Arterial collateral circulation pathways in patients with aortoiliac occlusive disease

Objectives Aortoiliac occlusive disease is a leading cause of morbidity and mortality worldwide. Patients typically present with intermittent claudication or critical limb ischemia but the majority of them remain asymptomatic. Collateral arterial pathways restore the arterial blood supply distal to the lesions. The objective of this study is the description of collateral pathways’ patterns of aortoiliac occlusive disease. Methods Records from the Department of Vascular Surgery of University General Hospital of Alexandroupolis were retrospectively searched from March 2016 to August 2018 for patients suffering from aortoiliac occlusive disease. Results Thirty-three patients (24 males, 9 females) with a mean age of 64.2 ± 11.8 years were included in this study. Twenty-two patients had diabetes mellitus, 25 hypertension, and 16 dyslipidemia. Twenty-two were active smokers. Seventeen patients suffered from intermittent claudication and 16 patients presented with critical limb ischemia. Seven patients had TASC-II B lesions, 10 TASC-II C lesions, and 16 patients had TASC-II D lesions. Systemic collateral pathways were dominant in 17 patients, whereas visceral pathways were prominent in 16 patients. While 62.5% of patients having lesions in the abdominal aorta presented systemic pathways, the lesions located only in the iliac arteries followed visceral patterns or systematic patterns equally. Conclusions Collateral anastomotic networks provide blood supply to regions distal to aortoiliac occlusive lesions. Their pattern is defined mainly by the location of the lesion and does not seem to associate with comorbid factors or the extent of the lesion. Failure to recognize these networks during surgery could lead to limb threatening situations.

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Prolonged regional analgesia in the complex treatment of extensive purulent-necrotic wounds on the background of decompensated arterial and venous insufficiency (case report

Wounds and wound infections The prof B M Kostyuchenok journal ◽

10.25199/2408-9613-2019-6-3-34-43. ◽

2020 ◽

Vol 6 (3) ◽

pp. 34-43

Author(s):

S. A. Orudzheva ◽

L. A. Blatun ◽

S. V. Sokologorskiy ◽

M. A. Sheina ◽

T. G. Turova ◽

...

Keyword(s):

Sciatic Nerve ◽

Blood Supply ◽

Critical Limb Ischemia ◽

Lower Limb ◽

Limb Ischemia ◽

Complex Treatment ◽

Intense Pain ◽

Arterial Blood Supply ◽

Arterial Blood

Objective: to demonstrate the successful complex treatment of a shin circular wound in a patient with intense pain due to critical limb ischemia and wound infection, which became possible against the background of prolonged peripheral blockade. Materials and methods. A 72-year-old patient with critical ischemia of the right lower extremity was treated for a circular purulent-necrotic wound of the shin leg from November 2016 to April 2017 at the Wounds and Wound Infections Department of FSBI “A. V. Vishnevsky NRC of Surgery” Ministry of Health of Russia. An examination revealed the impossibility of right lower limb arterial insufficiency surgical correction. The patient refused amputation of the lower limb. For the relief of pain, a long-term blockage of the sciatic nerve was used (infusion of ropivacaine 6.0–8.0 mg / hr into the perineural catheter, additional 100 mg ropivacaine boluses were used before performing traumatic daily dressings). The intensity of pain was evaluated on a visual analogue scale (VAS), sought to achieve a pain intensity of not more than 3 points at rest and not more than 4 points on – when moving. Results. Blockade of the sciatic nerve reduced the intensity of pain from 8–10 to 0–3 points, which made it possible to continue treatment. In total, the duration of sciatic nerve catheterization at the stages of treatment was 115 days (18 + 41 + 23 + 32), the maximum duration of one of the peripheral nerve catheterizations was 41 days. Complications associated with nerve catheterization were not observed in the patient. The pain syndrome is stopped, the area of the wound defect is reduced in size. Discharged for outpatient treatment. Conclusion. Long-term peripheral analgesia made it possible to gain time necessary for cleansing the wound surface from necrotic tissues, therapy with drugs that improve arterial blood supply to the limbs, as well as for performing reconstructive and reconstructive operations after the wound process has passed to the reparative stage. Long-term peripheral blockade is a prerequisite for the successful treatment of extensive wounds of the lower extremities caused by insufficient arterial blood supply at the stage of critical limb ischemia, accompanied by intense pain.

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Case report: Lower limb arterial blood supply arising from the renal artery with congenital absence of the ipsilateral iliac arteries

Clinical Radiology ◽

10.1016/s0009-9260(05)80649-x ◽

1992 ◽

Vol 45 (3) ◽

pp. 215-217 ◽

Cited By ~ 8

Author(s):

G.D. Oduro ◽

L.H. Cope ◽

I.M. Rogers

Keyword(s):

Case Report ◽

Renal Artery ◽

Blood Supply ◽

Lower Limb ◽

Congenital Absence ◽

Arterial Blood Supply ◽

Iliac Arteries ◽

Arterial Blood

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TCTAP C-259 Successful Limb Salvage from Critical Limb Ischemia Due to Aortoiliac Occlusive Disease with Severe Calcification

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.03.496 ◽

2017 ◽

Vol 69 (16) ◽

pp. S351

Author(s):

Tetsuya Nomura

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Occlusive Disease ◽

Aortoiliac Occlusive Disease ◽

Severe Calcification

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Anterior Rectal Resection in a Patient with Aortoiliac Occlusive Disease and Coexisting Collateral Pathways: Management and Pitfalls

Case Reports in Surgery ◽

10.1155/2016/3721260 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Floryn Cherbanyk ◽

Jean-Loup Gassend ◽

Olivier Martinet ◽

Snezana Andrejevic-Blant ◽

Henri-Marcel Hoogewoud

Keyword(s):

Multidisciplinary Approach ◽

Occlusive Disease ◽

Uneventful Recovery ◽

Aortoiliac Occlusive Disease ◽

Rectosigmoid Junction ◽

Iliac Arteries ◽

Anterior Rectal Resection ◽

Collateral Network ◽

Collateral Pathways ◽

The Common

Chronic aortoiliac occlusive disease most often affects the common iliac arteries and distal aorta but can progress all the way to the renal arteries, occluding the inferior mesenteric artery. A compensatory collateral network typically develops to preserve lower body perfusion. Inadvertent compression or ligation of such collaterals during surgery can have catastrophic consequences. In this article, we present the case of a 63-year-old patient with aortoiliac occlusive disease, requiring surgery for an adenocarcinoma of the rectosigmoid junction. A CT angiography was performed in order to map out the collateral pathways that had developed and Doppler ultrasound was used to mark their positions. The surgical procedure was adapted to his specific anatomy. A successful anterior resection was performed, and the patient made an uneventful recovery. In cases of aortoiliac obliteration, the existence of collaterals must be kept in mind and investigated with a multidisciplinary approach before any surgery is considered.

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Contemporary Outcomes of Iliofemoral Bypass Grafting for Unilateral Aortoiliac Occlusive Disease: A 10-Year Experience

The American Surgeon ◽

10.1177/000313480807400616 ◽

2008 ◽

Vol 74 (6) ◽

pp. 555-560 ◽

Cited By ~ 5

Author(s):

Christopher G. Carsten ◽

Corey A. Kalbaugh ◽

Eugene M. Langan ◽

Anna L. Cass ◽

David L. Cull ◽

...

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Functional Independence ◽

Occlusive Disease ◽

Secondary Patency ◽

Aortobifemoral Bypass ◽

Aortoiliac Occlusive Disease ◽

Symptom Resolution ◽

Acceptable Alternative

Current treatment of complex aortoiliac occlusive disease (AIOD) includes the aortobifemoral bypass or the femoral-femoral bypass. However, because of bilateral groin exposure and associated risks, there is a significant morbidity associated with these procedures. In appropriate patients with unilateral AIOD, the iliofemoral bypass graft (IFBPG) via a lower abdominal retro-peritoneal incision can be an acceptable alternative. The purpose of this study is to review the safety and efficacy as well as long-term outcomes of IFBPG in patients with unilateral AIOD. From July 1997 through June 2006, 40 patients (64.3 ± 11.2-years-old, range 41–89-years-old, 57.5% critical limb ischemia, 70% male, 95% smokers) with unilateral AIOD were treated with IFBPG. Perioperative complications and symptom resolution were measured and Kaplan-Meier life table analysis was used to analyze outcomes of primary and secondary patency, survival, limb salvage, contralateral intervention, and maintenance of ambulation and independent living status. The perioperative complication rate was 12.5 per cent (n = 5) including one patient who developed atrial-fibrillation and one who developed acute renal failure. Both patients experienced resolution of these symptoms before discharge. Other complications included one limb thrombosis and two wound infections. There were no perioperative deaths. Secondary patency was 97.5 per cent and 93.3 per cent at 1 and 5 years. Limb salvage in patients with critical limb ischemia (CLI) was 85.1 per cent and 79.1 per cent at 1 and 5 years. Limb amputation occurred due to infection (n = 2), or failed IFBPG (n = 2). Thirty-one patients (77.5%) experienced symptom resolution including 15 (88.2%) of the patients treated for claudication. Two patients (5%) required contralateral iliac intervention. Patient survival was 97.5 per cent and 64.5 per cent at 1 and 5 years. Greater than 90 per cent of patients maintained their functional independence at 5 years. IFBPG achieved excellent technical and functional outcomes, particularly in patients treated for vasculogenic claudication. This procedure is relatively safe and efficacious in a population of patients with complex unilateral AIOD and can be an acceptable alternative to the aortobifemoral bypass or fem-fem procedure.

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Risk assessment of vascular reconstruction by patients with critical limb ischemia and aortoiliac occlusive disease

Cardiovascular Surgery News ◽

10.24022/2588-0284-2019-3-2-87-93 ◽

2019 ◽

Vol 3 (2) ◽

pp. 87-93

Author(s):

A.N. Vachev ◽

A.V. Krugomov

Keyword(s):

Risk Assessment ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Vascular Reconstruction ◽

Occlusive Disease ◽

Aortoiliac Occlusive Disease

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Demographic and Comorbidity Pattern of Patients with Critical Limb Ischemia

Folia Medica ◽

10.1515/folmed-2017-0014 ◽

2017 ◽

Vol 59 (1) ◽

pp. 14-22 ◽

Cited By ~ 5

Author(s):

Răzvan A. Ciocan ◽

Sorana D. Bolboacă ◽

Şerban Rădulescu ◽

Bogdan Stancu ◽

Andra Ciocan ◽

...

Keyword(s):

Secondary Education ◽

Critical Limb Ischemia ◽

Peripheral Arterial Occlusive Disease ◽

Limb Ischemia ◽

High Serum ◽

Arterial Occlusive Disease ◽

Occlusive Disease ◽

Male Smoker ◽

Arterial Blood ◽

Peripheral Arterial

Abstract Aim: The present study aimed at identifying the pattern of patients with critical limb ischemia (CLI) compared with those with peripheral arterial occlusive disease (PAOD). Materials and methods: A four-year retrospective study was conducted with patients hospitalized in the Second Surgical Clinic at the Emergency County Hospital Cluj-Napoca. The medical charts of patients with PAOD (n=466) and CLI (n=223) were reviewed and data were collected. Results: The study included 689 patients; mean age 67 years for PAOD patients and 65 years for CLI patients. A significantly higher percentage of patients were male in both groups (79.25%, P < 0.0001). Most of the patients in both groups had received at least a secondary education (P < 0.0001). Most of the subjects in both groups were smokers (>71.30%) with no difference between groups (P = 0.566). No significant differences were found between the groups in comorbidities (diabetes, arterial blood hypertension, cardiac ischemia, rhythm disorders, P > 0.05). There were more CLI patients that were overweight than overweight patients with PAOD (P = 0.0004). High serum cholesterol (>200 mg/dL) and triglycerides (>150 mg/dL) levels were found in the CLI group (P < 0.05). Age was identified as a risk factors for amputation (OR = 1.03, 95%Cl [1.01−1.05], P = 0.0012). Conclusions: The profile of a patient with critical limb ischemia and peripheral arterial occlusive disease is a 65-67-year-old male smoker with at least a secondary education. The CLI patient is overweight with pathological serum levels of cholesterol and triglycerides.

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Arterial Blood Supply and Angiography of the Fore Foot in One- Humped Camel (Camelus dromederius)

International Journal of Veterinary Science ◽

10.37422/ijvs/20.044 ◽

2020 ◽

Keyword(s):

Blood Supply ◽

Digital Artery ◽

Detailed Data ◽

Arterial Blood Supply ◽

Anatomical Dissection ◽

Arterial Blood ◽

Median Artery ◽

Dorsal Metacarpal Artery

The present study was conducted on eight fresh forelimbs to investigate a detailed anatomical description of the arterial blood supply in adult dromedary camel’s foot. Anatomical and angiographic techniques were used in order to give detailed data about the origin and pattern of distribution of these arteries. Moreover, this data serve other researchers in comparison with different animals. The specimens injected with red colored gum milk latex for anatomical dissection and urograffin injection for angiographic purposes throughout the median artery. The main arterial blood supply of camel’s digit was derived from common palmar digital artery, palmar metacarpal artery, in addition to smaller branches detached from the dorsal metacarpal artery.

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