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Resumo A fístula arteriovenosa (FAV) é uma sequela incomum de rotura espontânea de aneurisma arterial dentro do sistema venoso adjacente. Descrevemos, em um paciente de 74 anos, o tratamento endovascular de FAV ilíaca à direita por aneurisma de artéria ilíaca comum (AIC) roto associado a aneurisma de AIC distal à esquerda, em cuja cirurgia foram preservadas as artérias lombares e mesentérica inferior por necessidade de excluir simultaneamente as artérias hipogástricas. Foram demonstrados os fenômenos na dinâmica do balanço hídrico ocorridos em decorrência da interrupção da FAV. A evolução do paciente foi benigna, com normalização das graves alterações hemodinâmicas que apresentava e com desaparecimento dos sintomas respiratórios atribuídos à hipertensão arterial pulmonar.

An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar and inferior mesenteric arteries because of the need to simultaneously exclude the hypogastric arteries. Dynamic fluid balance phenomena provoked by closure of the AVF are described. The patient had a benign postoperative course with normalization of the severe hemodynamic changes presented prior to the intervention and resolution of respiratory symptoms attributed to pulmonary arterial hypertension. [ABSTRACT FROM AUTHOR]

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Se relatan 3 observaciones de trombosis de los grandes troncos arteriales ( aorta, subclavia e ilíaca) en portadores de afecciones biliares concomitantes ( íle o biliar, cáncer de páncreas y litiasis vesicular y colecistitis aguda). También se relatan dos casos de trombosis arteriales de humeral y femoral en bacilares viscerales tratados con corticoides. Se señala la vinculación patogériica de ambos tipos de afecciones debido a un aumento de la trombofilia determinado por la afección abdominal previa.

Introducción. El síndrome de Leriche fue definido en 1940 por René Leriche como una enfermedad oclusiva aorto-ilíaca. Su importancia radica en que ocupa el segundo lugar en incidencia dentro de las enfermedades oclusivas arteriales, después de la enfermedad de la arteria femoral superficial. Objetivo. Presentar el caso clínico de un paciente con Síndrome de Leriche cuyo diagnóstico trombótico fue confirmado por una angiotomografía computarizada con su respectiva reestructuración en 3D. Adicionalmente, se informa al lector sobre los datos propios de la patología a través de una breve revisión de la literatura. Caso clínico. Paciente masculino con síntomas clínicos agudos de enfermedad oclusiva aorto-ilíaca o síndrome de Leriche en una extremidad. Se realiza el respectivo procesamiento de imagen asistida por computador (reconstrucción tridimensional) que evidencia la patología a pesar de que la ecografía Doppler no determinó trombosis inicial. Discusión. En procesos oclusivos arteriales se emplean técnicas no invasivas como la ecografía y la angiotomografía. Sin embargo, esta última es la técnica por excelencia, sobre todo para procesos trombóticos, pues agiliza la anticoagulación, así como el abordaje terapéutico. Conclusiones. La angiotomografía es una técnica no invasiva con alta sensibilidad y especificidad para detectar estenosis aorto-ilíaca. Se ha convertido en una gran herramienta diagnostica por sus alcances imagenológicos, como la obtención de imágenes iso volumétricas, que permiten evaluar todo el trayecto arterial en los diferentes planos, por medio del uso de medios de contraste, superando en resultados a la ecografía. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732. Introduction. Leriche syndrome was defined in 1940 by René Leriche as an aortoiliac occlusive disease. Its importance lies in it occupying second place in the incidence of occlusive arterial diseases, after superficial femoral artery disease. Objective. Present the clinical case of a patient with Leriche syndrome whose diagnosis of thrombosis was confirmed by a computed tomography angiography with its respective 3D reconstruction. Additionally, the reader is given information about the pathology through a brief summary of the literature. Clinical case. Male patient with acute clinical symptoms of aortoiliac occlusive disease or Leriche syndrome in one limb. The respective computer-assisted image processing (three-dimensional reconstruction) is carried out, which shows the pathology, despite the Doppler ultrasound not initially establishing thrombosis. Discussion. Non-invasive techniques are used in procedures for occlusive arteries, such as ultrasound and CT angiography. However, the latter is a technique par excellence, above all for thrombosis procedures, as well as the therapeutic approach. Conclusions. CT angiography is a non-invasive technique with high sensitivity and specificity in the detection of aortoiliac stenosis. It has become a great diagnostic tool because of its imagery scope, such as obtaining isovolumic images, which enable the assessment of the entire arterial route in different planes, through the use of contrast media, producing more results than the ultrasound. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732. Introdução. A síndrome de Leriche foi definida em 1940 por René Leriche como uma doença oclusiva aorto-ilíaca. Sua importância reside no fato de ocupar o segundo lugar em incidência dentro das doenças arteriais obstrutivas, após a doença na artéria femoral superficial. Objetivo. Apresentar o caso clínico de um paciente com síndrome de Leriche cujo diagnóstico trombótico foi confirmado por uma angiotomografia computadorizada (angio-TC) com reestruturação em 3D. Adicionalmente, o leitor é informado sobre os dados próprios da patologia através de uma breve revisão de literatura. Caso clínico. Paciente de sexo masculino com sintomas clínicos agudos da doença oclusiva aorto-ilíaca ou síndrome de Leriche em uma extremidade. Foi realizado o processamento da imagem assistida por computador (reconstrução tridimensional), evidenciando a patologia, ainda que a ultrassonografia Doppler não determinou trombose inicial. Discussão. Em processos oclusivos arteriais são utilizadas técnicas não invasivas como a ultrassonografia e a angiotomografia. No entanto, a angiotomografia é a técnica padrão ouro, principalmente para processos trombóticos, pois acelera a anticoagulação e a abordagem terapêutica. Conclusão. A angiotomografia é uma técnica não invasiva com alta sensibilidade e especificidade para detectar estenose aorto-ilíaca. Tornou-se uma ótima ferramenta de diagnóstico por suas características imagenológicas, como a obtenção de imagens isovolumétricas que permitem avaliar todo o trajeto arterial nos diferentes planos, através do uso de meios de contraste, superando os resultados da ultrassonografia. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732.

External iliac artery endofibrosis is a rare pathology that affects high-level endurance athletes, especially cyclists. Classical symptoms include pain, loss of power, and/or cramp in the affected limb while training at maximal effort. The patient's lack of atherosclerotic risk factors makes clinical suspicion of arteriopathy challenging. Moreover, the best management of such patients is still a subject of discussion. We report the case of a 36-year-old professional female endurance cyclist who presented with lower extremity pain during training. Right external iliac artery endofibrosis was diagnosed and the patient underwent surgical treatment. At two-months follow-up, she reported significant improvement in symptoms. This case highlights the importance of diagnosing peripheral vascular disease in young patients and athletes, who do not fit the ordinary profile of patients with atherosclerotic risk factors. [ABSTRACT FROM AUTHOR]

Background: Aneurysms and atheromatous processes are prominent pathological features that are commonly associated with significant morbidity and mortality. Objectives: This cadaveric study was conducted to evaluate the morphometric and histological aspects of atheromatous plaque formation in abdominal aortas and their branches and their associated morphological variations, if present, characterized by loops, kinking, or tortuosity. Methods: The study was performed using 30 human cadavers (approx. 65-75 years). Frequency of occurrence of calcified plaques in the abdominal aorta and its branches and their morphometric measurements were noted and histological features were observed with the aid of Hematoxylin & Eosin staining. Results: Variations in the abdominal aorta and the common iliac artery were observed in 16.6% of specimens. Atheromatous plaque formation was seen in 2 specimens (1 specimen was associated with kinking) while in 3 other specimens only variation in normal structure (kinking/tortuous artery) was observed. Histological analysis showed foamy macrophages and dense calcification, giving an atheromatous appearance. Conclusions: Cadaveric reports of the location, nature, and degree of plaque formation in the abdominal aorta and its branches are extremely important in clinical settings and for choosing treatment options. e [ABSTRACT FROM AUTHOR]

Introduction. Leriche syndrome was defined in 1940 by René Leriche as an aortoiliac occlusive disease. Its importance lies in it occupying second place in the incidence of occlusive arterial diseases, after superficial femoral artery disease. Objective. Present the clinical case of a patient with Leriche syndrome whose diagnosis of thrombosis was confirmed by a computed tomography angiography with its respective 3D reconstruction. Additionally, the reader is given information about the pathology through a brief summary of the literature. Clinical case. Male patient with acute clinical symptoms of aortoiliac occlusive disease or Leriche syndrome in one limb. The respective computer-assisted image processing (three-dimensional reconstruction) is carried out, which shows the pathology, despite the Doppler ultrasound not initially establishing thrombosis. Discussion. Non-invasive techniques are used in procedures for occlusive arteries, such as ultrasound and CT angiography. However, the latter is a technique par excellence, above all for thrombosis procedures, as well as the therapeutic approach. Conclusions. CT angiography is a non-invasive technique with high sensitivity and specificity in the detection of aortoiliac stenosis. It has become a great diagnostic tool because of its imagery scope, such as obtaining isovolumic images, which enable the assessment of the entire arterial route in different planes, through the use of contrast media, producing more results than the ultrasound. [ABSTRACT FROM AUTHOR]

Background: An iliac artery aneurysm is a permanent and focal dilation of the artery that measures more than 50% of the normal diameter of the vessel. Isolated iliac artery aneurysms are infrequent, mostly as an association with an abdominal aortic aneurysm. The objective of this article is mainly to focus on urological symptoms as the manifestations of iliac artery aneurysm, to propitiate an early diagnosis. Clinical case: In this article, we present a clinical case of a patient with generalized weakness, an episode of lipothymia and pain in the renal fossa, finding three aneurysms in the computed tomography, located in the right common iliac artery, the left internal iliac artery and the left external iliac artery. Later, the patient presents urological complications, after an obstruction of the right ureter, and therefore, a right hydronephrosis and loss of renal parenchyma function. Given this, urgent surgery is performed with satisfactory results. Conclusions: The diagnosis of an iliac aneurism represents a challenge since most patients are asymptomatic. As main manifestation, urinary compression symptoms represented a fundamental part of diagnostic suspicion, which coincides with other similar cases reported in the literature. [ABSTRACT FROM AUTHOR]

La enfermedad oclusiva aortoilíaca, o síndrome de Leriche, es una forma de la enfermedad arterial periférica, en la cual existe una oclusión de las arterias ilíacas desde su bifurcación. Su manifestación clínica es variable y la claudicación intermitente es la más frecuente; no obstante, es una enfermedad usualmente subdiagnosticada por su cronicidad y el sedentarismo de los adultos mayores, quienes más la presentan. Para el diagnóstico se cuenta con un abanico de opciones, que incluyen pruebas invasivas y no invasivas; la arteriografía es el método de elección. El tratamiento, por su parte, involucra cambios en el estilo de vida aunados a un tratamiento conservador o quirúrgico, según cada individuo.

A aterosclerose é caracterizada por lesões na camada íntima do vaso, os ateromas ou placas fibroadiposas se projetam para o interior do vaso, obstruem o lúmen vascular e enfraquecem a média subjacente. Um caso relacionado à fisiopatologia da aterosclerose é a Síndrome de Leriche, que consiste no agravo vascular, geralmente associado a uma arteriosclerose sistêmica, acomete principalmente as artérias ilíacas, as quais ocorrem obstrução parcial ou completa, comprometendo assim a irrigação dos membros inferiores e da pelve. Com a deficiência de vascularização há hipóxia das regiões afetadas podendo levar a necrose tecidual e consequentemente perda de função como impotência e infertilidade. A claudicação intermitente, presente em pacientes que sofrem deste mal, geralmente ocorre como dor na panturrilha, em obstruções mais altas, esta dor se estenderá para a região glútea e para a parte superior das coxas. O presente trabalho objetiva analisar a doença ateromatosa da macro e microcirculação e correlacionar com a Síndrome de Leriche, realizou-se então a dissecção cadavérica.Trata-se de uma pesquisa descritiva exploratória com abordagem qualitativa a partir da dissecação de um cadáver adulto do laboratório da FAMENE/PB, feito entre agosto a outubro do ano de 2011, utilizou-se látex, cateter nº 6, seringa 10ml, além de material usual de dissecação, assim como técnicas adequadas para este fim. A dissecação da Aorta abdominal, Aa. Carótidas, Aa. Renais, Aa. Coronárias e Aa. Ilíacas evidenciou placas de ateroma em sua parede, mostrando que o cadáver em questão possuía Doença Aterosclerótica. Percebeu-se com esse estudo a importância da anatomia para o melhor entendimento de algumas doenças e suas características anatômicas.

Iliac vein compression syndrome is a clinical condition in which the right common iliac artery extrinsically compresses the left common iliac vein. The syndrome predominantly affects young women between their 2nd and 4th decades of life. In view of the syndrome's potential complications, it should be recognized/diagnosed and treated in symptomatic patients before it causes irreversible damage to patients' venous systems. Noninvasive methods, such as venous color Doppler US are reasonable screening methods, but angiotomography and magnetic resonance angiography are more reliable diagnostic tools and the method of choice for confirmation of diagnosis remains multi-plane phlebography with measurement of pressure gradients. Endovascular treatment (angioplasty with placement of self-expanding stents) is safe and effective and can replace open surgical reconstruction and/or anticoagulation alone.

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

Aortoiliac aneurysms are particularly challenging to treat using a totally endovascular approach, because embolization of the internal iliac arteries can cause major complications. Several conventional and endovascular surgical techniques have been described that offer preservation of at least one internal iliac branch and options for completely endovascular treatment include branched stentgrafts and the parallel grafts technique. Here, the authors report the first case of endovascular treatment with preservation of an internal iliac branch using a Brazilian iliac branch device. [ABSTRACT FROM AUTHOR]

BACKGROUND: Endovascular treatment of peripheral arterial occlusive disease has become increasingly frequent in the past few years. Because it is a less invasive procedure, lower morbidity and mortality rates are associated with this form of treatment. OBJECTIVES: To describe the endovascular procedures performed in iliac arteries for the treatment of peripheral arterial occlusive disease. METHODS: This retrospective study assesses 59 cases of iliac artery angioplasty performed according to a specific protocol from January 2004 to February 2010. RESULTS: Mean age of patients was 62 years (minimum: 42, maximum: 89). Thirty seven were male (62.72%) and 22 female (37.28%). The main indications for treatment were moderate to severe intermittent claudication in 30 cases (50.84%) and rest pain or trophic lesions (critical ischemia) in 29 cases (49.15%). Postoperative follow-up included ankle-brachial index measurements and a duplex ultrasound at 30 days, 3 months, 6 months, 12 months, and every 6 months thereafter. Minimum follow-up time was 3 months, and maximum, 72 months (6 years), with primary and secondary patency rates of 91.37 and 94.82%, respectively. CONCLUSIONS: The results of this case series, combined with literature review results, allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.

Las fístulas ilíaco-vesicales son una rara complicación de los aneurismas de la aorta abdominal. Se presenta el caso de un paciente de 76 años con aneurisma roto de arteria ilíaca contenido en vejiga, que se manifestó por dolor abdominal y hematuria, y en quien se sospechó por tomografía una fístula ilíaco-vesical, la cual se confirmó durante la cirugía. El paciente falleció a los 20 días del procedimiento, por shock mixto séptico.Iliocovesical fistulas are infrequent complications of abdominal aortic aneurysms (AAA). We report the case of a 76 year-old male with a contained ruptured aneurysm of the iliac to the urinary bladder. Complaints on presentation were abdominal pain and hematuria; suspected iliacovesical fistula was reported on a computed tomography (CT) scan, which was confirmed during laparotomy. The patient died 20 days after the procedure due to mixed distributive septic shock.

A persistência da artéria isquiática é uma rara variação anatômica, com poucos casos descritos na literatura, manifestando-se por formação de aneurisma, massa pulsátil em glúteo, isquemia aguda ou crônica de membro inferior e compressão de nervo isquiático. O diagnóstico é confirmado com exames de imagem: mapeamento duplex, angiotomografia e angiorressonância magnética. O tratamento é indicado nos casos sintomáticos ou quando há formação de aneurisma, realizado através de ligadura ou embolização por via endovascular, sendo necessário a revascularização do membro nos casos em que a artéria isquiática é a principal responsável pelo suprimento sangüíneo do membro. Apresentamos o caso de uma paciente do sexo feminino, 43 anos, com pseudoaneurisma de artéria isquiática confirmada por mapeamento duplex e angiorressonância magnética, com quadro de neuropatia isquiática por compressão nervosa e dor local. A paciente foi submetida à exploração cirúrgica com ligadura da artéria isquiática e remoção dos trombos. No seguimento de 12 meses, apresentou importante melhora da dor e realizou fisioterapia motora para recuperação das funções neurológicas do membro.The persistent sciatic artery is a rare anatomical variation, with few cases described on the literature. It presents clinically as aneurysm formation, pulsate gluteal mass, acute or chronic limb ischemia and sciatic nerve compression. Diagnosis is confirmed by imaging methods: duplex scan, CT angiographt and magnetic resonance angiography. Treatment is indicated in symptomatic cases and when there is aneurysm formation and it is performed by ligation of the sciatic artery or endovascular embolization, associated with limb revascularization in the cases the sciatic artery is the main blood supply to the limb. We report the case of a 43 year-old female patient, ,with a false aneurysm of the sciatic artery confirmed by duplex scan and magnetic resonance angiography who had local pain and sciatic neuropathy due to neural compression. Surgical exploration was performed, with ligation of sciatic artery and thrombus removal. At the 12 months follow up there was significant pain relief and she was performing motor physical therapy to recover the neurological functions of the limb.

A Síndrome de May-Thurner é uma causa pouco comum de sinais e sintomas venosos relacionados ao membro inferior esquerdo. Esta síndrome é caracterizada pela compressão da veia ilíaca comum esquerda pela artéria ilíaca comum direita e, quando tal alteração anatômica causa sintomas que venham a prejudicar a qualidade de vida do paciente, existe a indicação de tratamento cirúrgico ou endovascular para correção desta alteração anatômica. Este artigo é o relato de um caso, no qual optou-se pelo tratamento endovascular com resultado satisfatório e as indicações, as nuances e os resultados esperados para esta técnica no tratamento da Síndrome de May-Thurner são discutidos. Foi concluído que, nesta síndrome, há eficácia do tratamento endovascular com melhora dos sintomas pela recanalização do sistema venoso, sem grandes riscos inerentes ao procedimento e com curto período de internação hospitalar.May-Thurner Syndrome is an uncommon cause of venous symptoms and signs related to the left lower limb. It is characterized by compression of the left common iliac vein by the right common iliac artery and, when such anatomical change causes symptoms that may impair the patients' quality of life, surgical treatment is indicated. This article addresses a case of May-Thurner syndrome in which we opted for endovascular treatment with satisfactory outcome, as well as a discussion about indications, nuances, and expected results. We concluded that endovascular treatment is effective in treating this syndrome, for it resolves the symptoms by recanalization of the venous system with little risks during the procedure and with short hospital stay.

Em doentes vítimas de trauma de grande energia uma lesão pélvica grave deve ser sempre suspeitada. Na sua maioria, as fraturas são estáveis, respondendo bem ao tratamento conservador. As fraturas da bacia constituem 3% do total das fraturas do esqueleto, associam-se a trauma de grande energia, sendo lesões potencialmente graves, com uma mortalidade significativa e grande número de lesões associadas. Há fundamentalmente três fontes de sangramento nas fraturas pélvicas: arterial, venosa e pelos topos ósseos da fratura. O sangramento arterial está mais associado com instabilidade hemodinâmica. Nos casos indicados, tanto a fixação externa precoce da fratura de bacia como a angiografia com embolização seletiva dos vasos sangrantes são métodos efetivos para a hemostasia. Os aneurismas de ramos da artéria ilíaca são raros, sendo na maioria pseudoaneurismas relacionados com o episódio traumático. A história natural dos pseudoaneurismas é desconhecida por serem uma identidade rara, mas a sua ruptura traduz-se em grande mortalidade. Relatamos um caso de trombose espontânea de pseudoaneurisma de ramo da artéria ilíaca direita.In patients who have been the victims of high-energy trauma, severe pelvic injury should always be suspected. Most of these fractures are stable and respond well to conservative treatment. Pelvic fractures constitute 3% of all skeletal fractures and are associated with high-energy trauma. They are potentially serious injuries with significant mortality and large numbers of associated lesions. There are fundamentally three sources of bleeding in pelvic fractures: arterial, venous and through the bone ends of the fracture. Arterial bleeding is more associated with hemodynamic instability. In such cases, both early external fixation of the pelvic fracture and angiography with selective embolization of the bleeding vessels are effective methods for achieving hemostasis. Aneurysms of iliac artery branches are rare and are mostly pseudoaneurysm relating to the traumatic event. The natural history of pseudoaneurysms is unknown because of their rarity, but if they rupture, the mortality rate is high. We report a case of spontaneous thrombosis of a pseudoaneurysm of a branch of the right iliac artery.

We report a case of right external iliac artery stenosis after kidney transplantation surgery caused by vascular clamp application injury. The patient presented with claudication of the ipsilateral lower limb and the lesion was diagnosed angiographically. The patient was treated with endovascular stent placement.

Treating narrow arteries and their bifurcations is a major challenge to the endovascular surgeon. We describe a new endovascular technique that was used to treat a narrow aorta and that may also be used to preserve other bifurcations. Using three straight stents may enable the endovascular surgeon to treat bifurcation while maintaining flow to both distal arteries.O tratamento de artérias de pequeno calibre e suas bifurcações é um grande desafio para o cirurgião endovascular. Descrevemos uma nova técnica endovascular que foi usada no tratamento de uma aorta de pequeno calibre e que também pode ser usada para preservar outras bifurcações. O uso de três stents retos pode permitir ao cirurgião endovascular o tratamento de bifurcação mantendo o fluxo em ambas as artérias distais.

Aneurismas isolados da artéria ilíaca interna são raros, acometem 0,1% da população e correspondem a 1% dos aneurismas aorto-ilíacos. Na maioria das vezes, os pacientes são assintomáticos, mas podem apresentar dor abdominal, massa pulsátil no hipogástrio ou na fossa ilíaca, sintomas compressivos urinários, gastrointestinais ou neurológicos. Podem ocasionar quadro de abdome agudo, principalmente quando há ruptura. O diagnóstico precoce dos aneurismas isolados de artéria ilíaca interna é incomum, sendo identificados quando mais volumosos ou rotos, o que aumenta significativamente sua morbimortalidade e torna seu prognóstico mais reservado. Dessa forma, representam um desafio terapêutico. A ligadura cirúrgica tem sido o tratamento mais comum, entretanto a cirurgia endovascular tem mostrado bons resultados, inclusive nos aneurismas rotos. É relatado caso de aneurisma de artéria ilíaca interna isolado roto diagnosticado durante laparotomia para abordagem de abdome agudo.Isolated internal iliac artery aneurysms are rare. They affect 0.1% of the population, and account for 1% of aortoiliac aneurysms. Patients are mostly asymptomatic, yet they can have abdominal pain, pulsatile mass in the hypogastrium or iliac fossa, or urinary, gastrointestinal or neurological compressive symptoms. Such aneurysms are likely to course with an acute abdomen, especially when ruptured. Early diagnosis of isolated internal iliac artery aneurysms is difficult, as they are more easily detected when larger or ruptured, which significantly raises their morbidity and mortality rate and determines a poor prognosis. Therefore, they are a therapeutic challenge. Surgical ligation has been the most common treatment; however, the endovascular approach has presented good outcomes, even in the event of ruptured aneurysms. A case of ruptured isolated iliac artery aneurysm diagnosed during a laparotomy (acute abdomen approach) is reported.

Contexto: A arteriografia com contraste (AC) tem sido o exame tradicional de avaliação de pacientes com suspeita de doença oclusiva aorto-ilíaca (DOAI). Recentemente, métodos menos invasivos, como a eco-Doppler, têm sido usados com a mesma finalidade. Objetivo: Comparar prospectivamente a eco-Doppler com a AC e eventual manometria arterial direta (MAD) na avaliação pré-operatória de pacientes com suspeita de DOAI. Métodos: Foram submetidos a eco-Doppler e a AC 125 pacientes internados para tratamento de doença arterial oclusiva dos membros inferiores, avaliando comparativamente 552 segmentos da aorta infrarrenal e das artérias ilíacas comum e externa. As lesões encontradas foram classificadas em cinco categorias: 1) normal e estenose leve (0 a 19%); 2) estenose moderada (20 a 49%); 3) estenose significativa (50 a 79%); 4) estenose crítica (80 a 99%); e 5) oclusão total. A MAD foi usada em 19 segmentos de 15 pacientes para classificar lesões limítrofes entre duas categorias. Foram calculados índices de validade (sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia) para distinguir lesões hemodinamicamente significativas de não-significativas e para distinguir estenoses críticas de oclusões. O padrão-ouro foi AC, complementado pela MAD. Foram também calculados coeficientes de correlação kappa entre arteriografias e eco-Doppler para o conjunto dos segmentos aorto-ilíacos. Resultados: Lesões clinicamente relevantes (estenoses de 50 a 99% e oclusões totais) foram observadas na eco-Doppler em 163 segmentos (29,5%) e na AC em 158 segmentos (28,6%). A eco-Doppler mostrou altos índices de validade para distinguir lesões hemodinamicamente significativas de lesões não-significativas em todos os segmentos (acurácia = 92%; kappa = 0,81) e para diferenciar estenoses críticas de oclusões (acurácia = 86%; kappa = 0,73). Os índices de correlação entre os resultados das eco-Doppler e das AC foram ótimos em todos os segmentos aorto-ilíacos. Conclusão: A eco-Doppler apresenta elevados índices de validade e ótimos coeficientes de correlação com a AC na avaliação de pacientes com suspeita de DOAI.Background: Contrast arteriography (CA) has been the traditional method of evaluation of patients with suspected aortoiliac occlusive disease (AIOD). Recently, less invasive methods, such as Doppler ultrasonography, have been used for the same purpose. Objective: The present study prospectively compares Doppler ultrasonography with CA and direct arterial manometry (DAM) in the preoperative evaluation of patients with suspected AIOD. Methods: A total of 125 patients admitted for treatment of arterial occlusive disease of the lower extremities underwent Doppler ultrasonography and CA, comparatively evaluating 552 aortic, common iliac e external iliac segments. The lesions found were classified into five categories: 1) normal and mild stenosis (0-19%); 2) moderate stenosis (20-49%); 3) significant stenosis (50-79%); 4) critical stenosis (80-99%); and 5) total occlusion. DAM was used in 19 segments of 15 patients to classify borderline lesions. Validity indexes (sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy) were calculated to distinguish hemodynamically significant from non-significant stenosis and to discriminate critical stenosis from total occlusions. The gold standard was CA, supplemented by DAM. Correlation coefficients (kappa statistics) between arteriography and Doppler ultrasonography were also calculated for the whole sample of aortoiliac segments. Results: Clinically relevant lesions (stenoses between 50-99% and total occlusions) were observed on Doppler ultrasonography in 163 segments (29.5%) and on CA in 158 segments (28.6%). Doppler ultrasonography showed high validity indexes to distinguish hemodynamically significant from non-significant lesions (overall accuracy = 92%; kappa = 0.81) and an overall accuracy of 86% (kappa = 0.73) to distinguish critical stenosis from total occlusion. Optimal correlation coefficients between the results of Doppler ultrasonography and CA were observed for all aortoiliac segments. Conclusion: Doppler ultrasonography has high validity indexes and optimal correlation coefficients with CA in the evaluation of patients with suspected AIOD.

Durante uma dissecção de rotina realizada em um cadáver do sexo masculino com 65 anos de idade foi constatada malformação arterial iliofemoral. A aorta abdominal estava consideravelmente deslocada lateralmente e também bifurcava em nível mais alto. A artéria ilíaca comum dividia-se uma vértebra acima do nível normal e a artéria femoral dava origem à artéria femoral profunda aproximadamente l,2 cm abaixo do ligamento inguinal, o que é consideravelmente proximal ao seu nível normal. Aqui nós apresentamos uma breve revisão de literatura e base embriológica dessas anomalias.During routine dissection, an Iliofemoral arterial malformation was noticed in a 65 year old male cadaver. The abdominal aorta was considerably laterally displaced and also bifurcated higher up. The common iliac artery divided one vertebral level higher and the femoral artery gave the profunda femoris artery about 1.2 cm below the inguinal ligament, which is considerably proximal to its usual level of origin. A brief review of literature and embryological basis of the anomalies are discussed.

OBJETIVO: Discorrer sobre os aspectos clínicos e o tratamento cirúrgico de uma série de casos de aneurismas isolados das artérias ilíacas. MÉTODOS: Foram analisados retrospectivamente os dados protocolados e os prontuários de 12 pacientes com diagnóstico de aneurisma isolado das artérias ilíacas, operados no Departamento de Cirurgia da Santa Casa de São Paulo, no período de novembro de 1999 a fevereiro de 2003. RESULTADOS: A freqüência do aneurisma isolado das artérias ilíacas foi de 1,5% dos aneurismas abdominais operados no período do estudo. A faixa etária variou entre 56 e 80 anos, 33% dos doentes apresentavam aneurisma bilateral, e os diâmetros dos aneurismas variaram entre 2,0 e 8,5 cm. Em 83% dos casos, os pacientes encontravam-se sintomáticos no momento do tratamento. Em nenhum dos casos o aneurisma se encontrava roto. A via de acesso utilizada nos aneurismas unilaterais foi a extraperitoneal homolateral à dilatação e, nos aneurismas bilaterais, a transperitoneal, longitudinal ou transversa. Não dissecamos o segmento posterior das artérias ilíacas para clampeamento, para evitar a ocorrência de lesão venosa intra-operatória. Não observamos mortalidade no período peroperatório. Em todos os casos, preservamos pelo menos uma artéria ilíaca interna. CONCLUSÃO: A via de acesso para os aneurismas isolados das artérias ilíacas deve ser individualizada. A preservação de pelo menos uma artéria ilíaca interna constitui uma regra a ser observada, bem como deve-se evitar a dissecção circunferencial das artérias ilíacas no intra-operatório.OBJETIVE: To discuss clinical aspects and surgical treatment of a series of cases of isolated iliac artery aneurysms. METHODS: Protocol data and medical charts of 12 patients with diagnosis of isolated iliac artery aneurysm were retrospectively analyzed. The patients underwent surgery at the Department of Surgery of Santa Casa de São Paulo, from November 1999 to February 2003. RESULTS: Frequency of isolated iliac artery aneurysm was 1.5% of abdominal aneurysms who underwent surgery in the period under investigation. Age group ranged between 56-80 years, 33% of patients presented bilateral aneurysm, and aneurysm diameters ranged between 2.0-8.5 cm. In 83% of cases, the patients were symptomatic during treatment. Aneurysms were not ruptured in any case. Extraperitoneal approach ipsilateral to the dilatation was used in unilateral aneurysms, and transperitoneal approach, longitudinal or transverse, in bilateral aneurysms. We did not dissect the posterior segment of the iliac arteries for clamping, in order to avoid intraoperative venous lesion. There were no deaths during the surgery. In all cases, we preserved at least one internal iliac artery. CONCLUSION: Approach to isolated iliac artery aneurysms should be chosen on an individual basis. Preserving at least one internal iliac artery is a rule to be observed. Circumferential dissection of iliac arteries during the surgery should be avoided.

A embolização das artérias ilíacas internas é usualmente realizada durante a correção endovascular dos aneurismas aorto-ilíacos, visando prevenir a ocorrência de endoleak. Entretanto, é freqüente a associação desse procedimento com inúmeras seqüelas pós-operatórias, em decorrência da diminuição do fluxo sangüíneo pélvico. Em virtude disso, torna-se necessário o desenvolvimento de dispositivos e estratégias para a preservação das artérias ilíacas internas durante a correção endovascular dos aneurismas aorto-ilíacos. Descrevemos aqui o emprego pioneiro de uma endoprótese ramificada Helical Sidebranch (Cook) para a artéria ilíaca interna, realizado com sucesso técnico imediato e controle pós-operatório satisfatório.Embolization of internal iliac arteries is usually performed during endovascular repair of aortoiliac aneurysms, with the aim of preventing occurrence of endoleaks. However, the association of this procedure with several postoperative sequelae is frequent, due to reduced pelvic blood flow. For this reason, there is the need to develop devices and strategies to preserve internal iliac arteries during endovascular repair of aortoiliac aneurysms. In this study, we describe a pioneering use of a Helical Sidebranch (Cook) branched stent-graft to the internal iliac artery, which was performed with immediate technical success and satisfactory postoperative control.

OBJETIVO: La cirugía endovascular se ha establecido como una opción eficaz en el tratamiento de la enfermedad oclusiva ateroesclerótica de las arterias iliacas. Sin embargo, el uso de estos procedimientos para tratar otro tipo de lesiones aún no ha sido bien estudiado. Nuestro objetivo es analizar indicaciones y resultados del uso de endoprótesis en lesiones iliacas no oclusivas. MATERIAL Y MÉTODOS: Revisamos retrospectivamente los registros de 14 pacientes consecutivos, todos hombres, 61,6 años de edad en promedio (rango: 25-80) tratados por vía endovascular entre 2001 y 2006 por lesiones iliacas no oclusivas. El estudio pre y postoperatorio incluyó tomografía computada. El procedimiento se efectuó en quirófano, utilizando un angiógrafo digital. Se usó acceso femoral insertando endoprótesis tubulares. RESULTADOS: En 11 pacientes se asoció embolización de arteria hipogástrica ipsilateral. Las patologías tratadas fueron: ocho aneurismas ateroescleróticos, 3 disecciones, 2 lesiones traumáticas y un pseudoaneurisma anastomótico. La co-morbilidad más frecuente fue la hipertensión en 43% de los casos. No hubo mortalidad operatoria. Un paciente presentó un pseudoaneurisma femoral tratado con compresión. Un paciente tratado por fístula arteriovenosa traumática a nivel iliaco resuelve su insuficiencia cardiaca, con persistencia asintomática de mínimo flujo. La estadía postoperatoria fue de 3 días (mediana). No se presentaron otras endofugas iniciales o tardías. Durante un seguimiento promedio de 20,5 meses (rango 1 a 49), un paciente fallece por cáncer y ninguno ha requerido procedimientos complementarios. CONCLUSIÓN: El tratamiento endovascular de lesiones iliacas mediante endoprótesis es seguro y permite un resultado durable en el manejo de un amplio espectro de patologías.OBJETIVO: A cirurgia endovascular se estabeleceu como opção eficaz no tratamento da doença oclusiva aterosclerótica das artérias ilíacas. Entretanto, o uso desses procedimentos para tratar outros tipos de lesão ainda não foi bem estudado. Nosso objetivo é analisar indicações e resultados do uso de endoprótese em lesões ilíacas não-oclusivas. MATERIAL E MÉTODOS: Revisamos retrospectivamente os registros de 14 pacientes consecutivos, todos homens, com idade média de 61,6 anos (faixa: 25-80 anos), tratados por via endovascular entre 2001 e 2006 por lesões ilíacas não-oclusivas. O estudo pré e pós-operatório incluiu tomografia computadorizada. O procedimento foi realizado em bloco cirúrgico, utilizando um angiógrafo digital. Foi utilizado acesso femoral, com a inserção de endopróteses tubulares. RESULTADOS: Em 11 pacientes, houve embolização de artéria hipogástrica ipsilateral associada. As patologias tratadas foram: oito aneurismas ateroscleróticos, 3 dissecções, 2 lesões traumáticas e um pseudo-aneurisma anastomótico. A comorbidade mais freqüente foi hipertensão, em 43% dos casos. Não houve mortalidade operatória. Um paciente apresentou um pseudo-aneurisma femoral tratado com compressão. Um paciente tratado por fístula arteriovenosa traumática em nível ilíaco teve sua insuficiência cardíaca resolvida, com persistência assintomática de mínimo fluxo. A estada pós-operatória foi de 3 dias (média). Não se apresentaram outras endofugas inciais ou tardias. Durante um acompanhamento médio de 20,5 meses (faixa de 1 a 49 meses), um paciente morreu de câncer e nenhum requereu procedimentos complementares. CONCLUSÃO: O tratamento endovascular de lesões ilíacas através de endoprótese é seguro e permite um resultado durável no manejo de um amplo espectro de patologias.

The internal iliac artery (IIA) is one of the branches of the common iliac artery and supplies the pelvic viscera, the musculoskeletal part of the pelvis, the gluteal region, the medial thigh region and the perineum. During routine cadaveric dissection of a male cadaver for undergraduate Medical students, we observed variation in the course and branching pattern of the left IIA. The artery gave rise to two common trunks and then to the middle rectal artery, inferior vesicle artery and superior vesicle artery. The first, slightly larger, common trunk gave rise to an unnamed artery, the lateral sacral artery and the superior gluteal artery. The second, smaller, common trunk entered the gluteal region through the greater sciatic foramen, below the piriformis muscle and presented a stellate branching pattern deep to the gluteus maximus muscle. Two of the arteries forming the stellate pattern were the internal pudendal artery and the inferior gluteal artery. The other two were muscular branches. [ABSTRACT FROM AUTHOR]

OBJETIVO: Avaliar os efeitos da homocisteinemia induzida na artéria ilíaca de suínos. MATERIAL E MÉTODO: Realizou-se estudo experimental comparativo em dois grupos homogêneos de sete suínos da raça Macau, com peso entre 20 e 30 kg durante 30 dias. Os animais foram divididos em dois grupos, sendo um deles alimentado com metionina adicionada à dieta por um período de 4 semanas. Foram colhidas amostras de sangue para a dosagem de colesterol, triglicerídeos, HDL e homocisteína. Os animais foram submetidos à arteriografia para avaliação da perviedade das artérias ilíacas e, posteriormente, sacrificados. As artérias ilíacas foram enviadas para análise histológica. RESULTADOS: Os animais sobreviveram ao experimento, e não houve alterações significativas nos níveis de colesterol total, triglicerídeos e HDL nos dois grupos. O exame microscópico do grupo-controle não apresentou alterações patológicas e foi semelhante em todas as preparações examinadas. No grupo da dieta com metionina, as placas eram formadas por macrófagos espumosos, mas não foram observadas células musculares lisas, cristais de colesterol ou células inflamatórias. A túnica média apresentava-se com lâmina elástica interna íntegra. No grupo-controle, não houve alteração nos níveis de homocisteína durante o experimento. No grupo-metionina, houve aumento dos níveis séricos da homocisteína, com valor médio de 59,80 µmol/l após 30 dias de dieta rica em metionina. CONCLUSÃO: A homocisteinemia induzida pela metionina causa aterogênese nas artérias ilíacas de suínos.OBJECTIVE: To assess the effects of induced homocystinemia in the swine iliac artery. MATERIAL AND METHOD: A comparative experimental study with two homogeneous groups of seven pigs from the Macao specimen, weighed between 20 and 30 kg, which were assessed during 30 days. The pigs were divided into two groups. One of them was fed with a methionine-rich diet for a 4-week period. Blood samples were collected for analyses of total cholesterol, triglycerides, HDL and homocysteine concentrations. The animals were submitted to arteriography to evaluate the patency of iliac arteries and then sacrificed. The iliac artery segment was removed for histological analysis. RESULTS: All animals survived the procedure, and there were no significant changes in total cholesterol, triglycerides and HDL concentrations in both groups. Microscopic examinations of the control group did not show pathological changes and was similar in all analyses. In the group receiving the methionine diet, the plaques were formed by foamy macrophages, but smooth muscle cells, cholesterol crystals or inflammatory cells were not seen. The tunica media had the internal elastic lamina intact. In the control group, there was no change in homocysteine levels during the experiment. In the methionine group, there was an increase in plasma homocysteine levels, with an average value of 59.80 µmol/l after 30 days with a methionine-rich diet. CONCLUSION: Homocystinemia induced by methionine causes atherogenesis in the swine iliac artery.

Neste trabalho é apresentado um caso de coexistência de aterosclerose aorto-ilíaca com rim em ferradura, em um homem com 57 anos de idade. O diagnóstico desta combinação rara foi feito pouco antes da cirurgia, com a angio-ressonância magnética constituindo o método diagnóstico pré-operatório mais importante para o planejamento cirúrgico. A abordagem transabdominal proporciona uma exposição excelente da aorta abdominal em pacientes com rim em ferradura, sem risco de lesão das artérias renais acessórias ou de ureter em posição anômala. A reconstrução foi feita com a implantação de uma prótese de Dacron em Y em posição aorto-bifemoral e, por causa da lesão aterosclerótica difusa e na presença do rim em ferradura, foi optado por anastomose proximal término-lateral.Coexistence of aortoiliac arteriosclerosis with horseshoe kidney in a 57-year-old man is presented. Diagnosis of this unusual combination was made shortly before surgery. Magnetic resonance angiography is the most important preoperative diagnostic tool for surgical planning. A transabdominal approach provides excellent exposure of the abdominal aorta in patients with a horseshoe kidney without risk of injury to renal accessory arteries or to a ureter in an anomalous position. Implantation of an aorto-bifemoral Y prosthesis was made using a Dacron bifurcation. By diffuse atherosclerotic lesion and in presence of horseshoe kidney, an end-to-side proximal anastomosis of the aorta was carried out.

An emergency operation for access related acute critical limb ischemia with signs of infection is described. Inguinal femoral reconstruction was performed with a bifurcated graft constructed from the ipsilateral saphenous vein.Uma operação de emergência relacionada à isquemia aguda com sinais de infecção é descrita. Reconstrução femoral inguinal foi realizada com um enxerto bifurcado feito a partir da veia safena ipsilateral.

The corona mortis is an anatomical variation related to the anastomosis between the internal and external iliac blood vessels, through certain arteries and veins that form arches above and behind the superior pubic ramous. Serious hemorrhages can result from iatrogenic injury of these vessels. The study objective was to characterize the obturator vessels in a sample of Colombian cadavers, to determine their morphometric features and the frequencies in which the arterial and venous patterns are present. Hemipelvises of 14 cadavers from the dissection room of the Department of Morphology at the Universidad del Valle, in Cali, Colombia, were taken as sample. Once the dissection of the vessels related with the obturator canal and the pelvic surface of the superior pubic ramous was completed, their morphological features were determined and measurements were taken of their diameters and lengths. The arterial variations, corona mortis and aberrant obturator artery, were present in 35.7% of the hemipelvises and the venous variations in 82.1%. The corona mortis artery was only present in 3.6% of the hemipelvises and 32.1% presented an aberrant obturator artery. The mode of the absolute frequencies of the venous patterns was the corona mortis vein, present in 75.0% of the hemipelvises. The knowledge of the arterial and venous patterns of the obturator vessels and their anatomical variations for the Colombian population is very important in order to avoid causing any injury to them in the course of clinical and surgical procedures that have to do with the anterior pelvic ring and the inguinal region. [ABSTRACT FROM AUTHOR]

Iliac vein compression syndrome is a clinical condition in which the right common iliac artery extrinsically compresses the left common iliac vein. The syndrome predominantly affects young women between their 2nd and 4th decades of life. In view of the syndrome's potential complications, it should be recognized/diagnosed and treated in symptomatic patients before it causes irreversible damage to patients' venous systems. Noninvasive methods, such as venous color Doppler US are reasonable screening methods, but angiotomography and magnetic resonance angiography are more reliable diagnostic tools and the method of choice for confirmation of diagnosis remains multi-plane phlebography with measurement of pressure gradients. Endovascular treatment (angioplasty with placement of self-expanding stents) is safe and effective and can replace open surgical reconstruction and/or anticoagulation alone. [ABSTRACT FROM AUTHOR]

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved. [ABSTRACT FROM AUTHOR]

Se reportan 13 enfermas con ligadura de arterias hipogástricas de urgencia durante 1996 y 1998. Las causas más frecuentemente diagnosticadas fueron el cáncer de cuello uterino sangrante y la sepsis puerperal, en este último complementado con histerectomía abdominal. No se presentaron complicaciones en el procedimiento quirúrgico. Se obtuvieron óptimos resultados al controlar el sangramiento presente o evitar que éste se produjeraHypogastric artery ligation under emergency situations was applied in 13 female patients during 1996 and 1998. The most frequent causes were the bleeding cervix carcinoma and peripheral sepsis, the latter being combined with abdominal hysterectomy. No complications were found in the original procedure. Optimal results in controlling bleeding or preventing it were obtained

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Background: Endovascular treatment of peripheral arterial occlusive disease has become increasingly frequent in the past few years. Because it is a less invasive procedure, lower morbidity and mortality rates are associated with this form of treatment. Objectives: To describe the endovascular procedures performed in iliac arteries for the treatment of peripheral arterial occlusive disease. Methods: This retrospective study assesses 59 cases of iliac artery angioplasty performed according to a specific protocol from January 2004 to February 2010. Results: Mean age of patients was 62 years (minimum: 42, maximum: 89). Thirty seven were male (62.72%) and 22 female (37.28%). The main indications for treatment were moderate to severe intermittent claudication in 30 cases (50.84%) and rest pain or trophic lesions (critical ischemia) in 29 cases (49.15%). Postoperative follow-up included ankle-brachial index measurements and a duplex ultrasound at 30 days, 3 months, 6 months, 12 months, and every 6 months thereafter. Minimum follow-up time was 3 months, and maximum, 72 months (6 years), with primary and secondary patency rates of 91.37 and 94.82%, respectively. Conclusions: The results of this case series, combined with literature review results, allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous dissection of the iliac artery (SDIA) is an extremely rare clinical manifestation, associated to different etiologies, and it usually shows an ischemia of the involved lower extremity. Clinical case: We report a case of a 48-year-old man, with past medical history of chronicle consumption of ergotamine, which presented left lower limb ischemia, while practicing physical exercise. An emergent contrast-enhanced computed tomography scan showed a spontaneous dissection of the common and the external left iliac artery. An endovascular therapy of the lesion was performed with self-expanding stents, achieving the reconstruction of the lesion, the recovery of the blood flow and of the lower limb ischemia. Conclusions: There are no previous descriptions of the association between ergotamine consumption, sport and this very rare pathology. Endovascular treatment represents a less invasive and, such as in our case report, successful management of the SDIA, and it should be considered among the alternative therapies. [ABSTRACT FROM AUTHOR]

The persistent sciatic artery is a rare anatomical variation, with few cases described on the literature. It presents clinically as aneurysm formation, pulsate gluteal mass, acute or chronic limb ischemia and sciatic nerve compression. Diagnosis is confirmed by imaging methods: duplex scan, CT angiographt and magnetic resonance angiography. Treatment is indicated in symptomatic cases and when there is aneurysm formation and it is performed by ligation of the sciatic artery or endovascular embolization, associated with limb revascularization in the cases the sciatic artery is the main blood supply to the limb. We report the case of a 43 year-old female patient, ,with a false aneurysm of the sciatic artery confirmed by duplex scan and magnetic resonance angiography who had local pain and sciatic neuropathy due to neural compression. Surgical exploration was performed, with ligation of sciatic artery and thrombus removal. At the 12 months follow up there was significant pain relief and she was performing motor physical therapy to recover the neurological functions of the limb. [ABSTRACT FROM AUTHOR]

The persistent sciatic artery is a rare anatomical variation, with few cases described on the literature. It presents clinically as aneurysm formation, pulsate gluteal mass, acute or chronic limb ischemia and sciatic nerve compression. Diagnosis is confirmed by imaging methods: duplex scan, CT angiographt and magnetic resonance angiography. Treatment is indicated in symptomatic cases and when there is aneurysm formation and it is performed by ligation of the sciatic artery or endovascular embolization, associated with limb revascularization in the cases the sciatic artery is the main blood supply to the limb. We report the case of a 43 year-old female patient, ,with a false aneurysm of the sciatic artery confirmed by duplex scan and magnetic resonance angiography who had local pain and sciatic neuropathy due to neural compression. Surgical exploration was performed, with ligation of sciatic artery and thrombus removal. At the 12 months follow up there was significant pain relief and she was performing motor physical therapy to recover the neurological functions of the limb. [ABSTRACT FROM AUTHOR]