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@#The functional reconstruction of large maxillofacial defects is a major issue in oral and maxillofacial surgery, and autologous bone transplantation is the main method. However, bone is readily absorbed following an autologous bone transplant. Even with vascular anastomosis, spontaneous osteoporosis of transplanted bone is still serious, which affects dental implantation and functional recovery. Therefore, osteoporosis of the grafted bone has become one of the main complications of jaw reconstruction, and there is no preventive measure. The problem that autologous bone with sufficient blood supply cannot avoid osteoporosis suggests that systemic factors such as nerves, which have been neglected in traditional methods, may regulate the internal environment of the transplanted bone. Based on previous studies on the regulation of mesenchymal stem cells by the neural microenvironment, we initiated a new surgical procedure for innervated and vascularized iliac bone flaps based on animal model and cadaver studies. In the innervated and vascularized iliac bone flap, vascular microanastomosis was performed in conjunction with microneuronal anastomosis between the simultaneously harvested ilioinguinal nerve (which innervates the iliac bone and is usually sacrificed and neglected in the conventional vascularized iliac bone flap) and the inferior alveolar nerve proximally and with the mental nerve distally. By conducting clinical retrospective studies and prospective randomized controlled trials, we proved that the novel method of simultaneous innervated iliac bone transplantation can not only prevent bone resorption but also restore the sensation of adjacent soft tissues such as the lip. This may solve the key problems of sensory loss and osteoporosis after mandibular reconstruction, ensure the success of dental implant dentures, and put forward the new concept of "blood supply + innervation" bi-system bone transplantation.
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Objective To analyze the correlation between internal iliac artery calcification and delayed graft function (DGF) and short-term prognosis of kidney transplant recipients. Methods Clinical data of 222 kidney transplant recipients were retrospectively analyzed. According to the recovery of renal function, all recipients were divided into the DGF group (n=50) and immediate graft function (IGF) group (n=172). According to whether the recipients were complicated with severe internal iliac artery calcification, DGF and IGF groups were further divided into the high-risk DGF (n=22), low-risk DGF (n=28), high-risk IGF (n=41) and low-risk IGF(n=131) subgroups, respectively. Clinical data of donors and recipients were statistically compared between two groups. The incidences of postoperative DGF and internal iliac artery calcification were recorded. The risk factors of DGF after kidney transplantation, and the correlation between internal iliac artery calcification and clinical parameters were analyzed. Short-term prognosis of recipients with DGF complicated with severe internal iliac artery calcification was evaluated. Results The incidence of DGF was 22.5% (50/222). Among all recipients, 28.4% (63/222) were complicated with severe internal iliac artery calcification. In the DGF group, 44% (22/50) of the recipients were complicated with severe internal iliac artery calcification, higher than 23.8% (41/172) in the IGF group (P < 0.05). Univariate analysis showed that high serum creatinine (Scr) level of donors, male donor, high triglyceride level and severe internal iliac artery calcification of recipients were the risk factors for DGF after kidney transplantation (all P < 0.05). Multivariate logistic regression analysis revealed that Scr≥143 μmol/L of donors and severe internal iliac artery calcification of recipients were the independent risk factors for DGF after kidney transplantation (both P < 0.05). Correlation analysis indicated that internal iliac artery calcification was weakly correlated with the age of recipients and renal artery anastomosis (both P < 0.05). In the DGF group, the Scr level at postoperative 1 month was significantly higher, whereas the estimated glomerular filtration rate (eGFR) was significantly lower than those in the IGF group (both P < 0.05). The eGFR at postoperative 12 months in the high-risk DGF subgroup was significantly lower than those in the low-risk DGF, high-risk IGF and low-risk IGF subgroups (all P < 0.05). Conclusions Internal iliac artery calcification is not only a risk factor for recovery of renal allograft function, but also negatively affects short-term prognosis of renal allograft function.
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Resumo A fístula arteriovenosa (FAV) é uma sequela incomum de rotura espontânea de aneurisma arterial dentro do sistema venoso adjacente. Descrevemos, em um paciente de 74 anos, o tratamento endovascular de FAV ilíaca à direita por aneurisma de artéria ilíaca comum (AIC) roto associado a aneurisma de AIC distal à esquerda, em cuja cirurgia foram preservadas as artérias lombares e mesentérica inferior por necessidade de excluir simultaneamente as artérias hipogástricas. Foram demonstrados os fenômenos na dinâmica do balanço hídrico ocorridos em decorrência da interrupção da FAV. A evolução do paciente foi benigna, com normalização das graves alterações hemodinâmicas que apresentava e com desaparecimento dos sintomas respiratórios atribuídos à hipertensão arterial pulmonar.
Abstract An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar and inferior mesenteric arteries because of the need to simultaneously exclude the hypogastric arteries. Dynamic fluid balance phenomena provoked by closure of the AVF are described. The patient had a benign postoperative course with normalization of the severe hemodynamic changes presented prior to the intervention and resolution of respiratory symptoms attributed to pulmonary arterial hypertension.
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Abstract Isolated external iliac artery aneurysm is a rare occurrence. These aneurysms have varied presentations depending on size and proximity. Both open surgical and endovascular modalities can be used for treatment depending upon presentation, aneurysmal anatomy, and patient condition. Preservation of at least one internal iliac artery is important to prevent post-repair hypogastric ischemia. There are no previous reports of IgG4-related disease (IgG4-RD) as etiology of these aneurysms. A 32-year-old male patient presented with a left lower abdominal lump and was found to have a left external iliac artery aneurysm on computed tomography angiography. The patient underwent iliofemoral bypass with an 8 mm polyester graft. Histopathological examination of the aneurysm wall suggested IgG4-RD. The patient fulfilled the 2020 Revised Comprehensive Diagnostic Criteria for IgG4-RD. An 18-Fluorodeoxyglucose-Positron Emission Tomography scan performed in the postoperative period showed no active disease, hence medical therapy was not instituted. The patient is doing well at 1 year.
Resumo O aneurisma isolado da artéria ilíaca externa é uma ocorrência rara. Esses aneurismas têm apresentações variadas, dependendo do tamanho e da proximidade. Ambas as modalidades cirúrgicas aberta e endovascular podem ser usadas para o tratamento, dependendo da apresentação, anatomia do aneurisma e condição do paciente. A preservação de pelo menos uma artéria ilíaca interna é importante para prevenir isquemia hipogástrica pós-reparação. A doença relacionada à imunoglobulina G4 (IgG4-RD) nunca havia sido encontrada como etiologia desse aneurisma. Um paciente do sexo masculino de 32 anos que apresentava um nódulo no abdome inferior esquerdo foi diagnosticado com aneurisma da artéria ilíaca externa esquerda na angiotomografia computadorizada. O paciente foi submetido a bypass iliofemoral com enxerto de poliéster de 8 mm. O exame histopatológico da parede do aneurisma era indicativo de IgG4-RD. O paciente cumpriu os Critérios Abrangentes Revisados para IgG4-RD de 2020. A tomografia por emissão de pósitrons com 18-fluorodesoxiglicose no pós-operatório não evidenciou doença ativa, não sendo instituída terapia medicamentosa. Após seguimento de 1 ano, o paciente está bem.
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【Objective】 To explore the effect of recovery autologous blood transfusion combined with bilateral internal iliac artery presetting in high-risk patients with hemorrhage during cesarean section. 【Methods】 A total of 162 high-risk patients with hemorrhage who underwent cesarean section from January 2021 to May 2023 in our hospital were prospectively selected and divided into in Groups A, B, and C with 54 cases in each group according to the indications for the method of transfusion. Group A received allogeneic blood transfusion, Group B received autologous blood transfusion, Group C received autologous blood transfusion combined with bilateral internal iliac artery balloon presetting. 【Results】 Intraoperative blood loss (mL) (1 600 vs 1 500 vs 800), postoperative hospital stay(d) (7 vs 7 vs 6) and operative time(min) (107 vs 104.50 vs 77) in group C were all lower than those in group A and B (P0.05); The autologous blood transfusion volume(mL) in group C was lower than that in group B (525.5 vs 261, P0.016 7). 【Conclusion】 Recovery autologous blood transfusion combined with bilateral internal iliac artery balloon presetting in cesarean section for high-risk patients with hemorrhage achieved ideal effects, which can significantly reduce intraoperative blood loss, intraoperative autologous blood transfusion, allogeneic red blood cells and plasma transfusion, as well as the operation time and postoperative hospital stay. In addition, it can improve the coagulation function and hysterectomy, which is conducive to ensuring the safety of maternal and promoting early rehabilitation, and preserving the fertility of patients to a certain extent, which is worthy of further clinical promotion.
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Objective:Verstaile free superficial circumflex iliac artery perforator flap(SCIAPF) were adopted for various reconstructive scenarios, and its clinical effect and value was evaluated.Methods:Retrospective analysis was performed on 42 patients with tissue defects admitted in the Department of Orthopeadic of the Second Affiliated Hospital of Wenzhou Medical University from January 2015 to May 2019. Nine patients had injury in the foot, 8 in ankle, 8 in calf, 7 in forearm, 9 in hand, and 1 in the mouth. All of the defects were repaired by SCIAPF, including 28 single soft tissue defect wounds, 8 multiple soft tissue defect, and 6 composite defects. The size of soft tissue defect were 1.2 cm×1.8 cm-14.0 cm×20.8 cm. The size of flaps were 1.5 cm×2.0 cm-15.3 cm×22.3 cm. The patients entered follow up by outpatient clinic visit and telephone reviews to observe the survival of the flaps, functional recovery and complications.Results:In this series, there were 28 flaps, including 18 pedicled with superficia branch of superficial circumflex iliac artery, 2 pedicled with deep branch of superficial circumflex iliac artery, and 8 pedicled with 2 branches. Six were chimeric flaps. Among them, 4 flaps were iliac bone flaps with superficial branch of superficial circumflex iliac artery flaps, and 2 were superficial iliac circumflex artery flap with sartorius muscle flap. Eight cases were resurfaced with lobulated SCIAPF. Arterial anastomoses: end-to-side in 35 arteries and end-to-end in 7 arteries. Venous anastomosis: end-to-end in 27 veins and end-to-side in 15 veins. Venous return through superficial iliac circumflex vein in 25 flaps, through venae comitantes in 12 flaps and through both in 5 flaps. All flap donor sites were sutured directly. All flaps survived uneventfully except for one that compromised with end-to-side anastomotic dehiscence and bleeding, and survived after re-anastomosis. All flaps and donor sites healed primarily. During the follow-up of 6-24(mean, 11.5) months, the pliable flaps were ruddy in colour and soft in texture, without obvious bloatness and pigmentation. The donor site healed well with linear scars in 35 cases and mild scar hyperplasia in 7 cases. The donor hip function were normal. Three patients suffered a numbness of the thigh caused by intraoperative injury lateral femoral cutaneous nerve and it disappeared completely after 3 months.Conclusion:New applications of lobulated or chimeric SCIAPF, based on the SCIA vasculature or its branches, can meet most of the clinical repair requirement.
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Objective:To investigate the effect of chimeric flap pedicled with superficial branch of superficial iliac circumflex artery in repair of soft tissue defect of dorsal hand combined with metacarpal bone defect.Methods:From May 2015 to January 2022, 34 patients(28 males and 6 females) of soft tissue defects of dorsal hand with metacarpal bone defects were treated in the Department of Orthopedics of Yibin Third People's Hospital. The age of patients ranged from 22 to 51 years old, with an average age of 37 years old. The areas of soft tissue defects after debridement were 2.5 cm×5.0 cm-4.5 cm×9.0 cm, and the defects were all in dorsal hand and dorsal wrist. The lengths of metacarpal bone defect were 1.8-4.1 cm. All the patients had only single metacarpal bone defect, among which: 14 patients had defects in first metacarpal bone, 7 in second metacarpal bone, 4 in third metacarpal bone, 8 in fourth metacarpal bone and 1 in fifth metacarpal bone. All the patients were repaired by chimeric flap pedicled with superficial branch of superficial iliac circumflex artery. The size of flaps were 3.6 cm×5.4 cm-5.2 cm×9.5 cm. Anticoagulation, thermal preservation and plaster fixation were applied for 4-6 weeks after surgery. Postoperative follow-ups included regularly outpatient clinic visit, telephone or Wechat reviews. Follow-up items covered: the feeling and appearance of flaps in recipient sites, healing of the donor sites and recovery of hand functions.Results:All the 34 chimeric flaps survived. Regular follow-up lasted for 3 to 15(average, 10) months. All incisions in the donor sites of hip healed in stage I. TPD of the flaps was 5.1-7.3(mean, 6.4) mm. Appearance of flaps in the receiving area were satisfactory without swelling. Movement of wrists and metacarpophalangeal joints met the basic requirement of movement. The healing time of metacarpal defect was 2-3 months with an average of 2.8 months. Hand functions were evaluated at excellent in 6 patients and good in 28, according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Conclusion:The chimeric flap pedicled with superficial branch of superficial iliac circumflex artery is an ideal flap to repair the soft tissue defect in dorsal hand combined with metacarpal bone defect. It has advantages of less donor site damage, good blood supply of flap, simple surgical procedure, and one-stage repair of a combined soft tissue and metacarpal bone defects.
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Objective:To introduce a new surgical procedure for harvesting an iliac bone flap with deep iliac circumflex vessels—"retrograde anatomical method", and report the effect of preliminary application with this procedure.Methods:From June 2018 to May 2021, 15 patients who admitted in the Department of Hand and Microsurgery, Xiangya Hospital of Central South University received surgeries of iliac bone flap with deep iliac circumflex artery by "retrograde anatomical method". During the surgery, appropriate cutaneous perforators or muscular branches were found near the medial side of the iliac bone of iliac tubercle. The branches were dissected from surface inwards to the starting point of deep circumflex iliac blood vessel with microsurgery and micro Schlieren forceps. The iliac bone flap was chiselled out, inserted into femoral head, and then anastomosed with the transverse branches of deep circumflex iliac blood vessel and lateral circumflex femoral blood vessel. All patients were included in the postoperative follow-up at the outpatient clinic to evaluate the preliminary effect of this procedure. Harris scores before and after surgery were assessed with paired t test. P<0.05 was considered statistically significant. Results:The length of iliac bone flap was at 3.0-5.0(4.0±0.5) cm, and the length of vascular pedicle was at 4.0-7.0(5.3±1.0) cm. The time of iliac bone flap harvest was 35-55(45.0±6.1) minutes. During the operation, the success rate of harvesting iliac bone flap with deep iliac circumflex artery was 100%, and blood had oozed out of bone surface before the pedicle of all iliac bone flaps was cut-off. The volume of intraoperative autologous blood transfusion was 100-400(226.7±78.2) ml. One patient suffered from traction injury of lateral femoral cutaneous nerve in the operation. The numbness of anterolateral thigh area occurred on the 1st day after the surgery, and relieved 4 months later. Other 14 patients did not suffer from postoperative numbness in the area of anterolateral thigh. The amount of drainage from donor site for the iliac bone flap was 50-70 ml[(62.7±7.5) ml in average] after surgery. Incisions at the donor sites of iliac bone flap healed in stage I. Postoperative follow-up lasted between 3 months and 3 years. There was no incision hernia and other complication in the donor sites of the iliac bone flap. There was a significant difference in Harris scores between at 9, 12 and 18 months after surgery and that before the surgery, respectively( P<0.05). After 18 months, Harris score were at a better level. Conclusion:The "retrograde anatomical method" can quickly determine the nutrient vessels of an iliac bone flap with deep circumflex iliac vessels. The surgical procedure is relatively simple with safe and reliable anatomy. Donor site damage and postoperative complications are greatly minimised. This surgical technique can be considered to be applied clinically.
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Los aneurismas de la arteria ilíaca aislados son extremadamente raros y representan solo entre el 2 por ciento y el 7 por ciento de todos los aneurismas intraabdominales. Este artículo tuvo como objetivo asociar los criterios actuales para el tratamiento quirúrgico en los aneurismas aislados y asintomáticos en la arteria ilíaca común. Se presenta un paciente masculino de 62 años, fumador, remitido del departamento de radiología, porque se observó en el ultrasonido abdominal dilatación aneurismática en arteria ilíaca común derecha. En la tomografía computarizada contrastada se confirmó aneurisma aislado con diámetros quirúrgicos. Se decidió operar y se realizó aneurismectomía más injerto por sustitución protésica con dacrón ilio-ilíaco, con una evolución clínica posoperatoria inmediata y tardía satisfactoria. El tratamiento de referencia para el aneurisma de la arteria ilíaca común ha sido la reparación quirúrgica abierta con injertos protésicos. El algoritmo de decisión se basó en el riesgo de ruptura, que depende a su vez del diámetro aneurismático y del ritmo de crecimiento. Actualmente, el umbral para la reparación electiva de la arteria ilíaca aislada puede considerarse con un mínimo de 3,5 cm de diámetro, pero existe nueva evidencia científica de que muchos pacientes pueden someterse a un tratamiento innecesario si se utiliza este diámetro. Esta es una entidad especial, no solo por su infrecuencia sino también por la mayor complejidad de su reparación(AU)
Isolated iliac artery aneurysms are extremely rare and account for only 2 percent to 7 percent of all intra-abdominal aneurysms. This article aimed to associate current criteria for surgical treatment in isolated and asymptomatic aneurysms in the common iliac artery. A 62-year-old male patient, smoker, referred from the radiology department, is presented because aneurysmal dilation was observed in the abdominal ultrasound in the right common iliac artery. The contrasted computed tomography confirmed an isolated aneurysm with surgical diameters. It was decided to operate and aneurysmectomy plus grafting was performed by prosthetic replacement with ilio-iliac dacron, with a satisfactory immediate and late postoperative clinical evolution. The reference treatment for common iliac artery aneurysm has been open surgical repair with prosthetic grafts. The decision algorithm was based on the risk of rupture, which in turn depends on the aneurysmal diameter and the rate of growth. Currently, the threshold for elective repair of the isolated iliac artery can be considered to be a minimum of 3.5 cm in diameter, but there is new scientific evidence that many patients may undergo unnecessary treatment if this diameter is used. This is a special entity, not only because of its infrequency but also because of the higher complexity of its repair(AU)
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Humans , Male , Middle Aged , Tomography, X-Ray Computed/methods , Iliac Artery , AneurysmABSTRACT
@#Endovascular aneurysm repair (EVAR) has gained acceptance as a viable alternative to open surgical treatment for abdominal aortic aneurysm (AAA). We report the use of snare guiding wire in bifurcated EVAR case with severely tortuous femoral access. A 63-year-old man referred to the hospital from another facility with complaints of pulsating mass in right iliac and umbilical region for the last 2 years. He was then admitted to the cardiac catheterization lab for EVAR under general anaesthetic. Endovascular aneurysm repair (EVAR), also known as an endoprosthesis, is a stent-graft device-guided therapy for a AAA. This procedure is a safer choice for individuals who are elderly or have pulmonary, cardiac, or renal problems. Tortuous iliac arteries might obstruct device delivery during EVAR. The Snare Guiding Wire approach might be an alternate method for EVAR to treat AAA if conventional cannulation is difficult or impossible in individuals with highly tortuous iliac access.
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The internal iliac artery originating from the common iliac artery is an important branch, and communicating with the branches of the abdominal aorta, such as lumbar artery and sacral median artery, forming rich collateral circulation and nourishing the blood supply of gluteal muscle and pelvic floor viscera. Surgical intervention is recommended when the maximum diameter of internal iliac artery aneurysms>2 cm. A variety of treatment modalities are available, particularly, endovascular technique has been successfully applied in the clinical treatment of internal iliac artery aneurysms, which can significantly improve the cure and reduce complications and deaths. This article reviews the previous literature and summarizes the progress of internal iliac artery aneurysms treatment.
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Objective:To investigate the results of the superficial circumflex iliac artery(SCIA)-based conjoined flap for covering extremely large lower limb defects.Methods:From February 2017 to June 2019, 15 patients were admitted, who suffered from severe degloved injury for the lower limb, including 9 males and 6 females with a median year of 45 (ranged, 36-67 ) years old. All were taken thorough and radical debridement and covered by the VSD device during the emergency operation. The dimension of defects was ranged from 25.0 cm ×8.0 cm to 50.0 cm ×15.0 cm. Using the lower abdominal wall or side chest wall as the donor site, the conjoined flap was dissected when the wound surface became granulating. The perforator match fashions included bilateral SCIA, and ipsilateral SCIA and thoracodorsal artery(TA). The donor sites were primary closure. The follow-up was accomplished by the same surgeon.Results:Fourteen flaps survived completely without significant complications, and distal necrosis was observed in one longitudinal flap, which was healed with the skin graft in the second stage. All flaps were available for a mean follow-up of 18 (ranged 16-24) months. The aesthetic outcomes were achieved on the recipient site without hairy appearance and hyper-pigmentation. A concealed line scare was left on the donor site, without the hernia and limited function. At the last follow-up, 7 cases were excellent and 1 case was good, evaluated with the LEFS criteria. And 6 cases were excellent and 1 case was good, assessed by the AOFAS criteria.Conclusion:The simultaneous reconstruction of extreme lower limb defects and better salvage treatment could be achieved by the SCIA-based conjoined flap. And as a versatile flap, it was blessed with concealed donor site, various design fashions, and larger dissection size in selected cases.
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Objective:To observe and summarise the clinical effect of free groin flap in repairing of soft tissue defects in extremities, and to explore the selection of main vessel in a flap.Methods:From January 2018 to January 2021, 146 patients with soft tissue defects in extremities were treated with free groin flaps in the Department of Hand and Microsurgery, Guangxi Guilin Xing'an Jieshou Orthopaedic Hospital. There were 126 patients with traumatic wound and 20 with chronic ulcer. In addition, 86 of the patients with bone fracture and exposure of internal fixator, 18 with tendon, nerve or artery injuries or defects. There were 6 patients with severe infection and other 3 with deep dead space. The sizes of wound ranged from 2.0 cm×3.0 cm to 25.0 cm×6.0 cm. The flap was the same size as the wound and not enlarged. Firstly, the superficial branch of superficial iliac circumflex artery was explored as the axial artery for all the flaps, then the blood supply vessels of the flap were selected according to the availability of the axial artery. The size, course, adjacent and possible length to be freed of the axial artery and the accompanying veins of a flap were recorded. The donor sites were directly sutured and closed. All patients were included in the postoperative follow-up at outpatient clinic.Results:Free groin flap were used to repair the wounds in all patients. However, the main blood supply vessel of the flap was not constant, and it was often required to adjust the way of flap harvesting. Superficial circumflex iliac artery was taken as the axial vessels in 141 patients (96.6%), among them, 133 cases(94.3%) had the superficial branch as the axis and 5 cases (3.6%) had deep branch as the axis. Three patients (2.1%) had the bone and soft tissue defects reconstructed with vascularised iliac mosaic osteocutaneous flap with superficial circumflex iliac artery as axial vessel and 5 cases(3.4%) had the superficial epigastric artery as axial vessel. The axial arteries were measured as follow: the superficial branch of the superficial circumflex iliac artery was 0.5-0.9 mm in diameter and 7.0-9.0 cm in length, the outer diameter of the deep branch was 1.2-1.4 mm and 9.0-11.0 cm in length, and the outer diameter of superficial epigastric artery was 1.0-1.6 mm and 8.0-11.3 cm in length. All the flaps survived smoothly after surgery and the follow-up period ranged 6-40 (mean 26) months. The texture of the flaps was soft with good function.Conclusion:Free groin flap can be used to repair soft tissue defects in extremities. The main axial vessel is the superficial branch of the superficial circumflex iliac artery, followed by the deep branch or the trunk. The superficial abdominal artery can also be used as an axial vessel. Under the circumstances, the flap design needs to be adjusted without changing the supply area
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Resumen Introducción: La angioplastia transluminal percutánea (ATP), se ha convertido en una técnica aceptada, en el tratamiento de la enfermedad obstrutiva aortoilíaca, con tasas de éxito del 90-92% y permeabilidad primaria del 55-72% a 5 años. Objetivo: Evaluar los resultados del tratamiento endovascular del sector aortoilíaco. Material y Método: Estudio descriptivo, retrospectivo (revisión de serie de casos unicéntrica), de pacientes, sometidos consecutivamente al tratamiento endovascular (ATP simple y ATP con stent) de la patología obstructiva del sector aortoilíaco, durante un período de 7 años (2002-2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizaron 103 procedimientos en 94 pacientes, sexo masculino: 63,83%, femenino: 36,17%, edad promedio: 67,4 años (rango 47-96), distribución de las lesiones según la clasificación TASC II: A (46,24%), B (39,78%), C (8,60%), D (5,38%), remodelando la biburfaccción aórtica (kissing stent) en un 6,80%, procedimientos híbridos (12,62%), seguimiento promedio (47,13 meses), éxito clínico (90,29%), exito técnico (94,17%), permeabilidad primaria, primaria asistida y secundaria a 5 años del 68,09%, 75,53% y 81,91% respectivamente, tasa de salvación de la extremidad a 5 años del 84,04%, mortalidad < 30 días del 1,94%, supervivencia a 5 años del 90,42%. Discusión: Las técnicas endovasculares del sector aortoilíaco son fiables, sus resultados ténicos y permeabilidad, están influenciados por el estadio clínico del paciente y severidad de las lesiones tratadas. Conclusión: En pacientes adecuadamente seleccionados, el tratamiento endovascular del sector aortoilíaco presenta excelentes resultados, permitiendo aumentar la indicación de tratamiento en pacientes considerados de alto riesgo.
Introduction: Percutaneous transluminal angioplasty (PTA) has become an accepted technique in the treatment of aortoiliac occlusive disease, with success rates of 90-92%, and primary patency of 55-72% at 5 years. Aim: To evaluate the results of endovascular treatment (PTA or PTA with stents) of the aortoiliac sector. Material and Method: Descriptive, retrospective study (single-center case series) of patients, consecutively subjected to endovascular treatment (PTA or PTA with stents) of aortoiliac occlusive disease, during a period of 7 years (2002 - 2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: 103 procedures were performed in 94 patients, male: 63.83%, female: 36.17%, mean age: 67.4 years (range 47-96), distribution of the lesions according to the TASC II classification: A (46.24%), B (39.78%), C (8.60%), D (5.38%), remodeling the aortic bifaction (kissing stent) in 6.80%, hybrid procedures (12.62%), average follow-up (47.13 months), clinical success (90.29%), technical success (94.17%), primary patency, assisted primary and secondary at 5 years of 68.09%, 75, 53% and 81.91% respectively, 5-year limb salvage rate of 84.04%, mortality < 30 days of 1.94%, 5-year survival of 90.42%. Discussion: Endovascular techniques in the aortoiliac sector are reliable, their technical results and patency are influenced by the clinical stage of the patient and the severity of the lesions treated. Conclusion: In appropriately selected patients, endovascular treatment of the aortoiliac sector, presents excellent results, allowing an increase in the indication for treatment in patients considered to be at high risk.
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Male , Female , Middle Aged , Aged , Aged, 80 and over , Arteriosclerosis/surgery , Endovascular Procedures , Iliac Artery/surgery , Aortic Diseases/surgery , Aortic Diseases/therapy , Arteriosclerosis/therapy , Iliac Artery/diagnostic imagingABSTRACT
SUMMARY: The inferior epigastric artery (IEA) is a major blood vessel that supplies the anterior abdominal wall. The aim of the current study was to provide clinicians, surgeons, and obstetricians with sufficient anatomical data on the inferior epigastric artery, such as its origin and branching pattern. The study included 20 embalmed cadavers, these cadavers were dissected, and the inferior epigastric artery and vena comitans/venae comitantes were identified and traced downwards to the external iliac vessels. The origins, caliber, course and pedicle length of both the artery and the vein(s) were studied. The inferior epigastric artery arose independently from the distal external iliac artery deep to the inguinal ligament in 19 (95 %) cadavers. The artery entered the rectus abdominis muscle at its middle third in 13 (65 %) cases and at its lower third in the remaining specimens. In this study, we found that the artery divided into two branches in 18 (90 %) of the cases; in the remaining two cases, it continued as one trunk. The average pedicle length was 7.2 cm. The mean caliber of the IEA was 3.7 mm. In 18 (90 %) dissections, the venous drainage consisted of a pair of venae comitantes that united to form a common vessel at their draining point on the external iliac vein. The average diameter was 3.9 mm. The current study focuses on the anatomical features of the inferior epigastric artery to increase the success rate of abdominal and pelvic operations in clinical practice.
RESUMEN: La arteria epigástrica inferior (AEI) es un vaso sanguíneo principal que irriga la pared abdominal anterior. El objetivo del presente estudio fue proporcionar a los médicos, cirujanos y obstetras suficientes datos anatómicos sobre la arteria epigástrica inferior, como su origen y patrón de ramificación. El estudio incluyó 20 cadáveres embalsamados, los que se disecaron y se identificó la arteria epigástrica inferior y la vena concomitante y se siguieron hasta los vasos ilíacos externos. Se estudiaron los orígenes, calibre, trayecto y longitud del pedículo tanto de la arteria como de la (s) vena (s). La arteria epigástrica inferior surgió independientemente de la arteria ilíaca externa profunda al ligamento inguinal en 19 (95 %) cadáveres. La arteria ingresó al músculo recto del abdomen en su tercio medio en 13 (65 %) casos y en su tercio inferior en las muestras restantes. En este estudio, encontramos que la arteria se dividió en dos ramas en 18 (90 %) de los casos; en los dos casos restantes, continuó como un tronco. La longitud media del pedículo fue de 7,2 cm. El calibre medio del AEI fue de 3,7 mm. En 18 (90 %) disecciones, el drenaje venoso consistió en un par de venas concomitantes las que formaron un vaso común en su punto de drenaje en la vena ilíaca externa. El diámetro medio fue de 3,9 mm. El estudio actual se centra en las características anatómicas de la arteria epigástrica inferior con el propósito de mejorar la tasa de éxito de las cirugías abdominales y pélvicas en la práctica clínica.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Rectus Abdominis/blood supply , Epigastric Arteries/anatomy & histology , Cadaver , Iliac Artery/anatomy & histologyABSTRACT
To report a rare case of a patient diagnosed with segmental arterial mediolysis with abdominal angina. The work is characterized as a Case Report with bibliographic review, the method used was the bibliometric analysis of articles published in the Pubmed database. The theoretical scan covered the years 2010 to 2020, and consisted of seeking out articles throughout all indexes using the terms: segmental arterial mediolysis and abdominal angina. The search occurred between the months of October and December of 2020. The information contained for the case report was obtained by the review of medical records, patient interview as well as records of laboratory tests and images. A 57-year-old man was diagnosed with segmental arterial mediolysis with abdominal angina after a series of investigations and imaging exams. These investigations were prompted due to a long- standing complaint of unexplained abdominal pain that had gone undiagnosed by other specialists. The evaluation of this pathology objectively requires the attainment of the earliest possible resolution, thus, clinical and complementary investigations must be carried out. To date, however, there are no established guidelines on therapy.
Reportamos un raro caso de un paciente diagnosticado de mediolisis arterial segmentaria con angina abdominal. El trabajo se caracteriza por ser un Reporte de Caso con revisión bibliográfica, el método utilizado fue el análisis bibliométrico de los artículos publicados en la base de datos Pubmed. La exploración teórica abarcó los años 2010 a 2020 y consistió en buscar artículos en todos los índices utilizando los términos: mediolisis arterial segmentaria y angina abdominal. La búsqueda se realizó entre los meses de octubre y diciembre de 2020. La información contenida para el reporte del caso se obtuvo mediante la revisión de historias clínicas, entrevista de pacientes así como registros de pruebas de laboratorio e imágenes. A un hombre de 57 años se le diagnosticó mediolisis arterial segmentaria con angina abdominal después de una serie de investigaciones y exámenes por imágenes. Estas investigaciones fueron motivadas debido a una queja de larga data de dolor abdominal inexplicable que no había sido diagnosticado por otros especialistas. La evaluación de esta patología de manera objetiva requiere la consecución de la resolución más temprana posible, por lo que se deben realizar investigaciones clínicas y complementarias. Sin embargo, hasta la fecha, no existen pautas establecidas sobre el tratamiento.
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Objective:To explore a comparative study of arterial end-to-end and end-to-side anastomosis in superficial branch of the superficial circumflex iliac artery(SCIA) perforator flap transfer.Methods:Between November, 2019 and December, 2020, 21 patients with the soft tissue defects in the limbs were repaired with superficial branch of the SCIA perforator flaps. The size of flaps ranged from 3.5 cm×7.0 cm to 9.0 cm×18.0 cm. According to the upper or anterior wall of the main artery in the recipient area having branches that matched the flap artery, 2 groups were established. End-to-end group: 10 cases were anastomosed end-to-end between the flap artery and branch of the main artery in the recipient area; End-to-side group: 11 cases were anastomosed end-to-side between the flap artery and side mouth of the main artery in the recipient area. The vein of flap was anastomosed end-to-end with the accompanying vein to the main artery in the recipient area. All of the donor sites were sutured directly. All patients were followed-up for 6-12 months and the survival of the perforator flap, the appearance and function of the perforator flap and the donor site were observed. All data of the 2 groups were conducted statistical analyzed. P<0.05 was statistically significant. Results:All 10 flaps in end-to-end group survived successfully. In end-to-side group, 2 cases had venous crisis in 11 cases of flaps,the exploration revealed venous thrombosis, and the arterial end-to-side anastomosis had smooth blood flow had embolism. One flap survived after re-anastomosis of the vein, and 1 flap was changed to a pedicled abdominal flap during the re-venous crisis. The postoperative follow-up was 6 months to 1 year. The appearance and function of the flap and donor site were satisfactory, without difference between the 2 groups. The SCIA superficial branch artery caliber, recipient artery branch or lateral caliber was not statistically different between the 2 groups( P>0.05). The time of anastomosis for end-to-end group was[(16.70±1.34) min]. It was lower than that of anastomosed end-to-side group[(23.73±1.68) min]. The difference was statistically significant( P<0.01). Conclusion:In superficial branch of the SCIA perforator flap transfer, if the upper or anterior wall of the main artery in the recipient area has a branch that matches the flap artery, the flap artery should first be anastomosed with its end. Because it dose not required to make a side port, and makes the operation more convenient with a short anastomosis time; Otherwise, perform end-to-side anastomosis with the main artery of the recipient site.
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Objective:To explore the strategies for the treatment of difficult iliac artery approach in endovascular repair of abdominal aortic aneurysm.Methods:The clinical data of 275 patients with abdominal aortic aneurysm who underwent endovascular surgery at the Department of Vascular Surgery, People′s Hospital of Xinjiang Uygur Autonomous Region from March 2010 to March 2019 were retrospectively analyzed, and the general clinical data such as age, gender, and comorbidities of the patients were recorded. The resource index was to carry out corresponding measures to perform surgery for patients with difficult access, analyze the incidence of the type of difficult access, treatment measures and effects.Results:Two hundred and seventy-five patients underwent endovascular repair, 78 of them (28.3%) had difficulty in accessing the iliac artery, including 29 cases (10.5%) with mild iliac artery stenosis, 7 cases (2.54%) with severe stenosis, and 3 cases with occlusion ( 1.09%), 39 cases (14.2%) were twisted. For patients with vascular twist, super-hard guide wire was used to correct iliac artery angulation. For patients with iliac artery stenosis, balloon dilation was performed. For severe stenosis, the artificial blood vessel was passed through the lateral peritoneum. After road transplantation, stent placement and other treatments were successfully performed endovascular repair.Conclusions:Pathway vascular disease can cause difficulties in endovascular treatment of abdominal aortic aneurysms. Endovascular repair can be successfully performed after corresponding treatments according to different difficulties, and the long-term patency rate is good.
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Objective@#The purpose of this study was to explore the application value of digital surgery in the reconstruction of mandibular composite defects with a chimeric deep circumflex iliac artery perforator flap (DCIAPF).@*Methods@# Six patients with complex defects within half of the mandible underwent reconstruction using DCIAPF from January 2019 to January 2020 in Shenzhen People’s Hospital. Doppler was used to locate the deep iliac circumflex artery, the range of mandibular osteotomy was designed, and DCIAPF was used to repair the mandibular composite under the guidance of the guide plate during the operation. Twelve months postoperatively, the facial shape, jaw height, and occlusal relationship were evaluated@*Results@#DCIAPF was harvested successfully in 6 patients, and the heights of all alveolar ridges and occlusal function of patients were significantly restored, without pain or snapping in the temporomandibular joint area.@*Conclusion @#The blood supply of DCIAPF is rich, and soft-bone tissue is sufficient for the reconstruction of mandibular composite defects. Combined with digital surgery, the accuracy and safety are improved.
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Abstract External iliac artery endofibrosis is a rare pathology that affects high-level endurance athletes, especially cyclists. Classical symptoms include pain, loss of power, and/or cramp in the affected limb while training at maximal effort. The patient's lack of atherosclerotic risk factors makes clinical suspicion of arteriopathy challenging. Moreover, the best management of such patients is still a subject of discussion. We report the case of a 36-year-old professional female endurance cyclist who presented with lower extremity pain during training. Right external iliac artery endofibrosis was diagnosed and the patient underwent surgical treatment. At two-months follow-up, she reported significant improvement in symptoms. This case highlights the importance of diagnosing peripheral vascular disease in young patients and athletes, who do not fit the ordinary profile of patients with atherosclerotic risk factors.
Resumo A endofibrose da artéria ilíaca externa é uma doença rara que afeta atletas de resistência (endurance) de nível competitivo, principalmente ciclistas. Os sintomas clássicos incluem dor, perda de força e/ou câimbras no membro afetado ao fazer esforço máximo durante o treino. A ausência de fatores de risco ateroscleróticos nesses pacientes torna a suspeita clínica de arteriopatia desafiadora. Além disso, o melhor manejo ainda é motivo de debate. Relatamos o caso de uma ciclista de resistência profissional, de 36 anos, que apresentou dor nos membros inferiores durante o treino. Foi diagnosticada endofibrose da artéria ilíaca externa, e a paciente foi submetida a tratamento cirúrgico. Após seguimento por dois meses, a paciente relatou melhora significativa dos sintomas. Este caso destaca a importância do diagnóstico de doença vascular periférica em pacientes jovens e atletas, os quais não se encaixam no perfil comum do paciente com fatores de risco ateroscleróticos.