Successful and Unsuccessful Blind Placement of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Catheters Through Damaged Arteries: A Report of Three Cases

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Philip Joseph Wasicek ◽  
William A Teeter ◽  
Peter Hu ◽  
Deborah M Stein ◽  
Thomas M Scalea ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Arterial Injury ◽  
Balloon Occlusion ◽  
Tactile Feedback ◽  
Balloon Inflation ◽  
Iliac Arteries ◽  
Tertiary Center ◽  
The Common

Background: Patients who receive REBOA for temporization of exsanguinating hemorrhage may have occult injuries sustained to the iliac arteries or aorta which may pose increased risks in performing REBOA. There is a paucity of literature describing the successful blind placement of wires and/or catheters for REBOA through damaged vasculature. Methods: Patients admitted between February 2013 and July 2017 at a tertiary center who had a successful or unsuccessful blind placement of a REBOA catheter or wire through a damaged iliac artery or aorta were included. Results: Three patients were identified. Two patients had successful placement of the REBOA catheter; one sustained injury to the external iliac artery, and the other sustained injury to the abdominal aorta. Confirmation of catheter placement was obtained before balloon inflation; and the damaged vessels were identified upon immediate operative intervention. One patient had unsuccessful placement of the REBOA catheter during cardiac arrest despite accurate access of the common femoral artery (CFA).  Conclusions: Emergent, blind placement of wires and catheters past arterial injuries is possible. Physical exam and/or tactile feedback should alert the surgeon to the possibility of arterial injury and imaging confirmation should precede balloon inflation if at all possible to minimize risk of further vascular injury.

scholarly journals Imaging Anatomy and Surface Localization of External Control Device-Targeted Arteries for Noncompressible Torso Hemorrhage

2021 ◽  
Author(s):  
Hua-yu Zhang ◽  
Yong Guo ◽  
Heng Liu ◽  
Hao Tang ◽  
Yang Li ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Organ Damage ◽  
Control Device ◽  
External Control ◽  
Vertical Distance ◽  
Localization Strategy ◽  
Surface Localization ◽  
The Common

ABSTRACT Background External hemorrhage control devices (EHCDs) are effective in reducing the death risk of noncompressible torso hemorrhage (NCTH), but the pressurized area is too large to prevent serious organ damage. This study aims to establish the surface localization strategy of EHCDs based on the anatomical features of NCTH-related arteries through CT images to facilitate the optimal design and application of EHCDs. Methods Two hundred patients who underwent abdominal CT were enrolled. Anatomical parameters such as the length of the common iliac artery (CIA), the external iliac artery (EIA), and the common femoral artery were measured; positional relationships among the EHCD-targeted arteries, umbilicus, anterior superior iliac spine (ASIS), and pubic tubercle (PT) were determined. The accuracy of surface localization was verified by the 3D-printed mannequins of 20 real patients. Results Aortic bifurcation (AB) was 7.5 ± 8.6 mm to the left of the umbilicus. The left CIA (left: 46.6 ± 16.0 mm vs. right: 43.3 ± 15.5 mm, P = .038) and the right EIA (left: 102.6 ± 16.3 mm vs. right: 111.5 ± 18.8 mm, P < .001) were longer than their counterparts, respectively. The vertical distance between the CIA terminus and the ipsilateral AB–ASIS line was 19.6 ± 8.2 mm, and the left and right perpendicular intersections were located at the upper one-third and one-fourth of the AB–ASIS line, respectively. The length ratio of EIA–ASIS to ASIS–PT was 0.6:1. The predicted point and its actual subpoint were significantly correlated (P ≤ .002), and the vertical distance between the two points was ≤5.5 mm. Conclusion The arterial localization strategy established via anatomical investigation was consistent with the actual situation. The data are necessary for improving EHCD design, precise hemostasis, and EHCD-related collateral injuries. Trial registration: Ratification no. 2019092. Registered November 4, 2020—retrospectively registered, www.chictr.org.cn.

scholarly journals Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: An underdiagnosed entity

2009 ◽  
Vol 50 (3) ◽  
pp. 505-509 ◽  
Author(s):  
Anil P. Hingorani ◽  
Enrico Ascher ◽  
Natalie Marks ◽  
Alexander Shiferson ◽  
Nirav Patel ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Iliac Artery ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Iatrogenic Injuries ◽  
The Common

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

2016 ◽  
Vol 15 (3) ◽  
pp. 250-253 ◽  
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.

Case 16.11

2014 ◽  
pp. 779-780
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Femoral Artery ◽  
Iliac Artery ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Severe Stenosis ◽  
Iliac Arteries ◽  
History Of ◽  
The Right ◽  
Multiple Episodes

22-year-old man with a history of multiple episodes of bleeding, bruising, and hematomas Coronal VR image from 3D CE MRA of the abdomen and pelvis (Figure 16.11.1) reveals lobulated aneurysms of both external iliac arteries and the right common femoral artery. Note the severe stenosis of the left external iliac artery distal to the aneurysm....

Deep Circumflex Iliac Artery as an Inflow Alternative for Surgical Revascularization: A Case Report

2019 ◽  
Vol 54 (1) ◽  
pp. 85-88
Author(s):  
Makoto Haga ◽  
Shinya Motohashi ◽  
Hidenori Inoue ◽  
Junetsu Akasaka ◽  
Shunya Shindo
Keyword(s):  
Femoral Artery ◽  
Iliac Artery ◽  
Bypass Graft ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Surgical Revascularization ◽  
Deep Circumflex Iliac Artery ◽  
The Common ◽  
Artery Disease ◽  
Pain At Rest

The common femoral artery (CFA) is the most widely used inflow in all types of surgical revascularization in patients with peripheral artery disease. However, the CFA cannot always be used because of calcification, obstruction, or previous dissection. Here, we report a rare case of selecting the deep circumflex iliac artery (DCIA) as a source of inflow to perform a surgical revascularization in a patient with chronic limb-threatening ischemia. A 62-year-old man was admitted to our hospital due to necrotized third and fifth toes with pain at rest. Computed tomography showed severe stenosis of the CFA, superficial femoral artery, and deep femoral artery, and an entirely stented external iliac artery. The DCIA was identified as the only patent artery. Considering the condition of the other arteries, we selected the DCIA as a source of inflow. Deep circumflex iliac–popliteal bypass was performed with a saphenous vein. The bypass graft was patent 9 months after surgery and limb salvage had been achieved.

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