Congenital absence of bilateral common iliac arteries.
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ABSTRACT:
SUBMITTER: George JM
PROVIDER: S-EPMC8095040 | biostudies-literature | 2021 Jun
REPOSITORIES: biostudies-literature
Publications
Congenital absence of bilateral common iliac arteries.
George Justin M JM Ilonzo Nicole N Choinski Krystina N KN Grossi Robert J RJ
Journal of vascular surgery cases and innovative techniques 20210209 2
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Project description:Bilateral absence of the common iliac artery is an extremely rare congenital vascular malformation in which the distal aorta divides directly into two external iliac arteries and two internal iliac arteries. In the case of the presence of this vascular malformation in association with an aortic aneurysm, preservation of the internal iliac artery flow during endovascular aortic repair represents a technical challenge. We have reported a case in which the bilateral absence of the common iliac artery associated with an infrarenal abdominal aortic aneurysm was successfully treated by endovascular aortic repair using commercially available iliac branched devices to maintain pelvic perfusion.
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Project description:Patient is a 72-year-old male who presented with abdominal pain and hypertension. Through bedside point-of-care ultrasound (POCUS), patient was found to have markedly enlarged bilateral iliac artery aneurysms with signs of impending rupture, which was confirmed on computed tomography (CT) angiogram of the abdomen/pelvis. Patient was immediately taken to the operating room for emergent repair of aneurysm, and was discharged from the hospital the next day. Point-of-care ultrasound is critical in diagnosis and guiding treatment in patients in the emergency department and should be considered in those with undifferentiated abdominal pain.TopicsAbdominal pain, iliac artery aneurysm, point-of-care ultrasound.
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Project description:Background: Instead of only practicing these perfectly matched end-to-side anastomoses in microsurgical laboratories, we must learn how to perform these so-called "imperfect" end-to-side anastomoses in the laboratory.MethodsThree types of end-to-side microvascular anastomoses using the rat common iliac artery (CIA), one with the proximal end of the CIA to the contralateral side of the CIA, another with the distal end of the CIA to the contralateral side of the CIA, and the third with the distal end of the CIA to the ipsilateral side of the common iliac vein (CIV), were presented to simulate different end-to-side anastomosis situations in a microsurgical laboratory. Diameters of CIA and CIV, distances between temporary clips, the length of arteriotomy or venotomy, and the distribution of stitches were recorded. The patency rates were evaluated immediately after the anastomosis was completed and 30 min later. After animal euthanasia, the donor vessel was cut close to the anastomotic site, and the orifice size and intimal attachment were evaluated by inspecting them through inside the vessel.ResultsThe diameters of the CIA and CIV were 0.8-1.2 mm and 1.2-1.5 mm, respectively. The end-to-side microvascular anastomosis arteriotomy or venotomy is approximately 2.00-2.50 mm, the distance between the aneurysm clips on the recipient CIA or CIV is approximately 4.00-7.00 mm, and the distance between the corner of the arteriotomy or venotomy and the temporary aneurysm clip was 1.00-3.00 mm. Three types of end-to-side anastomoses using the CIA were successfully performed, and 100% patency rates were achieved immediately and 30 min postoperatively. Good distribution of stitches, wide orifice, and intimal attachment were recorded in the study in all groups.ConclusionsThree types of end-to-side anastomoses using rat CIAs could be efficiently used to mimic three different anastomotic situations.
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