Emergent conversion of the Ovation Stent Graft System to aortouniiliac modification via occlusion of a unilateral internal iliac artery with a stentgraft as a bailout solution

Purpose To present a case of inadvertent collapse of the contralateral limb gate caused by misorientation during the deployment of the Ovation Abdominal Stent Graft System in a narrow aortic lumen and the bailout conversion to aortouniiliac modification, using a covered stent to exclude the orifice of the internal iliac artery (IIA). Technique description Despite the repeated efforts from the femoral and brachial site, the collapsed/occluded contralateral limb gate could not be catheterized. In order to exclude successfully the orifice of the IIA, an oversized stentgraft was placed immediately at the common-to-external iliac artery (CIA-EIA) transition followed by peripheral ligation of the latter. The procedure was completed with crossover femorofemoral bypass. Conclusion Occlusion the IIA orifice with an oversized stentgraft in the CIA-EIA transition can be considered as a safe, simple, fast, and efficient bailout maneuver, followed by EIA ligation and crossover bypass.

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Technical issues and clinical outcomes of endovascular repair of isolated iliac artery aneurysms: A single-center experience

Vascular ◽

10.1177/1708538118776854 ◽

2018 ◽

Vol 26 (6) ◽

pp. 591-599

Author(s):

Peixian Gao ◽

Dianning Dong ◽

Le Yang ◽

Hai Yuan ◽

Mo Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Stent Graft ◽

Iliac Artery ◽

Endovascular Repair ◽

Internal Iliac Artery ◽

Artery Aneurysm ◽

Covered Stent ◽

Internal Iliac ◽

Technical Issues ◽

Isolated Iliac Artery Aneurysms

Purpose Isolated iliac artery aneurysms are the relatively uncommon condition. This study aims to evaluate the technical issues and clinical outcomes of endovascular repair in a cohort of isolated iliac artery aneurysms treated. Methods We retrospectively reviewed 22 consecutive patients with isolated iliac artery aneurysms between December 2006 and September 2016. Iliac artery aneurysms were treated in one of the three ways: (1) standard bifurcated aortic stent graft placement with limb extension; (2) coverage of iliac artery aneurysms with covered stent grafts; and (3) embolization of the arterial branches distal to the aneurysms with coils or vascular plugs. Results Twenty-two patients (20 men) with a mean age 64.7 years underwent endovascular repair during the study period. The median diameter of the isolated iliac artery aneurysms was 5.9 ± 1.7 cm (2.9–9.0 cm). Technical success was 95.5%. Conversion to open surgery was performed in one patient with bilateral internal iliac artery aneurysms. Four patients underwent placement of a bifurcated stent graft. A covered stent graft was deployed in 16 patients, with embolization of internal iliac artery in 14 patients. Simple coil embolization of isolated internal iliac artery aneurysm was performed in one patient. There was one sudden cardiac death on day 4 after the procedure due to heart failure. During the follow-up period (range: 1–50 months, mean 19.8 months), five patients died of causes not related to isolated iliac artery aneurysms, and transient buttock claudication was observed in one patient. Conclusions Our study documents the safety and effectiveness of endovascular repair of isolated iliac artery aneurysms with low morbidity and mortality.

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BRANCHING PATTERN OF FETAL INTERNAL ILIAC ARTERY. PATRÓN DE RAMIFICACIÓN DE LA ARTERIA ILÍACA INTERNA FETAL

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v2.n3.13890 ◽

2016 ◽

Vol 2 (3) ◽

pp. 100-105 ◽

Cited By ~ 1

Author(s):

Sumathilatha Sakthivelavan ◽

Sakthivelavan D Sendiladibban ◽

Christilda Felicia

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

External Iliac Artery ◽

Branching Pattern ◽

Inferior Gluteal Artery ◽

Internal Pudendal Artery ◽

Superior Gluteal Artery ◽

Branching Patterns ◽

Internal Iliac ◽

The Common

Objetivo: Estudiar el patrón de ramificación de la arteria ilíaca interna del feto y que son equivalentes a la disposición de las ramas ilíacas internas en los adultos. Métodos: Veinticuatro mitades de pelvis fueron utilizados como muestras. Que se obtuvieron de fetos nacidos muertos, de 5 a 9 meses de edad gestacional. Resultados: la arteria ilíaca interna está en consonancia con la arteria ilíaca común y más grande que la arteria ilíaca externa. Tres tipos de ramificación se observaron sobre la base de las grandes ramas, a saber, la arteria glútea inferior, la arteria pudenda interna y la arteria glútea superior. Los resultados se correlacionaron con los patrones de ramificación descriptos por Piersol (1930). Conclusión: La disposición más común, tenía dos grandes troncos procedentes de la arteria iliaca interna, la posterior era la arteria glútea superior y la anterior se dividía en arterias pudenda y glútea inferior. Los otros patrones conducen variables en los adultos que son de importancia embriológicos y quirúrgicos. Objective: To study the branching pattern of fetal internal iliac artery and to correlate with the arrangement of the internal iliac branches in adults. Methods: Twenty four pelvic halves were used as specimens. They were obtained from the dead born fetuses of 5 to 9 months of gestational age. Results: Internal iliac artery was in line with the common iliac artery and larger than the external iliac artery. Three types of branching were observed based on the large branches namely inferior gluteal artery, internal pudendal artery and superior gluteal artery. The findings were correlated with the patterns of branching described by Piersol (1930). Conclusion: The most common arrangement had two large trunks originating from internal iliac artery, the posterior one being superior gluteal artery and the anterior one divided into internal pudendal and inferior gluteal arteries. The other patterns lead to variable branching patterns in adults that are of embryological and surgical significance.

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Rare origin of the obturator artery from the external iliac artery with two obturator veins

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.005116 ◽

2016 ◽

Vol 15 (3) ◽

pp. 250-253 ◽

Cited By ~ 2

Author(s):

Kiyoshi Goke ◽

Lucas Alves Sarmento Pires ◽

Tulio Fabiano de Oliveira Leite ◽

Carlos Alberto Araujo Chagas

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

External Iliac Artery ◽

Lateral Wall ◽

Iliac Vein ◽

Obturator Foramen ◽

Obturator Artery ◽

Iliac Arteries ◽

Internal Iliac ◽

The Common

Abstract The obturator artery is a branch of the internal iliac artery, although there are reports documenting variations, with origin from neighboring vessels such as the common iliac and external iliac arteries or from any branch of the internal iliac artery. It normally runs anteroinferiorly along the lateral wall of the pelvis to the upper part of the obturator foramen where it exits the pelvis by passing through said foramen. Along its course, the artery is accompanied by the obturator nerve and one obturator vein. It supplies the muscles of the medial compartment of the thigh and anastomoses with branches of the femoral artery on the hip joint. We report a rare arterial variation in a Brazilian cadaver in which the obturator artery arose from the external iliac artery, passing beyond the external iliac vein toward the obturator foramen, and was accompanied by two obturator veins with distinct paths. We also discuss its clinical significance.

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Up-and-Over Technique for Implantation of Iliac Branch Devices After Prior Aortic Endograft Repair

Journal of Endovascular Therapy ◽

10.1177/1526602817747283 ◽

2018 ◽

Vol 25 (1) ◽

pp. 21-27 ◽

Cited By ~ 9

Author(s):

David L. Dawson ◽

Giuliano de Almeida Sandri ◽

Emanuel Tenorio ◽

Gustavo S. Oderich

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Covered Stent ◽

Femoral Access ◽

Aortic Stent Graft ◽

Flow Divider ◽

Device Placement ◽

Internal Iliac ◽

Aneurysm Repair

Purpose: To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). Technique: This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. Conclusion: The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.

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An original external iliac artery reconstruction with internal iliac artery translocation in a blunt injury of the pelvic vessels in a 4-year-old child: A 12-year follow-up study

Journal of Vascular Surgery Cases and Innovative Techniques ◽

10.1016/j.jvscit.2019.09.003 ◽

2019 ◽

Vol 5 (4) ◽

pp. 492-496 ◽

Cited By ~ 1

Author(s):

David Chayen ◽

Leonel Copeliovitch ◽

Zalman Itzhakov ◽

Michael Zaretsky ◽

Igor Rabin

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

External Iliac Artery ◽

Blunt Injury ◽

Follow Up Study ◽

Internal Iliac ◽

Artery Reconstruction

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Variation in the origin of right obturator artery - A case report

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703921 ◽

2015 ◽

Vol 05 (03) ◽

pp. 105-106

Author(s):

Rani Nallathamby ◽

Ramakrishna Avadhani ◽

Sivarama C. H. ◽

Meril Ann Soman ◽

Meera Jacob

Keyword(s):

Case Report ◽

Iliac Artery ◽

High Frequency ◽

Internal Iliac Artery ◽

External Iliac Artery ◽

Anomalous Origin ◽

Obturator Artery ◽

Anterior Trunk ◽

Internal Iliac

AbstractMost commonly, the Obturator artery arises from the anterior trunk of internal iliac artery. However, origin of the Obturator artery from external iliac artery was reported at 25% by Missankov et al. [3], 1.1% by Bergman et al. [1], 1.3% by Jakubowicz and Czerniawska- Grzesinska [2].Due to its high frequency of variations in course and origin, Obturator artery had drawn the attention of anatomists, surgeons and radiologists. In this case report, we are presenting an anomalous origin of right Obturator artery from right external iliac artery. The knowledge of this variation is important anatomically, radiologically and surgically.

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Endovascular treatment of isolated iliac artery aneurysms using a custom-made stent graft with proximal barb fixation: early outcome

Vascular ◽

10.1177/1708538113478720 ◽

2013 ◽

Vol 21 (2) ◽

pp. 92-96 ◽

Cited By ~ 3

Author(s):

D L H Baird ◽

K Mani ◽

T Sabharwal ◽

P R Taylor ◽

H A Zayed

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Perioperative Complications ◽

External Iliac Artery ◽

Stent Grafts ◽

Landing Zone ◽

Custom Made ◽

Internal Iliac ◽

The Mean ◽

Isolated Iliac Artery Aneurysms

Current endovascular treatments for isolated iliac artery aneurysms (IIAAs) include the use of aortoiliac stent grafts with coverage of the distal aorta or stent grafts confined to the iliac artery without active proximal fixation. We report our experience in the use of custom-made Cook Zenith™ iliac limb stent grafts with proximal barb fixation. Patients treated from July 2009 to February 2011 were included. All imaging and patient records were assessed for perioperative and early outcomes. Nine IIAAs (seven patients) were treated. The mean patient age was 80 years (range 58-91 years). The mean aneurysm size was 48 mm (35-80 mm), and the mean length of the proximal landing zone (PLZ) was 29 mm (10-50 mm). The distal landing zone was in the external iliac artery after coil embolization of the internal iliac artery. The Mean diameter of the PLZ was 21 mm (20-24 mm). Technical success was achieved in eight cases. Perioperative complications included reoperation in one patient for groin bleeding and ischemia. On follow-up (mean 12 months, range 1-26), all aneurysms were successfully excluded from the circulation and there was no stent graft migration or thrombosis. Use of custom-made stent grafts with proximal barb fixation in treatment of IIAAs is a feasible option which may reduce the risk of migration when compared with stent grafts with lack of proximal fixation.

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Hemorrhage Secondary to Pelvic Fracture: Coil Embolization of an Aberrant Obturator Artery

Journal of Endovascular Therapy ◽

10.1177/152660280301000341 ◽

2003 ◽

Vol 10 (3) ◽

pp. 676-680 ◽

Cited By ~ 10

Author(s):

Bernd Daeubler ◽

Suzanne E. Anderson ◽

Michael Leunig ◽

Jürgen Triller

Keyword(s):

Iliac Artery ◽

Coil Embolization ◽

Internal Iliac Artery ◽

Pelvic Ring ◽

External Iliac Artery ◽

Vascular Anomaly ◽

Abdominal Ultrasound ◽

Obturator Artery ◽

Corona Mortis ◽

Internal Iliac

Purpose: To describe the anatomical variations of the corona mortis, a vascular anomaly that may lead to dangerous hemorrhage and possible death. Case Report: A 46-year-old male cyclist was involved in a collision with a car, during which he sustained fractures to the left ribs and pelvic ring. Abdominal ultrasound imaging demonstrated a large (12×6×7 cm) nonhomogeneous mass ventral to the bladder, suggestive of a hematoma, which was confirmed on computed tomography. During angiography, 2 branches of the internal iliac artery were identified as sources of the bleeding; these were successfully embolized with microcoils, but the bleeding continued. Examination of the external iliac system found a lacerated aberrant obturator artery arising from the inferior epigastric branch of the external iliac artery, a condition known as the corona mortis. Additional embolization quelled the hemorrhage. Conclusions: Coil embolization of the internal iliac artery branches is very effective in managing hemorrhage due to pelvic fractures, but variations in the origin of the obturator artery from the internal or external iliac artery may be additional sources of bleeding.

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Internal Iliac Artery Ligation: A Retrospective Analysis of Two Different Approaches

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1501 ◽

2017 ◽

Vol 9 (3) ◽

pp. 230-234

Author(s):

GS Jyothi

Keyword(s):

Retrospective Analysis ◽

Iliac Artery ◽

Internal Iliac Artery ◽

Common Iliac Artery ◽

Round Ligament ◽

Artery Ligation ◽

Internal Iliac Artery Ligation ◽

Internal Iliac ◽

Pouch Of Douglas ◽

The Common

ABSTRACT Aim To describe two different approaches of performing internal iliac artery ligation and their usefulness in different clinical situations. Introduction Internal iliac artery ligation is a very useful method to control pelvic hemorrhage. It can become a necessity at any point of time while performing obstetric or gynecological surgeries, and it is a procedure that needs to be accomplished in a matter of few minutes, before the patient goes into irreversible shock. Techniques Internal iliac artery ligation can be done by approaching the artery by opening the retroperitoneal space, either by dividing the round ligament or by opening the pouch of Douglas. The internal iliac artery is identified by locating the bifurcation of the common iliac artery with the ureter crossing it. The external iliac artery is the lateral branch of the common iliac artery and it runs a straight course to continue as the femoral artery in the lower limb. The ureter is identified by peristalsis, and the internal iliac artery is the short medial branch of the common iliac which runs a short course and immediately divides into an anterior and a posterior division, which in turn divide into a number of branches. The uterine artery is the branch of anterior division of the internal iliac artery. The internal iliac artery is ligated by passing a stout suture material under it with the help of a right-angled forceps, or it can be directly occluded with clips, applied using a clip applicator. Conclusion Both the approaches are equally effective and easy to perform. Approaching the internal iliac artery through the round ligament is easier in gynecological surgeries, whereas the pouch of Douglas approach is easier during cesarean section. Clinical significance Internal iliac artery ligation is almost always performed as an emergency, though the need to perform it can be anticipated in advance and the gynecologist can be prepared for it. It is essential for gynecologists to be conversant with this life and a uterus-saving procedure. There are two approaches of doing this procedure and the choice is entirely on the individual. It may not be possible to approach the pouch of Douglas when there are dense adhesions as in case of a frozen pelvis. And it may be time-consuming to approach the internal iliac artery by dividing the round ligaments when there is postpartum hemorrhage. Therefore, it is useful to know both the approaches, because one might encounter a situation where one may find it difficult to follow the technique one is familiar with. How to cite this article Podder AR, Jyothi GS. Internal Iliac Artery Ligation: A Retrospective Analysis of Two Different Approaches. J South Asian Feder Obst Gynae 2017;9(3):230-234.

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