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1.
BMC Surg ; 21(1): 273, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059048

RESUMO

BACKGROUND: Ileum obstruction due to internal hernia beneath external iliac artery after pelvic lymph node dissection (PLND) is extremely rare. We reported a case of acute strangulated internal hernia between the left external iliac artery and psoas major as late complication of laparoscopic hysterectomy with pelvic lymphadenectomy. CASE PRESENTATION: A 46-year-old woman, who with histories of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and PLND 9 years ago for the cervical malignant tumor, open appendectomy 18 years ago, visited our hospital complaining of aggravated left lower abdominal pain, bloating, nausea and vomiting from few hours ago. Left abdomen distention, tympanitic with rebound tenderness and muscular tension was detected during physical examinations. Accompanying with elevated inflammatory markers and mild intestinal dilatation showed in lab results and contrast-enhanced computed tomography (CT) respectively. After carefully reading the CT images, a small bowel was found between the left external iliac artery (EIA) and the psoas major, combined with the patient's surgical history, we suspected it might be internal hernia. Eventually, the emergency laparoscopic laparotomy confirmed our conjecture, the gap between the iliac vessels and the psoas major was closed with an absorbable suture, the patient was discharged on the fourth postoperative day. CONCLUSION: Primary closure of peritoneal fissue maybe an effective measure to potentially prevent internal hernia. The choice of surgical approach for pelvic tumors still needs further exploration but faster diagnosis and immediate laparotomy might promise a better prognosis.


Assuntos
Artéria Ilíaca , Laparoscopia , Feminino , Humanos , Histerectomia/efeitos adversos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Hérnia Interna , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Pessoa de Meia-Idade
2.
Khirurgiia (Mosk) ; (6. Vyp. 2): 52-58, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34032789

RESUMO

OBJECTIVE: To demonstrate endovascular management of common iliac artery aneurysms with iliac branch devices and to discuss some technical aspects of these interventions including bilateral procedures. MATERIAL AND METHODS: Endovascular abdominal aortic aneurysm repair with concomitant implantation of iliac branch devices was performed in 9 patients at the Petrovsky National Research Center of Surgery for the period from January 2019 to December 2020. Mean age of patients was 64.8± years (min 52; max 72 years). Preoperative planning and morphometric analysis were based on CT data with a slice thickness of 1 mm. Angiographic reconstruction was made using Osirix 3D software (OsiriX Foundation, Geneva, Switzerland). Abdominal aortic aneurysm was combined with common iliac artery aneurysm in 7 patients (77.7%). Three (33.3%) patients had isolated common iliac artery aneurysm without significant abdominal aorta enlargement (Reber type I). Bilateral common iliac artery aneurysms were detected in 1 (11.1%) patient. All patients had iliac artery aneurysms over 4 cm. Iliac branch device implantation was accompanied by endovascular abdominal aneurysm repair in all patients. RESULTS: Technical success rate was 100%. Six-month results were followed-up in 5 patients (55.5%), annual outcomes - in 2 patients (22.2%). Control examination consisted of a telephone interview, ultrasound of abdominal aorta, pelvic and lower limb arteries and computed tomography. All patients had no endoleaks, stent-graft thrombosis, as well as signs of ischemia of pelvic organs and lower extremities. Incidence of iliac artery aneurysm combined with abdominal aortic aneurysms is about 20%. Until recently, treatment of these patients was performed exclusively with covering of internal iliac artery. Improvement of technologies and development of iliac branch devices made it possible to preserve blood flow in internal iliac artery after endovascular management. This approach allowed avoiding of ischemic complications associated with embolization of internal iliac arteries.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco , Aorta Abdominal , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
3.
BMJ Case Rep ; 14(5)2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962916

RESUMO

A 79-year-old man developed bilateral intermittent claudication. Peritoneal dialysis had been initiated at 55 years of age to manage chronic renal failure. In addition, he underwent kidney transplantation at 61 years of age. His Ankle-Brachial Index (ABI) was 0.82 and 0.71 for the right leg and left leg, respectively. Furthermore, his serum creatinine level had increased from 0.98 mg/dL to 2.38 mg/dL over the past 2 years. CT angiography revealed focal calcified stenosis in the terminal abdominal aorta. However, ultrasound revealed no significant stenotic lesion in the supplied artery bound to the transplanted kidney from the right external iliac artery. We performed endovascular therapy for abdominal aortic stenosis using the pressure gradient. Following the procedure, the patient's symptoms disappeared and the ABI increased to 1.25 and 1.14 in the right leg and left leg, respectively. Furthermore, the serum creatinine level improved to 0.96 mg/dL.


Assuntos
Estenose da Valva Aórtica , Transplante de Rim , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Constrição Patológica , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino
4.
Eur J Radiol ; 139: 109711, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33910145

RESUMO

PURPOSE: To examine the effectiveness and safety of prophylactic internal iliac artery balloon occlusion for hemorrhage control in placenta accreta. METHOD: EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials data-bases were searched through November 2020. Clinical trials comparing the management of placenta accreta with and without internal iliac artery balloon occlusion were included. The meta-analysis results were expressed as the risk ratio (RR) or mean difference, with 95 % CIs. RESULTS: Fifteen studies including 1098 women were eligible. No statistically significant difference was found between the internal arterial balloon occlusion group and the control group with respect to estimated blood loss volume (-0.525 mL, [95 % CI, -1.112 to -0.061], p = 0.079.), red blood cells (RBCs) transfused in observational studies (-0.682 mL, [95 % CI, -1.540 to 0.176], p = 0.119.) and in randomized controlled trials (0.134 mL, [95 % CI, -0.214 to 0.482], p = 0.451.), intensive care unit admission (p = 0.197), hysterectomy in observational studies (p = 0.969) and in randomized controlled trials (p = 0.323), urinary system injury in observational studies (p = 0.182) and in randomized controlled trials (p = 0.956), Apgar score at 5 min (p = 0.641), and neonatal intensive care unit admission (p = 0.973). CONCLUSIONS: The currently available data demonstrate no significant differences between the internal iliac artery balloon occlusion group and the control group in blood loss and packed RBCs transfused for women with placenta accreta. Further large randomized controlled studies are needed to confirm our findings.


Assuntos
Oclusão com Balão , Placenta Acreta , Cesárea , Feminino , Humanos , Histerectomia , Artéria Ilíaca/diagnóstico por imagem , Recém-Nascido , Placenta Acreta/diagnóstico por imagem , Placenta Acreta/terapia , Gravidez , Estudos Retrospectivos
5.
BMC Musculoskelet Disord ; 22(1): 355, 2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853573

RESUMO

A recently published article by Lai et al. in BMC Musculoskeletal Disorders trying to show that patients with pelvic fractures undergoing non-selective internal iliac artery embolization may lead to a higher rate of surgical site infection. The authors also noted that only a small percentage of patients with contrast extravasation detected by emergency contrast-enhanced CT were subsequently confirmed by angiography, thus, considered that the value of enhanced CT in predicting arterial injury was limited. The authors also believe that embolization of the main stem may cause incomplete hemostasis due to the abundant collateral circulations in the pelvic cavity. Although the author's findings are mentioned in other studies, the article's data and pictures only partially supported its inferences, and the conclusions cannot be drawn directly. In this Correspondence, we tried to reinterpret the additional findings in the article from our perspective. Through this discussion, we hope that more colleagues can re-understand the safety and effectiveness of non-selective internal iliac artery embolization in treating hemodynamically unstable pelvic fractures during the early resuscitation stage.


Assuntos
Embolização Terapêutica , Fraturas Ósseas , Ossos Pélvicos , Embolização Terapêutica/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem
6.
Pol Merkur Lekarski ; 49(290): 150-152, 2021 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-33895764

RESUMO

Damage to large abdominal vessels during lumbar discectomy surgery is a rare but life-threatening complication. A CASE REPORT: The authors present the case of a 57-year-old patient who received surgery for critical degenerative lumbal spinal stenosis on the L4-L5 level. The diagnosis was based on strong right sciatica and neurogenic claudication. A bilateral laminotomy from the right and a microdiscectomy were performed. During surgery, no bleeding from the intervertebral space was observed and blood pressure was low but stable from the beginning. After surgery, the patient was in good general and neurological condition, without preoperative right-sided sciatica. Within a few hours after the operation, the circulatory and respiratory systems were stable with normal saturation and the patient did not report shortness of breath. Paleness of the skin and mucous membranes was observed. Follow-up morphology tests performed at 6 and 10.5 hours after surgery showed a decrease in the level of erythrocytes. The patient had palpable tenderness in the left hypochondriac region. Suspicion of bleeding into the abdominal cavity from arteries or iliac veins was stated. Immediately, an angio-computed tomography (CT) of the abdominal cavity was performed, which confirmed the presence of a hematoma in the peritoneal space and a pseudoaneurysm of the left iliac artery. The patient was urgently transported to the Vascular Surgery Clinic, where a Y-type covered stent was implanted percutaneously into both iliac arteries. After the procedure, there were symptoms of ischaemia in the left lower extremity and intermittent claudication. A Doppler study showed signs of narrowing at the stent level on the left side. The patient was reoperated after a CT check-up and a second stent was implanted into the left iliac artery, which allowed vasodilation and true flow in the artery. CONCLUSIONS: The authors suggest that both the neurosurgeon and anaesthesiologist should have been aware of the possibility of such a rare but life-threatening complication as iliac vessel damage during lumbar discectomy surgery. A quick diagnosis and implementation of a proper procedure reduces the high mortality rate caused by this complication. In cases of a sudden unjustified drop in blood pressure during lumbar discectomy, an immediate laparotomy should be performed to find and repair the site of laceration of a vessel. In patients who are stable hemodynamically, performing an angio-CT function of the abdominal cavity is suggested and the damaged artery should be treated with a covered stent.


Assuntos
Artéria Ilíaca , Vértebras Lombares , Discotomia/efeitos adversos , Humanos , Doença Iatrogênica , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade
7.
Am J Case Rep ; 22: e928957, 2021 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-33895771

RESUMO

BACKGROUND May-Thurner syndrome, also known as Cockett's syndrome, is characterized by vascular alterations due to stenosis of the left iliac vein, usually caused by compression against the vertebral column by the right iliac artery. Doppler ultrasound represents the first level of examination for the study of this vascular pathology, and allows a very accurate study of the lower-limb vessels. We describe an unusual presentation with double stenosis of the left common iliac vein. CASE REPORT A 73-year-old woman came to the clinic for acute onset of worsening dyspnea, with lymphedema of the left lower limb, and was examined using ultrasound and multidetector computed tomography. The Doppler ultrasound exam showed 2 compressions of the common iliac vein by the right and left iliac artery due to a combination of osteophytosis of the vertebral column and reduced distance between the left iliac vein and the spine. CONCLUSIONS May-Thurner syndrome should be suspected in patients with symptoms of venous stasis of the left lower limb. Doppler ultrasound identified stenosis of the common iliac vein and the consequent flow changes. Failure to diagnose and treat May-Thurner syndrome could expose patients to very serious risks to their health.


Assuntos
Síndrome de May-Thurner , Idoso , Constrição Patológica , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Síndrome de May-Thurner/complicações , Síndrome de May-Thurner/diagnóstico por imagem , Flebografia
8.
J Med Case Rep ; 15(1): 204, 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33902709

RESUMO

BACKGROUND: Failed aortofemoral and femoropopliteal bypass grafts in the lower extremity artery usually result in acute limb ischemia. Endovascular treatment and surgical revascularization have been reported for limb salvage. CASE PRESENTATION: A 72-year-old Japanese man was admitted with acute limb ischemia due to failed aortofemoral and femoropopliteal bypass grafts. Endovascular treatment with balloon angioplasty, thrombectomy, and stent implantation in the long chronic total occlusion from the right common iliac artery to the superficial femoral artery did not result in efficient flow due to thrombus transfer from a failed aortofemoral bypass graft. However, a rescue femorofemoral bypass (the left femoral to the right deep femoral artery) improved his symptoms, and implanted in-stent flow was gradually recovered. Lower extremity angiography performed 5 months later confirmed the patency of the iliofemoral in-stent flow. However, the femorofemoral bypass graft was unfortunately occluded due to the progression of left external iliac artery stenosis. The patency of the iliofemoral in-stent flow was confirmed at 1 year by ultrasonography. CONCLUSIONS: Improvement of the deep femoral artery flow plays an important role in the treatment of acute limb ischemia due to failed aortofemoral and femoropopliteal bypass grafts. Thus, increased collateral circulation to the periphery through the deep femoral artery dissolved the remaining in-stent thrombus in the iliofemoral artery.


Assuntos
Artéria Ilíaca , Trombose , Idoso , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Masculino , Stents , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do Tratamento , Grau de Desobstrução Vascular
9.
Clinics (Sao Paulo) ; 76: e2455, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33681945

RESUMO

OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.


Assuntos
Aneurisma da Aorta Abdominal , Aneurisma Ilíaco , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/epidemiologia , Artéria Ilíaca/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
10.
Khirurgiia (Mosk) ; (3): 73-77, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33710831

RESUMO

We report the results of open surgical correction of a giant false aneurysm of the distal anastomosis in long-term period after iliofemoral bypass surgery. Preoperative diagnostic procedures made it possible to determine the most appropriate treatment strategy. Aneurysm resection was followed by distal anastomosis repair on the right with prosthesis 10 mm. Postoperative imaging is presented. The authors concluded the effectiveness of revascularization strategy.


Assuntos
Falso Aneurisma , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Implante de Prótese Vascular , Humanos , Artéria Ilíaca/diagnóstico por imagem , Reoperação , Resultado do Tratamento
11.
Medicine (Baltimore) ; 100(6): e24710, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578610

RESUMO

RATIONALE: Pelvic fractures associated with acute external iliac artery thrombosis is less common, it is easily ignored in clinical practice, and it can result in limb amputation and hemipelvectomy due to prolonged limb ischemia. We present 2 patients with acute external iliac artery thrombosis following pelvic fractures. PATIENT CONCERNS: Case 1 is a 49-year-old male with occlusion of the right external iliac artery and pelvic fractures. Case 2 is a 52-year-old male with left external iliac artery occlusion and bilateral internal iliac artery rupture following pelvic fractures. DIAGNOSES: Case 1 was diagnosed with computed tomography angiography. Case 2 was diagnosed with ultrasound examination and computed tomography angiography. INTERVENTIONS: Case 1 was performed an open incision to remove thrombus of the right external iliac artery, the right iliac-femoral artery artificial bypass was adopted to restore the blood flow. Case 2 underwent segmental resection of the damaged artery and artificial vascular implantation of left external iliac artery, and angiographic embolization of bilateral internal iliac artery. However, a left hip disarticulation was performed due to osteofascial compartment syndrome at last. OUTCOMES: Case 1 was cured and discharged smoothly. Case 2 survived but left with a disability after disarticulation. LESSONS: Acute external iliac artery thrombosis after pelvic fractures is rare and limb-threatening, life-threatening. It is very important to detect and treat this potential complication timely when a patient with a pelvic fracture.


Assuntos
Fraturas Ósseas/complicações , Artéria Ilíaca/diagnóstico por imagem , Ossos Pélvicos/lesões , Trombose/etiologia , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico por imagem
12.
Br J Radiol ; 94(1121): 20201276, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33617294

RESUMO

OBJECTIVES: To assess the feasibility of whole-body dual-energy computed tomographic angiography (DECTA) at 40 keV with 50% reduced iodine dose protocol. METHODS: Whole-body CTA was performed in 65 patients; 31 of these patients underwent 120 kVp single-energy computed tomographic angiography (SECTA) with standard iodine dose (600 mgI/kg) and 34 with 40 keV DECTA with 50% reduced iodine dose (300 mgI/kg). SECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (SECTA group), and DECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (DECTA-40% group) and 80% (DECTA-80% group). CT numbers of the thoracic and abdominal aorta, iliac artery, background noise, signal-to-noise ratio (SNR), and arterial depiction were compared among the three groups. The CT dose index volumes (CTDIvol) for the thorax, abdomen, and pelvis were compared between SECTA and DECTA protocols. RESULTS: The vascular CT numbers and background noise were found to be significantly higher in DECTA groups than in the SECTA group (p < 0.001). SNR was significantly higher in the order corresponding to DECTA-80%, SECTA, and DECTA-40% (p < 0.001). The arterial depiction was comparable in almost all arteries; however, intrapelvic arterial depiction was significantly worse in DECTA groups than in the SECTA group (p < 0.0001-0.017). Unlike the pelvic region (p = 0.055), CTDIvol for the thorax (p < 0.0001) and abdomen (p = 0.0031) were significantly higher in the DECTA protocol than in the SECTA protocol. CONCLUSION: DECTA at 40 keV with 50% reduced iodine dose provided higher vascular CT numbers and SNR than SECTA, and almost comparable arterial depiction, but had a degraded intrapelvic arterial depiction and required a larger radiation dose. ADVANCES IN KNOWLEDGE: DECTA enables 50% reduction of iodine dose while maintaining image quality, arterial depiction in almost all arteries, vascular CT numbers, and SNR; however, it does not allow clear visualization of intrapelvic arteries, requiring a slightly larger radiation dose compared with SECTA with standard iodine dose.


Assuntos
Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/administração & dosagem , Iodo/administração & dosagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Abdome/irrigação sanguínea , Abdome/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos de Viabilidade , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pelve/irrigação sanguínea , Pelve/diagnóstico por imagem , Imagens de Fantasmas , Estudos Prospectivos , Doses de Radiação , Exposição à Radiação/análise , Razão Sinal-Ruído
13.
Cancer Radiother ; 25(2): 161-168, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33454191

RESUMO

PURPOSE: The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. PATIENTS AND METHODS: This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. RESULTS: Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03mm, 5.42mm and 8.73mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5mm. The CTV to PTV margins ranged from 3.12mm to 3.25mm for external iliac vessels and from 3.12mm to 4.18mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. CONCLUSIONS: We recommend CTV to PTV margins of 8mm, 6mm and 9mm in AP, ML and SI directions for prostate. And, we suggest 4mm and 5mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3weeks and especially the first week to check rectum volume.


Assuntos
Adenocarcinoma/radioterapia , Linfonodos/diagnóstico por imagem , Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Reto/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Algoritmos , Análise de Variância , Antagonistas de Androgênios/uso terapêutico , Humanos , Artéria Ilíaca/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Linfonodos/anatomia & histologia , Irradiação Linfática/métodos , Masculino , Movimentos dos Órgãos , Órgãos em Risco/anatomia & histologia , Órgãos em Risco/diagnóstico por imagem , Ossos Pélvicos/anatomia & histologia , Ossos Pélvicos/diagnóstico por imagem , Pelve , Estudos Prospectivos , Próstata/anatomia & histologia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Planejamento da Radioterapia Assistida por Computador/métodos , Erros de Configuração em Radioterapia , Radioterapia Conformacional , Radioterapia Guiada por Imagem , Reto/anatomia & histologia , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X , Carga Tumoral , Bexiga Urinária/anatomia & histologia
15.
Vasc Endovascular Surg ; 55(1): 91-94, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32875955

RESUMO

Spontaneous ilio-iliac arteriovenous fistula (AVF) associated with aneurysms affecting the abdominal aortic and iliac arteries is a rare condition. The classical clinical symptoms of ilio-iliac AVF include high-output heart failure, abdominal pain, abdominal bruits and thrills, a pulsatile abdominal mass, and venous congestion symptoms (leg edema and hematuria). The prompt repair of AVF is necessary to restore the patient's hemodynamics. We report a case in which a patient with aneurysms affecting the abdominal aortic and iliac arteries and an ilio-iliac AVF presented with high-output heart failure and leg ischemia and was successfully treated via endovascular stent graft repair.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Veia Ilíaca/cirurgia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Stents , Resultado do Tratamento
16.
Clinics ; 76: e2455, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1153982

RESUMO

OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.


Assuntos
Humanos , Aneurisma Ilíaco/epidemiologia , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Artéria Ilíaca/diagnóstico por imagem
17.
Tech Vasc Interv Radiol ; 23(3): 100689, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308529

RESUMO

Identification of the prostatic arteries (PAs) is one of the most challenging aspects of prostate artery embolization for treatment of benign prostatic hyperplasia-associated lower urinary tract symptoms. Operators require a detailed understanding of the prostate arterial anatomy to ensure technical and clinical success with minimal complications. Due to substantial variability in internal iliac artery branch patterns and specifically the origin of the PA, we focus on 3 clinically relevant classification systems used to categorize the pelvic vasculature. These include classification systems to understand the internal iliac artery branching pattern, PA origin variation, and intraprostatic branching.


Assuntos
Embolização Terapêutica , Artéria Ilíaca , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Humanos , Artéria Ilíaca/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia
18.
Tech Vasc Interv Radiol ; 23(3): 100690, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308535

RESUMO

Prostate artery embolization (PAE) is a minimally invasive treatment for benign prostatic hyperplasia associated lower urinary tract symptoms. The prostatic arterial anatomy, origins and collaterals, are highly variable and can lead to technical pitfalls and suboptimal results during PAE. In this paper we aim to discuss the variant prostate artery origins and collateral circulation to provide a primer on relevant anatomy for interventional radiologists performing PAE.


Assuntos
Circulação Colateral , Embolização Terapêutica , Artéria Ilíaca/anormalidades , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Fluxo Sanguíneo Regional
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