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Purpose: Catheter angiography remains essential to detect, characterize, and treat many vascular, traumatic, and neoplastic conditions affecting the pelvis, but the angiographic literature rarely mentions the common iliac artery (CIA) and its branches. The "normal" branches of the CIA principally consist of subangiographic rami supplying neighboring structures. Larger branches participate in the vascularization of the psoas muscle and the ureter. Less often, the CIA provides anomalous branches that complement or replace critical neighboring vessels. This study investigates the prevalence, type, and clinical relevance of CIA branches detectable during pelvic angiography. Methods: This study analyzes the prevalence of CIA branches in 100 consecutive angiograms that included bilateral CIA injections as well as selective catheterizations of the median sacral artery, both L4 ISAs, and both internal iliac arteries. CIA branches were classified as normal (i.e., neither supplementing nor replacing a normal artery), accessory (i.e., supplementing a normal artery), or aberrant (i.e., replacing a normal artery). Results: Forty-three branches arose from 38 CIAs (19% of CIAs) in 30 patients (30% of patients), including 20 normal branches (46.5%), 21 aberrant branches (48.8%), and 2 accessory branches (4.7%). Each of the 15 patients with aberrant branches had at least one anomalous vessel capable of providing a radicular or radiculomedullary artery. Conclusions: CIA branches were present in 30% of patients undergoing spinal angiography. While most normal branches were diminutive and clinically irrelevant, CIAs also provided vessels able to vascularize pelvic and vertebral structures, including the spinal cord or a spinal vascular malformation in 16% of cases. Our study therefore confirms that CIA injections represent an essential component of pelvic and spinal angiography. [ABSTRACT FROM AUTHOR]

An aortoenteric fistula (AEF) is an uncommon cause of gastrointestinal bleeding that requires prompt diagnosis and intervention owing to its high mortality rate. Moreover, iliac aneurysmo-colonic fistula is an exceptionally infrequent presentation. We report a unique case of a 71-year-old male presenting with hematochezia, later diagnosed with a primary fistula between a common iliac artery aneurysm and the sigmoid colon. Initially, the patient was misdiagnosed as having a gastrointestinal stromal tumor, leading to delayed and emergent surgical intervention due to massive bleeding 2 days later. This case is particularly notable for its rarity, misinterpretation of the initial diagnosis, complicated surgical procedures, and development of complications including ischemic myopathy. This case highlights the criticality of accurate diagnosis with a high index of suspicion, significance of consultation with a vascular surgeon for vascular abnormalities, and importance of considering ischemic time in the sequence of surgical treatments to ensure timely and appropriate management. [ABSTRACT FROM AUTHOR]

Introduction: Iliac aneurysms occur in 10% of patients with abdominal aortic aneurysms (AAA). There are three different endovascular approaches to their treatment in the context of infrarenal Endovascular Aortic Aneurysm Repair (EVAR): occlusion by coiling the internal iliac, incorporation using an iliac branch device, and delaying repair using a bell bottom limb. We sought to determine outcomes associated with these three strategies in our practice. Methodology: The study was a combined prospective cohort study with a retrospective arm: prospective patient recruitment was done for 1 year from September 2019 and ended by September 2020, and retrospective data was collected from 2017 to 2019. Demographic, procedural, and imaging data was collected. SPSS was used to analyze data as patients were classified by limbs in four groups: iliac branched, bell bottom, coil and cover technique, and standard treated limbs. Results: There were 65 male and 4 female patients included in this study incorporating 137 limbs with a mean age of 78 years (SD ± 8 years). Two patients died after discharge (at 3 and 21 months postoperatively, without hospital admission) and five patients were lost to long-term follow-up. Three patients had operations that deviated from the plan: one was an IBD converted to bell bottom, one was an IBD that was converted to coil and cover, and one was a bell bottom that did not seal. Follow-up revealed late type IB endoleak in three bell bottom limbs and one limb treated with coil and cover. Common iliac occlusion occurred in one IBD, three bell bottom limbs, and two limbs treated with coil/cover technique. There were four additional ischemic events (buttock claudication in three and intestinal ischemia in one): all ischemic events occurred in the coil and cover group (p =.001). Conclusions: Given the small population size examined in this study, there is no statistical difference between treatment groups; however, there was a trend toward bell bottom technique being associated with higher incidence of type IB endoleak. Coil and cover technique was associated with decreased IB endoleak; however, Buttock claudication and intestinal ischemia occurred more significantly in this group. Using IBD may be the best strategy to improve short- and long-term outcomes in patients with iliac aneurysms. [ABSTRACT FROM AUTHOR]

Purpose: To describe snare-assisted vessel targeting to selectively overcome a dissection in the iliac bifurcation and gain antegrade access to the hypogastric artery (HA). Technique: The technique is demonstrated in a 64-year-old woman with an asymptomatic Crawford type III thoracoabdominal aneurysm. A 2-stage endovascular repair, consisting of a thoracic endovascular aortic repair (TEVAR) and a branched endovascular aortic repair was planned. In the control angiography after TEVAR, a disrupted plaque with consequent dissection in the right iliac bifurcation was detected. The perfusion of the common iliac artery and external iliac artery resulted impaired. The targeting of the right HA through a contralateral antegrade approach failed, whereas an ipsilateral retrograde approach was possible but unsuitable for therapeutic purposes. Using the catheter of the retrograde ipsilateral access, a snare from a contralateral crossover was cached and dragged into the HA, allowing the targeting of the vessels and further endovascular therapy with angioplasty and stenting. Follow-up 8 months postoperatively demonstrated the patency of the stents and well-preserved perfusion in the right iliac bifurcation. Conclusion: The snare-dragging technique can be used to gain access to vessels presenting challenging conformations or dissections. This application may be a valuable support for complex endovascular treatment in a variety of patients. Clinical Impact: The snare-dragging technique can be used to gain access to vessels presenting challenging conformations or dissections. It allows the catheterization to be establish from the easiest and safest approach and then "transferred" from one access to the other. It avoids the risk of repeated loss of catheterization due to unstable and unfavorable working angles, and it saves time and radiation. It permits different material combinations, adapting to the available resources and materials. We believe that the current technique may increase the strategy spectrum available for endovascular therapy and complex endovascular procedures. [ABSTRACT FROM AUTHOR]

Internal iliac artery aneurysms are a relatively uncommon condition that can have serious consequences if left untreated. This paper presents a case of erectile dysfunction caused by thrombosis of the internal iliac artery aneurysms in a 52-years-old male patient with common iliac and internal iliac artery aneurysms. Following the intracavernous selfinjection treatment, the patient’s complaints about erectile dysfunction ceased. Aneurysms were monitored closely. To the best of our knowledge, this represents the first case of erectile dysfunction being presented as a consequence of thrombosed iliac artery aneurysms. Erectile dysfunction itself is not a life-threatening condition. However, it should be highlighted that erectile dysfunction can be a sign of life-threatening iliac artery diseases, as in this case. Therefore, it is crucial to recognize the potential seriousness of this condition and to investigate it thoroughly. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the technical feasibility, safety, and early outcomes of a snare-less, endovascular abdominal aortic aneurysm repair (EVAR)-first technique (SET) for iliac branch endoprosthesis (IBE) placement. Methods: We retrospectively reviewed all patients who received IBEs between July 2018 and March 2022. Patients were divided into 2 categories based on method of IBE deployment: SET or Standard. Primary endpoints were technical success, major adverse events, mortality, reintervention, internal iliac artery (IIA) patency, and freedom from IIA branch instability. Technical success was defined by successful deployment of both the EVAR and the IBE with maintained patency of the IIA and no stent graft migration. Results: There were 20 patients (90% male, median age 72 [65.4-74.5] years) who underwent IBE placement. Among these, 5 (33.3%) underwent SET to treat 5 common iliac artery (CIA)/IIA aneurysms, while the remaining 15 (66.7%) underwent standard IBE deployment with through-and-through femoral access (n=13) or trans-brachial access (n=2) to treat 19 CIA/IIA aneurysms. Overall median renal to iliac bifurcation length was 169 (152-177) mm, with 9 patients falling short of the minimum of 165 mm for on-label IBE placement. Median contrast used was 148 (120-201) mL, fluoroscopy time 42.8 (35.0-49.8) minutes, estimated blood loss 200 (100-275) mL, and procedure time 192 (167-246) minutes, with no significant differences between the 2 groups. Technical success was achieved in 100% of cases. At 30 days, there were no mortalities or major adverse events in either group; there were 100% IIA patency, no IIA instability, and no reinterventions in both groups. Median follow-up in the SET group was 5.7 (5.5-6.2) months, with 1 death at 6 months and 1 type 1B endoleak at 6 months requiring reintervention. Median follow-up for the Standard group was 1.6 (0.8-2.1) years with 2 non–aneurysm-related deaths and no reinterventions at 1 year. Conclusions: SET for IBE is a safe and effective approach that decreases technical complexity and mitigates anatomic barriers to IBE placement. Clinical Impact: SET for IBE is a safe and effective approach to IBE placement that decreases technical complexity. A critical component to this technique is a large bore sheath with a stiff steerable tip. Importantly, this approach also mitigates anatomic barriers to IBE placement, expanding applicability of IBE technology to patients who may be otherwise ineligible. [ABSTRACT FROM AUTHOR]

Purpose: Measure out of the standard interval in the aorta diameter is a clue for aortic aneurysm or hypoplasia. Pediatric studies focusing specifically on the normal diameter of the abdominal aorta (AA) were limited in the literature. Therefore, the main goal of this work was to determine changes in the effective diameter of AA in healthy children aged 1–18 years for diagnosis of vascular diseases. Methods: This retrospective work focused on abdominopelvic computed tomography views of 180 children (sex: 90 males / 90 females, average age: 9.50 ± 5.20 years) without any abdominopelvic disease to measure diameters of AA, common iliac artery (CIA), external iliac artery (EIA), and first lumbar vertebra (L1). Results: Vessel and vertebra diameters increased in pediatric subjects between 1 and 18 years (p < 0.001). Considering pediatric age periods, vessel diameters increased steadily, but L1 diameter showed an irregular growth pattern between age periods. All parameters were greater in males than females (p < 0.05), except from effective diameters of AA over the coeliac trunk (p = 0.084) and over the renal artery (p = 0.051). The ratios of diameters of vessels to L1 increased depending on ages between 1 and 18 years. Considering pediatric age periods, the ratios increased from infancy period to postpubescent period in irregular pattern; however, the ratios for right and left CIA, and AA over the aortic bifurcation did not alter after late childhood period. All ratios for males were similar to females (p > 0.05). Conclusion: Our age-specific ratios may be beneficial for surgeons and radiologists for the diagnosis of vascular disorders such as aortic aneurysm. [ABSTRACT FROM AUTHOR]

Adverse iliofemoral anatomy may preclude complex endovascular aortic aneurysm repair (EVAR). In our practice, staged iliofemoral endoconduits (ECs) are planned prior to complex EVAR to improve vascular access and decrease operative time while allowing the stented vessel to heal. This study describes the long-term results of iliofemoral ECs prior to complex EVAR. Between 2012 and 2023, 59 patients (44% male; median age, 75 ± 6 years) underwent ECs before complex EVAR using self-expanding covered stents (Viabahn). For common femoral artery (CFA) disease, ECs were delivered percutaneously from contralateral femoral access and extended into the CFA to preserve the future access site for stent graft delivery. Internal iliac artery patency was maintained when feasible. During complex EVAR, the EC extended into the CFA was directly accessed and sequentially dilated until it could accommodate the endograft. Technical success was defined as successful access, closure, and delivery of the endograft during complex EVAR. Endpoints were vascular injury or EC disruption, secondary interventions, and EC patency. Unilateral EC was performed in 45 patients (76%). ECs were extended into the CFA in 21 patients (35%). Median diameters of the native common iliac, external iliac, and CFA were 7 mm (interquartile range [IQR], 6-8 mm), 6 mm (IQR, 5-7 mm), and 6 mm (IQR, 6-7 mm), respectively. Internal iliac artery was inadvertently excluded in 10 patients (17%). Six patients (10%) had an intraoperative vascular injury during the EC procedure, and six patients (10%) had EC disruption during complex EVAR, including five EC collapses requiring re-stenting and one EC fracture requiring open cut-down and reconstruction with patch angioplasty. In 23 patients (39%), 22 Fr OD devices were used; 20 Fr were used in 22 patients (37%), and 18 Fr in 14 patients (24%). Technical success for accessing EC was 89%. There was no difference in major adverse events at 30 days between the iliac ECs and iliofemoral ECs. Primary patency by Kaplan-Meier estimates at 1, 3, and 5 years were 97.5%, 89%, and 82%, respectively. There was no difference in primary patency between iliac and iliofemoral ECs. Six secondary interventions (10%) were required. The mean follow-up was 34 ± 27 months; no limb loss or amputations occurred during the follow-up. ECs improve vascular access, and their use prior to complex EVAR is associated with low rates of vascular injury, high technical success, and optimal long-term patency. Complex EVAR procedures can be performed percutaneously by accessing the EC directly under ultrasound guidance and using sequential dilation to avoid EC disruption. [ABSTRACT FROM AUTHOR]

Background: The internal iliac artery (IIA) originates from the common iliac artery at the level of the sacroiliac joint and bifurcates between the L5 and S1 vertebrae. The aim of the present meta-analysis was to demonstrate the most up-to-date and evidence-based data regarding the general anatomy of the IIA, including their variations, length, and diameter. Materials and methods: Major online medical databases such as PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to find all studies considering the anatomy of the IIA. Eligibility assessment and data extraction stages were performed. Results: In the general population the pooled prevalence of Type I (The superior gluteal artery arises independently with the inferior gluteal and internal pudendal arteries arising from a common trunk which dividing inside [Type IA] or outside [Type IB] pelvic cavity) was found to be 56.57% (95% CI: 53.00–60.10%). The pooled mean length of the IIA was 39.95 mm (SE = 1.79) in the overall population. The pooled mean diameter of the IIA was found to be 6.86 mm (SE = 0.27). Conclusions: The IIA is responsible for supplying most of the structures located in the pelvis. Hence, it is crucial to be aware of the possible variants of the said vessel. The results presented in our study may be highly significant in various surgical procedures performed in that region. [ABSTRACT FROM AUTHOR]

Background: Arterial morphology varies and changes with increasing age. This may challenge the success of endovascular procedures and influence candidate selection. The study aimed to determine the mean dimensions, tortuosity severity, and tortuosity phenotype of the iliofemoral pathway of adult males and females from a South African sample. Furthermore, the relationship between increased age and changes in vessel morphology was investigated. Design: A retrospective cross-sectional study was conducted using a sample of 224 (117 males and 107 females) computed tomography angiograms of patients hospitalized due to traumatic injuries (aged 18–80 years), accessed from Tygerberg Hospital, Cape Town, South Africa. Methods: The arterial lengths and lumen diameters of the common iliac (CIA), external iliac (EIA), and femoral arteries (FA) were measured. Tortuosity severity was described by visual estimation and quantified using the tortuosity index (TI) and inflection count metric (ICM). The data were compared between right and left sides of the body, the sexes, and age categories. Results: On average, the common iliac artery was the widest (9.50 ± 1.53 mm), while the external iliac artery was the longest (110.89 ± 16.04 mm). Bilateral asymmetries were observed. Arterial diameters were larger in males. Regression analysis revealed a strong positive relationship between arterial tortuosity and increasing age, particularly in females. Tortuosity was most frequently observed in the external iliac artery. However, the c-shaped curving tortuosity phenotype was observed in all three arteries investigated. Conclusion: The morphology of the iliofemoral arterial pathway varied bilaterally, between the sexes, and with increased age. These findings align with previous studies, noting the variable morphology of the iliofemoral pathway, in countries outside of Sub-Saharan Africa. Sex- and age-specific descriptions of arterial anatomy may enhance the safety of endovascular procedures and interventions. These descriptions contribute towards the development of a reference database of typical arterial anatomy in South Africa, ultimately assisting with patient selection and the identification of vascular pathologies.

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 (p0.05). 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. [Med-Science 2023; 12(4.000): 1030-5]

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]

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]

Purpose: The purpose of this report is to describe the use of a double-branched custom-made iliac branch device (IBD) for the endovascular repair of an aorto-bi-iliac aneurysm with concomitant bilateral hypogastric aneurysms. Technique: A 61-year-old man on peritoneal dialysis underwent a computed tomography (CT) of the infrarenal aorta before planned kidney transplantation. The CT showed an asymptomatic aorto-bi-iliac aneurysm of 54 mm involving the hypogastric artery (HA) bilaterally (right HA 31 mm; left HA 40 mm). The treatment consisted of an endovascular aortic repair (EVAR) and the bilateral implantation of custom-manufactured IBDs with double inner branches to preserve both superior and inferior gluteal arteries. At 1 year follow-up, the patient remains free of symptoms and the postoperative CT showed a successfully excluded aneurysm with patent bridging stent grafts to all HA branches. Conclusion: The bilateral implantation of double-branched IBDs is a feasible technique. Preservation of both hypogastric arteries and its branches can be achieved with this technique and therefore decrease the risk of buttock claudication and other ischemic complications. [ABSTRACT FROM AUTHOR]

Objective To explore the distribution of iliac vessels in the anterior lower lumbar spine using CT angiography, and to provide vascular anatomical references for anterior lower lumbar surgery. Methods Select 100 male and 100 female patients who underwent abdominal CT angiography at Guizhou Provincial People′s Hospital from June 2016 to November 2018 for observation and measurement research;（1）Observe and record the distribution of the bifurcation points of the abdominal aorta and the confluence points of the common iliac vein;（2）Measure the distance from the vertex of the angle between the left common iliac vein and the right common iliac artery to the upper edge of the L5-S1 intervertebral space, and the distance between the left common iliac vein and the inner edge of the right common iliac artery at the upper and lower edges of the L5-S1 intervertebral space. Results （1）64% of the L4 vertebral body is flat at the bifurcation point of the abdominal aorta. The confluence point of the common iliac vein accounts for 42% of the L4 vertebral body and 40% of the L4-5 intervertebral space.（2）Abdominal aortic bifurcation angle：（51.01 ± 9.24）° for males, （50.51 ± 7.92）° for females;The confluence angle of the common iliac vein is（58.82 ± 11.81）° for males and（62.47 ± 12.46）° for females;The angle between the left common iliac vein and the right common iliac artery is（64.92 ± 12.07）° for males and（68.73 ± 13.87）° for females. （3）When the confluence point of the common iliac vein is level with the L4 vertebral body, L4 5 intervertebral space, and L5 vertebral body：① The distance from the vertex of the angle between the left common iliac vein and the right common iliac artery to the upper edge of the L5-S1 intervertebral space is（26.51 ± 8.11）mm, （16.18 ± 6.70）mm, and（7.82 ± 4.26）mm, respectively;② The distances between the left common iliac vein and the medial edge of the right common iliac artery from the L5-S1 intervertebral space are（32.52 ± 9.95）mm, （28.63 ± 11.48）mm, and（16.27 ± 7.71）mm, respectively The distance between the left common iliac vein and the inner edge of the right common iliac artery at the lower edge of the L5-S1intervertebral space is（43.88 ± 9.86）mm, （41.55 ± 11.05） mm, and（33.17 ± 9.40） mm, respectively. ④ The area of the "iliac vascular triangle" is （486.32 ± 246.26）mm2, （263.94 ± 178.47）mm2, and（85.49 ± 71.45）mm2, respectively The surgical windows for the L5-S1 intervertebral space are（496.98 ± 114.48）mm2, （488.89 ± 127.69）mm2, and（344.32 ± 166.63）mm2, respectively. Conclusion （1）There are significant anatomical changes at the bifurcation point of the abdominal aorta and the confluence point of the common iliac vein;The bifurcation point of the abdominal aorta is mostly flat on the L4 vertebral body, and the confluence point of the common iliac vein is mostly flat on the L4 vertebral body and the L4-5 intervertebral space.（2）When the confluence point of the common iliac vein is level with the L4 vertebral body, there is sufficient vascular safety zone in front of the lower lumbar spine for surgical operation;When the confluence point of the common iliac vein is located in the L4-5 intervertebral space, there is a certain vascular safety zone in front of the lower lumbar spine for surgical operation;When the confluence point of the common iliac vein is flat on the L5 vertebral body, the safety zone of the anterior blood vessels of the lower lumbar spine cannot meet the surgical requirements at this time.（3）When the confluence point of the common iliac vein is level with the L4 vertebral body and the L4-5 intervertebral space, there is sufficient surgical vascular safety zone in the anterior L5-S1 intervertebral space, but the vascular safety zone is gradually reduced. Preoperative CT angiography examination to clarify the vascular safety zone is helpful for surgical safety. [ABSTRACT FROM AUTHOR]

Background: Iliac arteries are commonly affected by occlusive atherosclerotic disease, leading to arterial insufficiency and lower extremity symptoms. Atherosclerosis in the iliac region often coexists with pathologies below the inguinal ligament. Aims: This study aimed to compare the effectiveness of unilateral common iliac artery stenting versus bilateral kissing stents in terms of clinical and technical success for treating unilateral common iliac artery ostial lesions. Method: A prospective study (October 2022-April 2023) that included 40 patients randomly assigned to two groups. Group A received bilateral kissing stents, while group B underwent unilateral common iliac artery stenting. Clinical evaluation, technical success, and complications were assessed over six months. Results: Technical success rate was 100 % in groups A and B, six months primary patency rate in group A was 95% had patent stent with good inflow while 5% had claudication at 100 M, treated by a balloon expandable stent. While in group B, 85% had patent stent with good inflow while 5% had claudication at 100 M, treated by balloon expandable stent, 5% had renal failure, congested heart failure and died, and 5% neglected medication. DFI occurred, sepsis and AKA was done as a lifesaving. Conclusion: Unilateral common iliac artery stenting demonstrated comparable clinical outcomes, technical success, and complication rates to bilateral kissing stents. It provides a safe and effective alternative for treating unilateral common iliac artery ostial lesions. [ABSTRACT FROM AUTHOR]

Ventricular septal defect (VSD) is a known complication after myocardial infarction associated with high mortality. Extracorporeal membrane oxygenation (ECMO) is being successfully used in patients with VSD as a bridge to definitive surgical repair. Although often the only possibility to stabilize hemodynamics and oxygenation, ECMO has many potential complications, carrying significant morbidity and mortality. Here, the patient presented with a postinfarct VSD on peripheral venoarterial ECMO who developed a dissection of the common iliac artery (CIA) on the 5th day after ECMO implantation. As a result, a sudden drop in ECMO flow has become evident along with high pressures in the arterial cannula. After a definitive diagnosis of a CIA lesion obstructing the blood flow was made, trans-ECMO endovascular repair of CIA was performed. Four days after endovascular repair, we encountered the same problem of decreased blood flow associated with stent kinking and were approached with another endovascular repair to re-establishing full ECMO flow. [ABSTRACT FROM AUTHOR]

It has been suggested that covered stents (CS) may lower restenosis rates compared with bare metal stents (BMS) after endovascular treatment of the common iliac artery. This trial aimed to provide additional evidence on the efficacy of CS vs. BMS in the common iliac artery. This multicentre, randomised, single blind controlled superiority trial compared balloon expandable CS and balloon expandable BMS for advanced atherosclerotic lesions in the common iliac artery; this was defined as a stenosis > 3 cm in length or occlusion. The primary end point was freedom from binary restenosis after two years of follow up. The study was conducted according to the principles of the Declaration of Helsinki (version: October 2008) and registered with the Dutch Trial register (NTR3381). One hundred and seventy-four limbs were included between 2012 and 2019 with 87 limbs in each group. Six patients crossed over from the BMS group to the CS group but were analysed according to an intention to treat principle. Freedom from binary restenosis after two years of follow up was 84.7% (95% CI 76.7 – 92.7%) in the BMS group and 89.1% (95% CI 82.4 – 95.8%) in the CS group (p =.40). Freedom from occlusion was 95.0% (95% CI 90.3 – 95.7%) in the BMS group and 96.4% (95% CI 92.5 – 100%) in the CS group (p =.66). Freedom from target lesion revascularisation was 91.1% (95% CI 84.8 – 97.3%) and 95.2% (95% CI 90.7 –99.7%), respectively (p =.31). Technical success, complications, haemodynamic success, and clinical success were also comparable between both groups. Per-protocol analysis did not affect the outcomes of the study. No difference was found between balloon expandable CS and BMS for treating advanced atherosclerotic lesions of the common iliac artery. [ABSTRACT FROM AUTHOR]

Background: Instead of only practicing these perfectly matched end-to-side anastomoses in microsurgical laboratories, we must learn how to perform these so-called “imperfect” end-to-side anastomoses in the laboratory.MethodsThree types of end-to-side microvascular anastomoses using the rat common iliac artery (CIA), one with the proximal end of the CIA to the contralateral side of the CIA, another with the distal end of the CIA to the contralateral side of the CIA, and the third with the distal end of the CIA to the ipsilateral side of the common iliac vein (CIV), were presented to simulate different end-to-side anastomosis situations in a microsurgical laboratory. Diameters of CIA and CIV, distances between temporary clips, the length of arteriotomy or venotomy, and the distribution of stitches were recorded. The patency rates were evaluated immediately after the anastomosis was completed and 30 min later. After animal euthanasia, the donor vessel was cut close to the anastomotic site, and the orifice size and intimal attachment were evaluated by inspecting them through inside the vessel.ResultsThe diameters of the CIA and CIV were 0.8–1.2 mm and 1.2–1.5 mm, respectively. The end-to-side microvascular anastomosis arteriotomy or venotomy is approximately 2.00–2.50 mm, the distance between the aneurysm clips on the recipient CIA or CIV is approximately 4.00–7.00 mm, and the distance between the corner of the arteriotomy or venotomy and the temporary aneurysm clip was 1.00–3.00 mm. Three types of end-to-side anastomoses using the CIA were successfully performed, and 100% patency rates were achieved immediately and 30 min postoperatively. Good distribution of stitches, wide orifice, and intimal attachment were recorded in the study in all groups.ConclusionsThree types of end-to-side anastomoses using rat CIAs could be efficiently used to mimic three different anastomotic situations.

Purpose: Nickel-titanium (nitinol) alloys possess a special set of properties that allow for a wide range of applications. Specifically, the transformation temperature for self-expanding nitinol peripheral stents allows for easy crimping at or below room temperature and reformation at body temperature becoming superelastic. Case Report: We report the case of an elderly man with iliac stenting 1 month prior, who presented several weeks after recovering from coronavirus disease 2019 with recurrent anterior-wall ST-elevation myocardial infarction. This was complicated by deformation and infolding of the previously implanted nitinol self-expanding stent in his right common iliac artery (CIA). Understanding nitinol's specific properties, we proceeded with rapid injections of iced saline to cool the nitinol stent to its transformation temperature while nudging the distal end of the stent with a partially inflated balloon. This maneuver softened the nitinol stent, allowing us to "unfold" and reappose it against the wall of the right CIA, resulting in successful restoration of the original shape of the nitinol self-expanding stent. Conclusion: This represents the first reported case describing treatment of an infolded nitinol self-expanding peripheral stent by exploiting the transformation temperature of nitinol using iced cold saline to successfully restore the stent's original shape and structure. [ABSTRACT FROM AUTHOR]

Abstract Background Peripheral arterial disease is a progressive atherosclerotic disease with symptoms ranging from an intermittent claudication to acute critical limb ischemia and amputations. Drug-coated balloons and stents were developed to prevent neo-intimal proliferation and restenosis after percutaneous transluminal angioplasty. Randomized controlled trials showed that drug-coated, notably paclitaxel-coated, devices reduce restenosis, late lumen loss, and the need for target lesion re-vascularization compared with uncoated ones. However, the size of these trials was too small to prove superiority for “hard” clinical outcomes. Moreover, available studies were characterized by too restrictive eligibility criteria. Finally, it remains unclear whether paclitaxel-coated balloons may impair long-term survival. Alternative drug-coated balloons, the so-called limus-based analogs, have been approved for clinical use in patients with peripheral arterial disease. By encapsulating sirolimus in phospholipid drug nanocarriers, they optimize adhesion properties of sirolimus and provide better bioavailability. Methods In this investigator-initiated all-comer open-label phase III randomized controlled trial, we will evaluate whether sirolimus-coated balloon angioplasty is non-inferior and eventually superior, according to a predefined hierarchical analysis, to uncoated balloon angioplasty in adults with infra-inguinal peripheral arterial disease requiring endovascular angioplasty. Key exclusion criteria are pregnancy or breastfeeding, known intolerance or allergy to sirolimus, and participation in a clinical trial during the previous 3 months. The primary efficacy outcome is the composite of two clinically relevant non-subjective “hard” outcomes: unplanned major amputation of the target limb and endovascular or surgical target lesion re-vascularization for critical limb ischemia occurring within 1 year of randomization. The primary safety outcome includes death from all causes. Discussion By focusing on clinically relevant outcomes, this study will provide useful information on the efficacy and safety of sirolimus-coated balloon catheters for infra-inguinal peripheral arterial disease in a representative (“all-comer”) population of unselected patients. As regulatory agencies had raised safety concerns in patients exposed to paclitaxel-coated devices (versus uncoated ones), collect mortality data up to 5 years after randomization will be collected. Trial registration ClinicalTrials.gov NCT04238546

BACKGROUND: Aging is accompanied by a progressive decline in the structure and function of multiple organs. The structure and function of arterial vessels are impaired during the aging process. OBJECTIVE: To observe the effect of aging on the ultrastructure of arterial wall. METHODS: Five adult Sprague-Dawley rats and five aged Sprague-Dawley rats were selected. The common iliac artery of the rats was taken under anesthesia and fixed in glutaraldehyde, and the ultrasonography of the intima and media of the common iliac artery was observed using a transmission electron microscope. RESULTS AND CONCLUSION: The connection between endothelial cells of the common iliac artery in adult rats was normal, while there was a relatively large gap between endothelial cells of the common iliac artery in aged rats. Smooth muscle cells of the common iliac artery in adult rats exhibited a contractile phenotype, and there were many elastic fibers in the extracellular matrix; in aged rats, smooth muscle cells presented with a synthetic phenotype, and the number of collagen fibers in the common iliac artery was significantly increased. Dead endothelial cells and smooth muscle cells, characterized by chromatin degradation and cell lysis, were observed in the common iliac artery of aged rats, whilst no cell death was observed in adult rats. These findings indicate that the intima of the common iliac artery is thickened, smooth muscle cells present with a synthetic phenotype, the number of elastic fibers is reduced and the number of collagen fibers is increased in aged rats compared with adult rats. [ABSTRACT FROM AUTHOR]

Complete resection for retroperitoneal sarcoma (RPS) involving major vessels frequently requires vascular resection and reconstruction. The use of artificial grafts often leads to postoperative vascular graft infection (VGI), which usually requires reoperation and sometimes leads to death. In the present study, the data of RPS patients who underwent contralateral iliac artery (IIA) transposition for reconstruction of the common iliac artery (CIA) after RPS resection from 2015–2019 were retrospectively analyzed. Clinical, intraoperative, and postoperative outcomes were described. Contralateral IIA transposition was performed to reconstruct the CIA after segmental resection in three patients. All patients underwent concomitant organ resection. Colon resection was performed for all patients, nephrectomy was performed for two patients, and segmental resection of the left ureter with transurethral ureterostomy was performed for one patient. Complete resection was achieved in all patients, and microscopic tumor infiltration to the CIA was observed in all patients (tunica adventitia: 2, tunica media: 1). No major complications occurred during the hospital stay. During the follow-up period (6.0–29.1 months), one patient died from tumor recurrence, and the other two patients did not have any evidence of recurrence or metastatic disease at the latest follow-up. The level of lower limb function was favorable (MSTS93 scores: 28–30). The pelvic organ functions, including bowel, bladder, and sexual functions, were not impaired in any of the patients. This novel technique in which contralateral IIA transposition is performed to reconstruct the CIA after RPS resection is simple and reliable and may be a good alternative to artificial grafts. [ABSTRACT FROM AUTHOR]

Background: Peripheral arterial disease is a progressive atherosclerotic disease with symptoms ranging from an intermittent claudication to acute critical limb ischemia and amputations. Drug-coated balloons and stents were developed to prevent neo-intimal proliferation and restenosis after percutaneous transluminal angioplasty. Randomized controlled trials showed that drug-coated, notably paclitaxel-coated, devices reduce restenosis, late lumen loss, and the need for target lesion re-vascularization compared with uncoated ones. However, the size of these trials was too small to prove superiority for "hard" clinical outcomes. Moreover, available studies were characterized by too restrictive eligibility criteria. Finally, it remains unclear whether paclitaxel-coated balloons may impair long-term survival. Alternative drug-coated balloons, the so-called limus-based analogs, have been approved for clinical use in patients with peripheral arterial disease. By encapsulating sirolimus in phospholipid drug nanocarriers, they optimize adhesion properties of sirolimus and provide better bioavailability.Methods: In this investigator-initiated all-comer open-label phase III randomized controlled trial, we will evaluate whether sirolimus-coated balloon angioplasty is non-inferior and eventually superior, according to a predefined hierarchical analysis, to uncoated balloon angioplasty in adults with infra-inguinal peripheral arterial disease requiring endovascular angioplasty. Key exclusion criteria are pregnancy or breastfeeding, known intolerance or allergy to sirolimus, and participation in a clinical trial during the previous 3 months. The primary efficacy outcome is the composite of two clinically relevant non-subjective "hard" outcomes: unplanned major amputation of the target limb and endovascular or surgical target lesion re-vascularization for critical limb ischemia occurring within 1 year of randomization. The primary safety outcome includes death from all causes.Discussion: By focusing on clinically relevant outcomes, this study will provide useful information on the efficacy and safety of sirolimus-coated balloon catheters for infra-inguinal peripheral arterial disease in a representative ("all-comer") population of unselected patients. As regulatory agencies had raised safety concerns in patients exposed to paclitaxel-coated devices (versus uncoated ones), collect mortality data up to 5 years after randomization will be collected.Trial Registration: ClinicalTrials.gov NCT04238546. [ABSTRACT FROM AUTHOR]

Introduction: Brucella is a genus of aerobic Gram negative bacteria that causes the disease brucellosis. It is considered a zoonotic infection transmitted to humans by ingestion of unpasteurised dairy products. Although aortic involvement is rarely seen, it can be a life threatening complication of this disease. This case report describes a ruptured aneurysm of the common iliac artery (CIA) due to secondary infection by Brucella melitensis. Report: A 79 year old man with a known isolated aneurysm of the CIA presented with acute abdominal pain. Contrast enhanced computed tomography (CT) revealed rupture of the aneurysm. The patient underwent prompt endovascular repair. Several weeks after an uneventful recovery, the patient presented with spiking fever and abdominal discomfort. CT revealed an abscess anterior to the CIA. Blood and pus cultures grew B. melitensis. In recurrent re-admissions, conservative antibiotic therapy proved to be insufficient. Eventually, neo-aorto-iliac system (NAIS) reconstruction using bilateral femoral veins was performed to provide definitive treatment four months after initial presentation. Conclusion: Although Brucella infected aneurysms are rare, they are associated with life threatening disease. Diagnosing this type of brucellar infection can be challenging owing to the long incubation time needed for blood and tissue cultures. Definitive treatment of these aneurysms often needs open surgery and antibiotics for complete treatment. Vigilant surveillance is required to monitor for post-operative complications such as graft infection, recurrent (false) aneurysm, and abscess formation.

Purpose: Migration is a major cause of reintervention after endovascular aneurysm repair (EVAR). In patients with common iliac artery (CIA) dilation due to proximal migration of the iliac limb, internal iliac blood flow can be preserved by implanting an iliac branch device (IBD). Case Report: In this report, we discuss the case of a patient in whom the bilateral limbs were completely displaced into the aortic aneurysm due to proximal migration of the iliac limb after EVAR. By taking advantage of the characteristics of this migration, we formed a pull-through wire through the native terminal aorta without passing through the flow divider of the stent graft, and the IBD was deployed safely. Conclusion: The present case indicates that the preservation of at least 1 internal iliac artery is possible in patients with CIA dilation due to proximal migration of the iliac limb. However, the unique features of each case must be considered to determine the appropriate approach. [ABSTRACT FROM AUTHOR]

Aortoiliac occlusive disease (AIOD), especially proximal to the transplant artery, in kidney transplant patient activates the renin-angiotensin-aldosterone system by limiting graft renal perfusion and causes symptoms that can occur with transplant renal artery stenosis (TRAS) such as refractory hypertension, water retention, and graft renal dysfunction. Immediate clinical suspicion is difficult due to the nature of the progressive disease unlike TRAS. Herein, we present an interesting case of bilateral common iliac artery occlusion (AIOD, TASC II, type C) that manifested as uncontrolled blood pressure and decreased allograft function in a patient who had kidney transplant 17 years ago. The patient was successfully diagnosed with duplex scan, ankle-brachial index (ABI) and computed tomography angiography and treated with percutaneous luminal angioplasty and stent graft insertion.

Pseudoaneurysms of the common iliac artery caused by Brucellosis are exceedingly uncommon. Infected common iliac artery pseudoaneurysms, particularly those caused by brucellosis, are more difficult to diagnose and cure than general pseudoaneurysms. The risk of mortality is significantly high in this condition. Nonsurgical treatment of a brucellosis-induced common iliac artery pseudoaneurysm is futile, and it should be operated on as soon as feasible. Long-term and multi-course antibacterial therapy with combination antibiotics is required. For the treatment of Brucella-infected pseudoaneurysms, endovascular surgery can be both effective and safe.

Introduction and Importance: Aneurysms are dilatations of arteries, with abdominal aortic ectasias (AAE) considered precursors to abdominal aortic aneurysms (AAA). Iliac artery aneurysms (IAAs), often accompanying AAA, present a serious risk, particularly due to rupture. Here, the authors present a case highlighting the importance of recognizing and managing isolated bilateral common iliac artery aneurysms (CIAAs)., Case Presentation: A 66-year-old male presented following a road traffic accident (RTA) with ankle and leg pain. Examination revealed tenderness in the leg, mild right flank tenderness, and a history of mild pelvic pain. Biochemical studies showed deranged glucose and lipid levels. Imaging revealed large CIAAs, prompting surgical intervention. The patient's fracture was also managed accordingly., Clinical Discussion: CIAAs are rare but serious, typically occurring in elderly males with risk factors including advanced age, male sex, smoking, and hypertension, while diabetes and hyperlipidemia may exert protective effects. While often asymptomatic, they can lead to complications such as thrombosis or rupture. Diagnosis relies on imaging, and intervention is recommended for larger or symptomatic aneurysms., Conclusion: It's crucial to consider CIAAs in high-risk individuals and recognize the significance of early detection and intervention to prevent potentially life-threatening complications. Prompt management, either through open surgical repair or endovascular options, is crucial for improving patient outcomes., Competing Interests: All the authors declare that they have no competing interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Ruptured abdominal aortic aneurysms and common iliac artery aneurysms (CIAAs) are rarely associated with an arteriovenous fistula (AVF). In such cases, surgery is frequently extremely difficult and the prognosis is usually poor. We report a case of a ruptured CIAA with a common iliac AVF in a 58-year-old male patient who presented with symptoms of severe edema in his left lower extremity. We used an aneurysm wall patch to repair the fistula and successfully reconstruct the common iliac vein, and a bifurcated prosthetic graft for abdominal aortic and iliac artery replacement., (@ 2024 The Editorial Committee of Annals of Vascular Diseases.)

Background Although exceedingly uncommon, iliac artery pseudoaneurysms might complicate trauma, surgical, or interventional operations. Aim We are presenting this case to emphasize how vital it is to rule out vascular lesions as a possible diagnosis when patients arrive with mass or pressure feelings in various body areas. Result Report of a 29-year-old man with a painful right lower abdomen pulsatile mass that turned out to be a pseudo aneurysm originating from the right common iliac artery, which was verified by contrast-enhanced CT and CT angiography. A large aneurysm connected to a fistula between the right common iliac artery and vein was discovered after open surgery where aneurysmal sac excised and PTFE interposition graft was used to reconstruct the artery and on follow up patient pass smoothly. Conclusion Serious implications might follow from misdiagnosing these lesions as soft tissue tumors or abscesses so it is paramount to put arterial lesion in differential diagnosis. [ABSTRACT FROM AUTHOR]

Spontaneous dissection of the iliac artery is very rare. We report the case of a 49-year-old man who presented with spontaneous dissection of common iliac artery involvement of the aorta. We treated him by unibody bifurcated stent grafting and deployed the second stent-graft to prevent the collapse of the true lumen of the right iliac artery. For the sake of preserving pelvic blood flow, proximal type I endoleak was not treated. After 3 years, the endoleak still existed, without any aneurysmal formation. Further, the dissection of the distal external iliac artery still existence after 3 months, but the virtual disappearance after 3 years.