic. The TOF-MRA systematically underestimated the minimal effective vessel diameter in comparison with CTA (for the effective vessel diameter in mm, the right common iliac artery (CIA)/external iliac artery (EIA)/common femoral artery (CFA) MRA vs. CTA was 8.04 ± 1.46 vs. 8.37 ± 1.54 (p < 0.0001) and the left CIA/EIA/CFA MRA vs. CTA was 8.07 ± 1.32 vs. 8.28 ± 1.34 (p < 0.0001)). The absolute difference between the MRA and CTA was small (for the Bland–Altman analyses in mm, the right CIA/EIA/CFA was −0.36 ± 0.77 and the left CIA/EIA/CFA was −0.25 ± 0.61). The overall correlation between the MRA and CTA measurements was very good (with a Pearson correlation coefficient of 0.87 (p < 0.0001) for the right CIA/EIA/CFA and a Pearson correlation coefficient of 0.9 (p < 0.0001) for the left CIA/EIA/CFA). The feasibility agreement between the MRA and CTA for transfemoral access was good (the right CIA/EIA/CFA agreement was 97.9% and the left CIA/EIA/CFA agreement was 95.7%, Kohen's kappa: 0.477 (p = 0.001)). Conclusions: The TOF-MRA protocol was feasible for the assessment of the access route in an all-comer pre-TAVI population. This protocol might be a reliable technique for patients at an increased risk of contrast-induced nephropathy. [ABSTRACT FROM AUTHOR]

Purpose To determine the efficacy and safety of iliac branch device (IBD) implantation and to evaluate its limitations based on 7 years of experience in a single center. Materials and Methods This single-center study included patients with bilateral common iliac artery aneurysms (CIAAs). We investigated follow-up CT and reviewed the internal iliac artery (IIA) patency and complications related to IBD. A retrospective analysis was performed and the overall survival rate and freedom from reintervention rate were reported according to the Kaplan–Meier method. Results Of the 38 patients with CIAAs, only 10 (12 CIAAs) were suitable for IBD treatment. Five patients underwent unilateral IBD insertion with contralateral IIA embolization, and three (60%) showed claudication; however, symptoms resolved within 6 months. The 7-year freedom from IBD-related reintervention rate was 77.8%. No procedure-related deaths occurred. Conclusion IBD has good technical success and long-term patency rates; however, anatomical factors frequently limit its application, particularly in Asians. Additionally, unilateral IIA embolization showed relatively mild complications and a good prognosis; therefore, it can be performed safely for anatomically complex aortoiliac aneurysms. [ABSTRACT FROM AUTHOR]

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]

Aim: Simultaneous multilevel hybrid-based reconstructions using both endovascular and open femoral endartectomy merit the interest with the widespread adoption of these techniques by vascular surgeons. Here we presented our experience on hybrid-based approach to treat total occlusive iliofemoral lesions and study the technical success and mid-term results of combined femoral endarterectomy and endovascular treatment of iliac occlusion. Material and Methods: This retrospective single center study included patients with only total occlusion in the unilateral iliac artery. The patients underwent hybrid procedure--open femoral endarterectomy and endovascular revascularization of the external or common iliac artery-between 2016 and 2022. Statistical analysis was performed by using SPSS software version 25. Results: Totally 103 patients who underwent hybrid procedures for pervasive unilateral iliac artery occlusions were included in this study. Of the study cohort, 76% were male patients with a mean age of 74±8.7 years. Technical success rate was 89.3%. Acute myocardial infarction was the most common complication. The 30-day mortality was 7.8% (n=8) and all of them were in-hospital deaths. The survival rates of this cohort at 30 days, 6 months and 12 months were 92.2%, 88.1% and 83.7%, respectively. The primary patency at 30 days, 6 months, and 12 months were 98.1%, 96.6%, and 93.7%, respectively. Conclusion: The clinical and technical outcomes in this study suggest that the hybrid approach to pervasive iliofemoral occlusions, combining femoral endarterectomy and endovascular iliac revascularization, is an effective and applicable treatment in terms of patency rates and perioperative complications. [ABSTRACT FROM AUTHOR]

Introduction: The mainstay of endovascular treatment in peripheral arterial disease is digital subtraction angiography with an iodinated contrast. In patients with a known contrast allergy, the current most commonly used alternative is to perform carbon dioxide angiography. Operator experience and availability of carbon dioxide (CO2) angiography delivery systems are, however, limited. Intravascular ultrasound is now commonly used in combination with fluoroscopy in peripheral venous interventions and in coronary arterial disease and we propose that this also provides a safe and effective alternative option to guide endovascular intervention in patients with a known contrast allergy. Case report: We present a case describing the use of intravascular ultrasound and fluoroscopy to guide endovascular treatment of a critical left common iliac artery stenosis in a patient with known anaphylaxis to iodinated contrast. Discussion: Intravascular ultrasound is fast becoming the gold standard treatment option in peripheral venous interventions; however, the use in peripheral arterial disease is limited. We believe this is the first case that reports the use of predominantly intravascular ultrasound in endovascular peripheral arterial intervention with a contrast adjunct. Conclusion: We have demonstrated that intravascular ultrasound is a safe and effective alternative or adjunct to iodinated contrast for arterial angiography and stenting in the setting of patient contra-indications. [ABSTRACT FROM AUTHOR]

A surgical site infection (SSI) rate of 4%–8% has been reported in patients who undergo open reduction and internal fixation (ORIF) for acetabular fractures. Studies have identified risk factors for SSI, but none have performed a nationwide analysis of SSI in surgically managed acetabular fracture patients. The National Inpatient Sample (NIS) database was queried for patients who underwent ORIF for acetabular fractures from 2016 to 2019. Analysis was performed on all patients who underwent ORIF for acetabular fractures, as well as those who only underwent ORIF for isolated acetabular fractures. Clinical characteristics, hospital course, discharge disposition, and hospitalization costs were compared between groups. Multivariate regression analysis was conducted to assess predictors of SSI. 41,725 patients undergoing acetabular fracture repair were identified, of which 490 (1.2%) developed SSI during hospitalization. Age (45.90 vs 49.90, p < 0.001) and Injury Severity Scale (5.99 vs 8.30, p < 0.001) were increased in patients who developed SSI. History of hypertension (HTN) (OR = 2.343, 95% CI 1.96–2.80, p < 0.001), longer hospital length of stay (30.27 days vs 10.00 days, p < 0.001) and total charges ($469,005 vs $193,032, p < 0.001) were associated with SSI. Lower rates of routine discharge were seen in SSI patients (OR = 0.333, 95% CI 0.260–0.426, p < 0.001). Higher rates of inpatient death were associated with SSI (OR = 2.210, 95% CI 1.172–4.17, p = 0.019). Multiple procedures in addition to acetabular fracture repair, iliac artery embolization, substance abuse, later time to internal fixation and HTN were predictive of SSI (p < 0.001). Severity of injury, time to fixation, and factors associated with compromised cardiovascular integrity were predictors of SSI. Identifying patients at risk for SSI should lead to clinical maneuvers that may optimize outcome. [ABSTRACT FROM AUTHOR]

Introduction: Mycotic pseudoaneurysms are rare but severe sequelae of an arterial wall infection. If undiagnosed and untreated they can lead to significant morbidity and mortality through complications such as arterial rupture or dissection. Case report: This report details the case of a 64-year-old-male who developed a left common iliac artery mycotic pseudoaneurysm from Proteus mirabilis, which was associated with a prevertebral abscess. The patient presented with isolated, left lower extremity edema and intermittent fevers. The case is unique in both the pathogen (P mirabilis) and in its association with presumed direct arterial wall infection from an adjacent prevertebral abscess. Conclusion: The obscure presentation highlights the need for a high clinical suspicion of such a diagnosis when a patient presents with a certain constellation of symptoms and the right predisposing risk factors in their history. [ABSTRACT FROM AUTHOR]

Background: To investigate the association between erectile dysfunction (ED) as well as epistaxis (ES) in relation to the extent of iliac atherosclerosis. Methods: In this retrospective cross-sectional study, all consecutive male patients treated at our institution from 01/2016 to 12/2020 undergoing abdominal CT scan were evaluated. Patients (n = 1272) were invited by mail to participate in the study in returning two questionnaires for the evaluation of ED (IIEF-5) and ES. Patients who returned filled-in questionnaires within a 3-month deadline were included in the study. The extent of atherosclerosis in the common iliac artery (CIA) and the internal iliac artery (IIA) was assessed by calcium scoring on unenhanced CT. Stratification of results was performed according to reported IIEF-5 scores and consequential ED groups. Results: In total, 437 patients (34.4% of contacted) met the inclusion criteria. Forty-two patients did not fulfill predefined age requirements (< 75 years) and 120 patients had to be excluded as calcium scoring on nonenhanced CT was not feasible. Finally, 275 patients were included in the analysis and stratified into groups of "no-mild" (n = 146) and "moderate-severe" (n = 129) ED. The calcium score (r=-0.28, p < 0.001) and the number of atherosclerotic lesions (r=-0.32, p < 0.001) in the CIA + IIA showed a significant negative correlation to the IIEF-5 score, respectively. Patients differed significantly in CIA + IIA calcium score (difference: 167.4, p < 0.001) and number of atherosclerotic lesions (difference: 5.00, p < 0.001) when belonging to the "no-mild" vs. "moderate-severe" ED group, respectively. A multivariable regression model, after adjusting for relevant baseline characteristics, showed that the number of atherosclerotic CIA + IIA lesions was an independent predictor of ED (OR = 1.05, p = 0.036), whereas CIA + IIA calcium score was not (OR = 1.00031, p = 0.20). No relevant correlation was found between ES episodes and IIEF-5 scores (r=-0.069, p = 0.25), CIA + IIA calcium score (r=-0.10, p = 0.87) or number of atherosclerotic CIA + IIA lesions (r=-0.032, p = 0.60), respectively. Conclusions: The number of atherosclerotic lesions in the iliac arteries on nonenhanced abdominal CT scans is associated with the severity of ED. This may be used to identify subclinical cardiovascular disease and to quantify the risk for cardiovascular hazards in the future. Trial registration: BASEC-Nr. 2020 − 01637. [ABSTRACT FROM AUTHOR]

Introduction: Simultaneous pancreas kidney (SPK) transplantation is an invaluable procedure to enhance the quality of life of insulin-dependent patients with advanced renal disease. The creation of vascular anastomoses of the donor's pancreas vessels to the recipient's, is of utmost importance to predict the graft outcome and surgical complications. In the study we introduce a novel technique for arterial reconstruction during SPK transplantation. Methods: Conventionally, during the SPK transplantation, a so-called Y-graft is anastomosed between donor's superior mesenteric and splenic artery to the recipient's right iliac artery. In the study we adopted a new technique by preparing an extra extension using the donor's carotid artery, to be anastomosed to the Y-graft and the iliac artery. In this non-blinded randomized clinical trial we compared the surgical complications and early outcomes between the 2 groups of patients with the traditional and new arterial reconstruction techniques during 3 months after transplantation. Results: Thirty adult patients were included in the study. The incidence of pancreatitis, vascular thrombosis and surgical site infection was lower in the new Y-graft and extension technique, which was not statistically significant. However, the calculated Cohen's d index showed the medium effect of new Y-graft and extension technique on complication after SPK transplantations. Conclusion: The post-operative complications tend to be lower in the novel arterial reconstruction technique, however a study on a larger patient group is encouraged to confirm our primary results. Trial registration: The study was registered at the Iranian Registry of Clinical Trials on 12/05/2022; IRCT 20210625051701N2; (http://www.irct.ir/). [ABSTRACT FROM AUTHOR]