Subject(s)
Iliac Artery , Perforator Flap , Plastic Surgery Procedures , Soft Tissue Injuries , Thumb , Humans , Male , Perforator Flap/blood supply , Perforator Flap/transplantation , Thumb/injuries , Thumb/surgery , Adolescent , Plastic Surgery Procedures/methods , Iliac Artery/surgery , Iliac Artery/injuries , Iliac Artery/transplantation , Soft Tissue Injuries/surgery , Free Tissue Flaps/transplantation , Free Tissue Flaps/blood supplyABSTRACT
BACKGROUND: Tumorous diseases of the jaw demand effective treatments, often involving continuity resection of the jaw. Reconstruction via microvascular bone flaps, like deep circumflex iliac artery flaps (DCIA), is standard. Computer aided planning (CAD) enhances accuracy in reconstruction using patient-specific CT images to create three-dimensional (3D) models. Data on the accuracy of CAD-planned DCIA flaps is scarce. Moreover, the data on accuracy should be combined with data on the exact positioning of the implants for well-fitting dental prosthetics. This study focuses on CAD-planned DCIA flaps accuracy and proper positioning for prosthetic rehabilitation. METHODS: Patients post-mandible resection with CAD-planned DCIA flap reconstruction were evaluated. Postoperative radiograph-derived 3D models were aligned with 3D models from the CAD plans for osteotomy position, angle, and flap volume comparison. To evaluate the DCIA flap's suitability for prosthetic dental rehabilitation, a plane was created in the support zone and crestal in the middle of the DCIA flap. The lower jaw was rotated to close the mouth and the distance between the two planes was measured. RESULTS: 20 patients (12 males, 8 females) were included. Mean defect size was 73.28 ± 4.87 mm; 11 L defects, 9 LC defects. Planned vs. actual DCIA transplant volume difference was 3.814 ± 3.856 cm³ (p = 0.2223). The deviation from the planned angle was significantly larger at the dorsal osteotomy than at the ventral (p = 0.035). Linear differences between the planned DCIA transplant and the actual DCIA transplant were 1.294 ± 1.197 mm for the ventral osteotomy and 2.680 ± 3.449 mm for the dorsal (p = 0.1078). The difference between the dental axis and the middle of the DCIA transplant ranged from 0.2 mm to 14.8 mm. The mean lateral difference was 2.695 ± 3.667 mm in the region of the first premolar. CONCLUSION: The CAD-planned DCIA flap is a solution for reconstructing the mandible. CAD planning results in an accurate reconstruction enabling dental implant placement and dental prosthetics.
Subject(s)
Iliac Artery , Surgical Flaps , Humans , Male , Female , Middle Aged , Surgical Flaps/blood supply , Surgical Flaps/transplantation , Iliac Artery/surgery , Iliac Artery/diagnostic imaging , Aged , Adult , Surgery, Computer-Assisted/methods , Imaging, Three-Dimensional , Plastic Surgery Procedures/methods , Mandibular Neoplasms/surgery , Retrospective Studies , Mandibular Reconstruction/methods , Mastication/physiology , Treatment OutcomeABSTRACT
RATIONALE: Uterine arteriovenous fistula (UAVF) is a rare vascular abnormality that can cause severe and potentially life-threatening hemorrhage. Uterine artery embolization is a common treatment that may affect ovarian and uterine perfusion and cause fertility problems. We herein report our experience treating 2 patients with UAVF who underwent resection after temporary occlusion of both internal iliac arteries. PATIENT CONCERNS: Both patients presented with a large UAVF after incomplete miscarriages in the second trimester. Magnetic resonance imaging revealed a UAVF measuring 3.6â ×â 2.6â ×â 2.1 cm over the myometrium of the posterior uterine in case 1, and a UAVF of 7.1â ×â 4.1â ×â 4.5 cm was identified in case 2. DIAGNOSIS: Uterine arteriovenous fistula, retained products of conception. INTERVENTIONS: The patients underwent resection of UAVF with temporary occlusion of the internal iliac arteries and hysteroscopic removal of the retained products of conception. OUTCOMES: Intraoperative bleeding were minimal. Neither patient exhibited abnormal uterine bleeding at the 6-month follow-up. Follow-up ultrasonography and magnetic resonance imaging showed normal uterine myometrium and endometrium and no residual disease. LESSONS: UAVF resection after temporary occlusion of the internal iliac arteries is a promising treatment approach for UAVF. This technique can reduce intraoperative bleeding and remove the potential hemorrhage-related lesion while preserving fertility.
Subject(s)
Arteriovenous Fistula , Iliac Artery , Humans , Female , Iliac Artery/surgery , Iliac Artery/diagnostic imaging , Arteriovenous Fistula/surgery , Adult , Uterine Artery/surgery , Uterine Artery/diagnostic imaging , Pregnancy , Uterine Hemorrhage/etiology , Uterine Hemorrhage/surgery , Uterine Artery Embolization/methods , Magnetic Resonance Imaging , Uterus/blood supply , Uterus/surgeryABSTRACT
BACKGROUND: The introduction of radial-specific equipment has made transradial (TR) aortoiliac (AI) endovascular therapy (EVT) more convenient. OBJECTIVES: The authors aimed to investigate the perioperative outcomes of the TR approach in patients undergoing AI EVT for symptomatic peripheral artery disease. METHODS: The COMFORT (Contemporary Strategy for Aortoiliac Intervention) registry was a prospective, multicenter, observational study enrolling patients with symptomatic peripheral artery disease undergoing AI EVT between January 2021 and June 2023. The primary outcome was perioperative complications, whereas the secondary outcomes included core laboratory-evaluated residual stenosis >30%, time to hemostasis, time to ambulation, 30-day patency, and 30-day limb symptoms. These outcomes were compared between TR and non-TR AI EVT after propensity score matching. RESULTS: The TR approach was selected for 231 of the 947 patients (24.3%). The TR approach was chosen more in patients with a higher ankle-brachial index, chronic total occlusion, aortic lesion, bare nitinol stent implantation, and plain angioplasty, whereas it was chosen less in patients with dialysis, a history of AI EVT, chronic limb-threatening ischemia, bilateral calcification, and simultaneous infrainguinal EVT (all P < 0.05). After propensity score matching, the incidence of perioperative complications did not differ significantly between the groups (TR group: 6.0% vs non-TR group: 5.1%; P = 0.69). The proportions of residual stenosis, 30-day patency, and 30-day limb symptoms were not significantly different (all P > 0.05); however, the time to hemostasis and the time to ambulation were shorter in the TR group (both P < 0.05). CONCLUSIONS: Non-TR AI EVT and TR AI EVT using radial-specific equipment were associated with a similar risk of perioperative complications. The TR approach helps shorten the time required for hemostasis and ambulation.
Subject(s)
Endovascular Procedures , Iliac Artery , Peripheral Arterial Disease , Radial Artery , Registries , Vascular Patency , Humans , Female , Male , Aged , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Prospective Studies , Radial Artery/physiopathology , Treatment Outcome , Time Factors , Iliac Artery/diagnostic imaging , Iliac Artery/physiopathology , Iliac Artery/surgery , Middle Aged , Peripheral Arterial Disease/therapy , Peripheral Arterial Disease/physiopathology , Peripheral Arterial Disease/diagnostic imaging , Risk Factors , Risk Assessment , Aged, 80 and over , Catheterization, Peripheral/adverse effects , Stents , PuncturesABSTRACT
BACKGROUND: This study was conducted to evaluate the differences between pre- and postoperative access conditions in percutaneous endovascular aortic repair (PEVAR). METHODS: Between December 2021 and October 2023, PEVAR was performed on 61 patients using the Perclose ProStyle (Abbott Vascular). Enhanced computed tomography and ankle-brachial index tests were performed preoperatively and postoperatively. The inner diameter and area of the iliofemoral artery were automatically measured, and the pre- and postoperative values were compared (114 legs). The same analysis was performed on 12 legs with previous groin operations; open surgical EVAR was performed in 9 legs, an endarterectomy of the femoral artery in 1, and a femoropopliteal bypass in the other leg. RESULTS: All patients were discharged without surgical site infections, lymphatic fistulas, or retroperitoneal haematomas. There were no significant differences between the pre-and postoperative inner diameter and inner area of the external iliac artery and common femoral artery. There were no significant differences between the preoperative and postoperative ankle-brachial index tests. In 12 legs with a previous groin operation, the postoperative ankle-brachial index tests and inner diameter and area of the external iliac artery and common femoral artery were statistically equal to the preoperative values. CONCLUSIONS: This study can support the safety of percutaneous endovascular aortic repair, even in patients with redo groin operations.
Subject(s)
Ankle Brachial Index , Endovascular Procedures , Femoral Artery , Iliac Artery , Humans , Femoral Artery/surgery , Femoral Artery/diagnostic imaging , Male , Endovascular Procedures/methods , Female , Aged , Iliac Artery/surgery , Iliac Artery/diagnostic imaging , Prospective Studies , Middle Aged , Tomography, X-Ray Computed , Aged, 80 and over , Aortic Aneurysm, Abdominal/surgery , Endovascular Aneurysm RepairABSTRACT
Arterio-ureteral fistulas (AUFs), which are relatively rare but potentially life-threatening, require prompt diagnosis and treatment. We reported a case of AUFs following robot-assisted laparoscopic radical cystectomy (RARC) with extended pelvic lymph node dissection and ileal conduit urinary diversion for muscle-invasive bladder cancer, which resulted in massive hemorrhage. Urine leaked from the anastomosis between the ureter, and the end of the ileal conduit was infected, which resulted in an AUF between the pseudoaneurysm of the right common iliac artery and the ureter. The AUF was managed successfully by vascular intervention with an arterial stent graft.
Subject(s)
Aneurysm, False , Cystectomy , Iliac Artery , Laparoscopy , Robotic Surgical Procedures , Ureteral Diseases , Urinary Fistula , Vascular Fistula , Humans , Cystectomy/adverse effects , Aneurysm, False/etiology , Aneurysm, False/surgery , Urinary Fistula/etiology , Urinary Fistula/surgery , Ureteral Diseases/etiology , Ureteral Diseases/surgery , Iliac Artery/surgery , Vascular Fistula/etiology , Vascular Fistula/surgery , Male , Postoperative Complications/surgery , Postoperative Complications/etiology , Urinary Bladder Neoplasms/surgery , Aged , Middle AgedABSTRACT
Mycotic aneurysms of the iliac and other large arteries are rare and are associated with increased morbidity and mortality. Treatment of mycotic aneurysms usually requires modification of the surgical technique done for cases of degenerative or atherosclerotic aneurysms. Degenerative and atherosclerotic fusiform aneurysms are usually managed with aneurysmorrhaphy using a prosthetic graft, which however is not ideal for mycotic aneurysms. Avoidance of prosthetic material at the site of mycotic aneurysm is a better option with higher chances of resolution of infection and favorable patient outcome.
Subject(s)
Aneurysm, Infected , Iliac Aneurysm , Humans , Aneurysm, Infected/surgery , Aneurysm, Infected/diagnostic imaging , Iliac Aneurysm/surgery , Iliac Aneurysm/diagnostic imaging , Male , Treatment Outcome , Blood Vessel Prosthesis Implantation/methods , Iliac Artery/surgeryABSTRACT
Foot injuries, particularly degloving injuries, can lead to segmental loss of neurovascular structures in the toes, making simultaneous reconstruction of both the foot and toes challenging. This case report presents a technique using the superficial circumflex iliac artery perforator (SCIP) flap for immediate reconstruction of the dorsal foot and revascularization of multiple toes. A 28-year-old man suffered a degloving injury on the dorsum of his foot resulting in a 9 × 6cm skin defect, open fracture dislocations, exposure of tendons, and neurovascular injury, which included a 6-7.5 cm segmental defect of the vessels supplying the first, second, and third toes leaving all three toes ischemic. Immediate reconstruction was performed by harvesting a 12.5 × 5cm SCIP flap including both the superficial and deep branches and incorporating the superficial inferior epigastric vein (SIEV). The SCIP deep branch was used to revascularize the third and second toes and the SIEV vein graft used for the first toe. The patient recovered well, no complications were observed at the 2-year follow-up, preserving all three toes and regaining mobility. The use of the SCIP flap as a flow-through flap provides thin skin flap cover, good vessel caliber size match with digital vessels and reduces the need for vein grafts from distant sites improving surgical efficiency. These attributes make the flow-through interposition SCIP flap an excellent choice for reconstructing foot defects and revascularizing toes. We report this case to demonstrate the utility of the SCIP flap in immediate soft tissue cover and digit revascularization.
Subject(s)
Foot Injuries , Iliac Artery , Perforator Flap , Plastic Surgery Procedures , Toes , Humans , Male , Adult , Perforator Flap/blood supply , Iliac Artery/surgery , Plastic Surgery Procedures/methods , Toes/surgery , Toes/blood supply , Foot Injuries/surgery , Degloving Injuries/surgeryABSTRACT
Here, we describe an interesting case of a patient with the duplication of inferior vena cava, high-positioned bifurcation of the abdominal aorta with transposition of iliac arteries, and right renal aplasia associated with end-stage renal disease who underwent kidney transplant. In this case, the patient with anorectal malformations with a vaginal fistula was prepared and underwent a kidney transplant. During the surgery, we discovered duplicated inferior vena cava and transposed iliac arteries. After the surgery, computed tomography angiography revealed the inferior vena cava duplication with the 2 connections between the right and left inferior vena cava with the formation of an anomalous circle, high-positioned bifurcation of the abdominal aorta at the level of the L2 vertebral body, and transposition of right and left iliac arteries. Also, we observed the right kidney aplasia and absence of blood circulation in the left native kidney. In our case, a delayed diagnosis of pyelonephritis resulted in the progression to end-stage renal disease that necessitated a kidney transplant, during which we found these anomalies. We confirmed the asymptomatic course of these anomalies, diagnosed only during radiological imaging or surgical intervention. Patients with congenital anomalies of the kidney and urinary tract should undergo complete investigations before surgical decisions. Diagnosis of this pathology in the preoperative period, especially in transplant patients, will alert the surgery team in advance of the operation and allow preparation for the intraoperative difficulties that are typically associated with anomalies such as inferior vena cava transposition or aplasia.
Subject(s)
Aorta, Abdominal , Kidney Failure, Chronic , Kidney Transplantation , Vascular Malformations , Vena Cava, Inferior , Humans , Vena Cava, Inferior/abnormalities , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgery , Female , Kidney Failure, Chronic/surgery , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/diagnosis , Treatment Outcome , Aorta, Abdominal/abnormalities , Aorta, Abdominal/surgery , Aorta, Abdominal/diagnostic imaging , Vascular Malformations/surgery , Vascular Malformations/complications , Vascular Malformations/diagnostic imaging , Aortography , Computed Tomography Angiography , Abnormalities, Multiple/surgery , Phlebography/methods , Incidental Findings , Iliac Artery/surgery , Iliac Artery/abnormalities , Iliac Artery/diagnostic imaging , Adult , Pyelonephritis/surgery , Pyelonephritis/etiology , Pyelonephritis/diagnosis , Pyelonephritis/diagnostic imaging , Predictive Value of TestsABSTRACT
OBJECTIVES: To compare the clinical outcomes of anterolateral femoral interregional flap with turbocharge technique and traditional anterolateral femoral flap in repair of large limb wounds. METHODS: Clinical data of 38 patients with large limb surface wound (11 cm×39 cm-16 cm×65 cm) admitted to the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from May 2018 to May 2022 were retrospectively analyzed. Eighteen patients were treated by anterolateral thigh perforator flap combined with superficial circumflex iliac artery flap (ALTP-SCIAP) with turbocharge technique (interregional flap group); while 20 patients were treated with unilateral or bilateral anterolateral femoral flaps, combined with skin grafting if necessary (traditional anterolateral femoral flap group). The survival of skin flap, repair of donor area, complications and patient satisfaction were compared between the two groups. RESULTS: In interregional flap group, 18 flaps were harvested and transplanted, the flap width, length and the viable area were (9.9±2.0) cm, (44.2±3.5) cm and (343.2±79.9) cm2, respectively. In traditional anterolateral femoral flap group, 29 flaps were harvested and transplanted, the flap width, length and the viable area were (11.0±2.8) cm, (21.7±3.2) cm and (186.4±49.2) cm2, respectively. There were significant differences in the flap length and the viable area between the two groups (t=22.365 and 8.345, both P<0.05). In the interregional flap group, the donor site of flap was closed by direct suture in 11 flaps, by skin retractor assisted suture in 6 flaps, and by skin grafting in one flap. In traditional anterolateral femoral flap group, the donor site of flap was closed by direct suture in 12 flaps, by skin retractor assisted suture in 11 flaps, and by skin grafting in 6 flaps. The skin graft rates of the two groups were 5.6% (1/18) and 20.7% (6/29), respectively (χ2=2.007, P>0.05). The interregional flap group had lower postoperative complications rate (5.6% vs. 35.0%, χ2=4.942, P<0.05) and higher patient satisfaction rate (94.4% vs. 70.0%, χ2=4.448, P<0.05) than traditional anterolateral femoral flap group. CONCLUSIONS: Compared with the traditional anterolateral femoral flap, the anterolateral femoral interregional flap with turbocharge technique has a larger flap area, most of the donor areas of the flap can be sutured directly without skin grafting and with less complications and a higher patient satisfaction rate.
Subject(s)
Perforator Flap , Plastic Surgery Procedures , Skin Transplantation , Surgical Flaps , Humans , Retrospective Studies , Skin Transplantation/methods , Plastic Surgery Procedures/methods , Male , Female , Patient Satisfaction , Femur/surgery , Thigh/surgery , Iliac Artery/surgery , Wound Healing , Middle Aged , AdultABSTRACT
Non-iatrogenic trauma of the iliac artery is rarely reported but is always life-threatening. In this report, we describe the case of a child with complete transection and partial disappearance of the iliac artery caused by bicycle handlebar impalement. He experienced catastrophic hemorrhage, malignant arrhythmia, and difficulty in exploring transected vessel stumps. Aggressive infusion, blood transfusion in time, and pediatric vascular characteristics help delay the deterioration during anesthesia induction. Eventually he was successfully rescued by performing interventional balloon occlusion and open revascularization after more than 7 h post-trauma. A series of interventions and precautionary methods may benefit such severely injured patients; thus, these methods should be highlighted.
Subject(s)
Iliac Artery , Humans , Iliac Artery/surgery , Iliac Artery/injuries , Male , Child , Bicycling/injuries , Balloon Occlusion/methods , Vascular System Injuries/surgery , Vascular System Injuries/etiology , Vascular Surgical Procedures/methods , Wounds, Nonpenetrating/surgeryABSTRACT
PURPOSE: Internal iliac artery ligation (IIAL) has been used as a damage control procedure to treat hemodynamically unstable pelvic fracture for many years. However, there is ongoing debate regarding the effectiveness and safety of this hemostatic method. Therefore, we performed a systematic literature review to assess the efficacy and safety of IIAL for pelvic fracture hemostasis. METHODS: Three major databases, PubMed, Embase, and Google Scholar, were searched to screen eligible original studies published in English journals. Two reviewers independently read the titles, abstracts, and full texts of all literature. Articles were included if they reported the use and effects of IIAL. RESULTS: A total of 171 articles were initially identified, with 22 fully meeting the inclusion criteria. Among the analyzed cases, up to 66.7% of patients had associated abdominal and pelvic organ injuries, with the urethra being the most frequently injured organ, followed by the bowel. The outcomes of IIAL for achieving hemostasis in pelvic fractures were found to be satisfactory, with an effective rate of 80%. Hemorrhagic shock was the leading cause of death, followed by craniocerebral injury. Notably, no reports of ischemic complications involving the pelvic organs due to IIAL were found. CONCLUSION: IIAL has a good effect in treating hemodynamically unstable pelvic fracture without the risk of pelvic organ ischemia. This procedure should be considered a priority for hemodynamically unstable pelvic fracture patients with abdominal organ injuries.
Subject(s)
Fractures, Bone , Hemodynamics , Iliac Artery , Pelvic Bones , Humans , Iliac Artery/surgery , Iliac Artery/injuries , Fractures, Bone/surgery , Pelvic Bones/injuries , Ligation/methods , MaleABSTRACT
We aimed to analyze the feasibility of endovascular treatment for brucellosis-related aorta-iliac artery pseudoaneurysm. We did a statistical analysis that among the 11 cases, the thoracic aorta was involved in 3 cases, the abdominal aorta was involved in 6 cases, and the iliac artery was involved in 2 cases. Five patients had a history of contact with cattle and sheep, 3 had a history of drinking raw milk, 10 patients had a fever before the operation, and 11 patients had positive serum agglutination test. Blood culture was positive in 2 patients. All patients were given anti-brucellosis treatment immediately after diagnosis. One died of aortic rupture 5 days after emergency endovascular gastrointestinal bleeding. Endovascular-covered stent implantation and active anti-brucellosis therapy were used to treat 10 patients. The follow-up period was 8 years without aortic complications or death for all patients. We think early diagnosis and a combination of anti-brucellosis drugs and endovascular therapy may be the first choice for treating the pseudoaneurysm caused by Brucella.
Subject(s)
Aneurysm, False , Brucellosis , Endovascular Procedures , Humans , Aneurysm, False/therapy , Aneurysm, False/microbiology , Aneurysm, False/etiology , Aneurysm, False/diagnosis , Brucellosis/complications , Brucellosis/diagnosis , Male , Endovascular Procedures/methods , Female , Middle Aged , Adult , Stents , Aged , Aneurysm, Infected/microbiology , Aneurysm, Infected/diagnosis , Aneurysm, Infected/therapy , Iliac Artery/surgery , Iliac Aneurysm/microbiology , Iliac Aneurysm/surgery , Iliac Aneurysm/therapy , Iliac Aneurysm/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Treatment Outcome , Retrospective StudiesSubject(s)
Arteriovenous Fistula , Heart Failure , Iatrogenic Disease , Iliac Artery , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/surgery , Heart Failure/etiology , Arteriovenous Fistula/etiology , Arteriovenous Fistula/surgery , Arteriovenous Fistula/diagnostic imaging , Lumbar Vertebrae/surgery , Male , Adult , Cardiac Output, High/etiology , Treatment Outcome , FemaleABSTRACT
INTRODUCTION: Fournier's gangrene, a rare infectious condition affecting the external genitalia, often requires aggressive medical-surgical interventions, resulting in variable scrotal tissue loss. Despite numerous proposed reconstruction techniques, achieving a consensus on the most effective approach that balances aesthetics and function remains elusive. This case report presents a one-year follow-up on scrotal reconstruction using a pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) propeller flap. CASE REPORT: A 56-year-old patient with significant scrotal tissue loss due to Fournier's gangrene underwent scrotal reconstruction using a pedicled SCIP propeller flap. Optimal placement was ensured through a subcutaneous tunnel, with a thin thigh skin graft applied to cover the penile skin defect. DISCUSSION: The SCIP flap is distinguished by its thin and pliable characteristics, rapid harvesting and featuring a discreet donor site. It stands as a compelling alternative to skin grafts, providing advantages in sensory restoration, color congruence, and resilience against tension. Considering the thickness of the reconstruction helps both in recovering testicular function and improving the appearance by restoring the natural contour. CONCLUSION: The utilization of the pedicled SCIP propeller flap for scrotal tissue loss resulting from Fournier's gangrene has demonstrated both aesthetic and functional success, underscoring its potential as an effective reconstructive option.
Subject(s)
Fournier Gangrene , Iliac Artery , Perforator Flap , Scrotum , Humans , Male , Fournier Gangrene/surgery , Scrotum/surgery , Middle Aged , Perforator Flap/blood supply , Iliac Artery/surgery , Plastic Surgery Procedures/methodsABSTRACT
BACKGROUND: Considering a patient's anatomy and vascular conditions, aorto-femoral bypass is a treatment approach for the open repair of abdominal aortic aneurysms. This study aimed at evaluating changes in the remnant iliac artery and their correlation with the preservation state of retrograde flow from femoral anastomosis. METHODS: Of 221 patients who underwent abdominal aortic aneurysm surgery between 2007 and 2022 in Pusan National University Hospital, 29 patients who underwent aorto-femoral bypass were included in this retrospective cohort study. Of these patients, 21 underwent aortobifemoral bypass and 8 underwent aortoiliac-and-femoral bypass. The change in size of the iliac artery from preoperative to postoperative and whether this difference in size depended on the status of postoperative retrograde flow were investigated. Additionally, factors affecting overall mortality and ischemic complications were identified. RESULTS: The median duration from operation to the last follow-up was 2069.5 days (about 5.7 years). The average age of the patients was 78.1 years, and the proportion of males was 75.9%. In cases of disappearance of postoperative retrograde flow from the femoral anastomosis, the postoperative iliac artery size was significantly reduced compared to its preoperative size (18.4 ± 18.9 mm vs. 13.2 ± 7.9 mm, respectively; P = 0.04). The group with maintained retrograde flow had significantly larger residual common iliac artery size than the group with disappearance of flow. (20.0 ± 28.0 mm vs. 14.6 ± 8.5 mm, respectively; P = 0.02). Disappearance of retrograde flow was a significant factor in the iliac artery size reduction after surgery (odds ratio, 2.5; 95% confidence interval, 1.9-5.3; P = 0.02). Three patients with maintained retrograde flow (18.8%) required intervention owing to an increase in the size of the iliac artery. The factors that significantly influenced overall death as analyzed by Cox proportional hazard regression were chronic obstructive pulmonary disease (hazard ratio, 36.8; 95% confidence interval, 1.6-870.0; P = 0.03), peripheral arterial occlusive disease (hazard ratio, 12.7; 95% confidence interval, 1.4-115.8; P = 0.02), and disappearance of retrograde flow (hazard ratio, 8.7; 95% confidence interval, 1.2-63.9; P = 0.03). CONCLUSIONS: Among the open repair methods for abdominal aortic aneurysms, if retrograde flow was not maintained through femoral anastomosis when aorto-femoral bypass was performed, the size of the remaining iliac artery decreased. However, loss of retrograde flow increased long-term mortality. When aorto-femoral bypass is performed, regular imaging follow-up is necessary at appropriate intervals to check the remnant iliac artery and retrograde flow.
Subject(s)
Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis Implantation , Femoral Artery , Iliac Artery , Regional Blood Flow , Humans , Male , Retrospective Studies , Iliac Artery/surgery , Iliac Artery/physiopathology , Iliac Artery/diagnostic imaging , Female , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/physiopathology , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/mortality , Femoral Artery/surgery , Femoral Artery/physiopathology , Femoral Artery/diagnostic imaging , Aged , Treatment Outcome , Risk Factors , Time Factors , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/mortality , Blood Vessel Prosthesis Implantation/instrumentation , Aged, 80 and over , Hospitals, University , Computed Tomography Angiography , Ischemia/physiopathology , Ischemia/surgery , Ischemia/diagnostic imaging , Ischemia/etiology , Ischemia/mortality , Postoperative Complications/etiology , Middle AgedABSTRACT
BACKGROUND: The efficient resurfacing of multiple adjacent defects (MADs) requires precise reconstructive strategy. Various approaches (e.g., several flap transferring or prelamination of the recipient site) have been reported, but recipient-site impairments, pain, long hospitalization, and low cost-benefit results fatefully considered them as compromise approaches. This study aims to evaluate the feasibility of MADs reconstruction with free multipaddle superficial circumflex iliac artery perforator (SCIAP) flaps. METHODS: From Dec 2015 to Dec 2020, we enrolled patients with upper and lower extremity defects treated with various multipaddle SCIAP flaps (2-paddle, 3-paddle, and 4-paddle). Patient demographics and outcomes of each group were collected. RESULTS: Thirty-two, 21, and 6 patients underwent 2-paddle, 3-paddle, and 4-paddle SCIAP flaps transfers, respectively. All multipaddle SCIAP flaps survived without vascular problems, and the donor sites were closed directly. Except for 3 cases of 2-paddle SCIAP flaps drained by superficial circumflex iliac vein venous return, most cases (n = 56) were drained by venae comitans. Minor complications, including partial flap necrosis (4 cases) and lateral femoral cutaneous nerve palsies (11 cases), were treated conservatively. All patients were satisfied with the reconstructive outcome. CONCLUSION: Multiple adjacent defects reconstruction is still a Gordian knot and lacks a golden standard. The free multipaddle SCIAP flap was demonstrated as a promising alternative, not only enriching its versatility but also initially highlighting the "replace need with need" reconstructive demand.
Subject(s)
Perforator Flap , Plastic Surgery Procedures , Humans , Male , Female , Middle Aged , Adult , Perforator Flap/blood supply , Plastic Surgery Procedures/methods , Aged , Iliac Artery/surgery , Feasibility Studies , Retrospective Studies , Free Tissue Flaps , Young Adult , Adolescent , Lower Extremity/surgery , Upper Extremity/surgery , Graft SurvivalABSTRACT
BACKGROUND: Aortoiliac occlusive disease (AIOD) has traditionally been treated with aortobifemoral bypass (ABF). Unibody endograft (UBE) for AIOD, however, has been increasingly utilized in selected patients. We report outcomes of patients undergoing ABF or UBE for AIOD. METHODS: Patients (2016-2021) undergoing elective ABF or UBE with a unibody device for AIOD were identified at an academic institution. Chi-square and Kaplan-Meier analysis were used to evaluate outcomes by group. RESULTS: One hundred thirty-one patients undergoing UBE or ABF were screened, with 82 included. Twenty-one patients underwent UBE (25.6%) and 61 (74.4%) underwent ABF. UBE patients were older (63.8 vs. 58.2 years; P = 0.01), with a higher prevalence of diabetes (52.4 vs. 19.7%; P = 0.004). Significant differences were seen between UBE and ABF including a shorter surgery length (214 vs. 360 min; P = 0.0001), less blood loss (300 vs. 620 mls; P = 0.001), larger minimum aortic diameter (14.6 vs. 12.6; P = 0.0006), larger common iliac artery (9.5 vs. 7.9; P = 0.005) and lower postoperative ankle-brachial index (0.8 vs. 0.9; P = 0.04). There were no differences in TASC C/D iliac lesions in the UBE than ABF group (66.6% vs. 63.9%; P < 0.82) or Trans-Atlantic Inter-Society Consensus classification femoropopliteal lesions. Unadjusted analysis revealed no significant differences between UBE and ABF for 30-day mortality (0 vs. 1.6%; P = 1), stroke (0 vs. 3.3%; P = 1), or major adverse cardiac events (4.8 vs. 4.9%; P = 1). There were no significant differences in mid-term surgical outcomes over a mean follow-up period of 23.7 months between UBE and ABF groups; specifically endovascular (0 vs. 8.2%; P = 0.3) or open/hybrid reintervention (9.5 vs. 14.8%; P = 0.7) with similar limb occlusion (4.8 vs. 27.8; P = 0.12). Kaplan-Meier estimated primary, primary-assisted, and secondary patency at 36 months were similar with 94%, 100%, and 94% for UBE and 86%, 95%, and 86% for ABF, respectively. Estimated survival at 36 months was 95% for UBE and 97% for ABF (P = 0.8). CONCLUSIONS: Equivalent outcomes were seen between AIOD treated with UBE or ABF in similar patient populations. Mid-term outcomes such as reintervention and patency are similar for UBE and ABF. We still recommend ABF over UBE as a primary modality of treatment in surgically fit patients with greater complexity aortoiliac lesions and with smaller arterial diameters, especially women.