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The infrarenal aorta, aortic bifurcation, and iliac arteries: Advice about balloon angioplasty and stent placement
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Lesions that are limited to the infrarenal aorta may be accessed through a unilateral femoral approach on either side. Lesions of the aorta that extend near or into the aortic bifurcation should be accessed with a guidewire placed through each iliac artery. This is discussed in more detail in the next section. If there is coincidental, nonbifurcation, unilateral iliac disease that also requires treatment along with a separate aortic lesion, the access should be ipsilateral to the iliac lesion. This permits treatment of both the aortic and iliac lesions through the same approach without passing guidewires and sheaths over the aortic bifurcation.
Vascular Access
Published in Richard R Heuser, Giancarlo Biamino, Peripheral Vascular Stenting, 1999
Evaluation of the anatomy of the aortic bifurcation and common iliac arteries is important when considering a crossover technique. The two most common reasons for failure are an acutely angled aortic bifurcation or diffusely diseased and calcified common iliac arteries (Fig. 3.2). This is evaluated with an abdominal aortogram performed by placing a pigtail catheter in the terminal aorta. Once suitable anatomy is identified, a flexible guidewire placed in the terminal aorta is directed to the contralateral iliac artery by means of a 5F or 6F diagnostic internal mammary artery or Judkins’ right 4 catheter (Fig. 3.3). Once a guidewire is secured into the contralateral external iliac or common femoral artery, a guiding catheter or long sheath can be advanced to the contralateral side.
Complications of open repair of unruptured abdominal aortic aneurysm
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Aortic bifurcation is carefully identified and both common iliac arteries are carefully mobilized in patients needing aortobi-iliac reconstruction. Anterior, medial, and lateral walls of the common iliac arteries are mobilized, but author does not completely dissect the posterior wall to prevent injury to the confluence of common iliac veins. On the left side, sigmoid colon may need to be mobilized along the white line of Toldt in patients with aneurysmal common iliac arteries. In patients with heavily calcified or diseased aorta at the aortic neck, supraceliac clamping is often safer than attempting to clamp a significantly diseased artery. Distal anastomosis to femoral arteries should be avoided unless the patient has concomitant iliac artery occlusive disease. Anastomosis to femoral arteries is associated with increased risk of surgical site infection in the groin and late development of an anastomotic aneurysm. Inferior mesenteric artery is looped with double looped Silastic tape. Prior to aortic clamping, heparin is administered intravenously (100 international units/per kg to maintain ACT of 250–300s). Standard repair is accomplished using intraluminal technique. In patients with mycotic aneurysms, the entire aneurysm sac should be removed. Knitted Dacron graft for aortic and aortoiliac reconstruction is preferred. After removal of mural laminated thrombus bleeding from lumbar arteries is controlled with 2-0 GI silk suture. In patients with heavily calcified posterior wall of the aorta, local endarterectomy of the ostia of the lumbar arteries is performed to secure a transfixation suture. Reconstructions performed with a tube or a bifurcated graft. The aortic neck is prepared for proximal anastomosis by “T-ing” of the aortotomy between the normal and the aneurysmal aorta. With a continuous “3-0” or “4-0” polypropylene suture is used for anastomosis.2 In patients with friable aorta, author prefers interrupted horizontal mattress sutures tied on pledgets and reinforced with a second layer of continuous suture. Before checking the integrity of proximal anastomosis, BioGlue (CryoLife, Kennesaw, GA) is applied in patients with friable aortic neck. Distal anastomosis to the aortic bifurcation or to the common iliac artery is performed with continuous suture.
Anorectal side-effects of radical cystectomy
Published in Scandinavian Journal of Urology, 2022
It is well known from colorectal surgery that extensive dissection close to the inferior mesenteric artery and aorta is associated with autonomic nerve dysfunction. In modern nerve-sparing rectal cancer surgery, impotence, for instance, should no longer be a consequence. However, impotence is unfortunately an unavoidable consequence of routine radical cystectomy, and its occurrence cannot be used as a sign of unintended structural damage. However, the degree of aggression of lymph node dissection, a much-debated topic among urologists [3,4], could cause damage to the autonomic innervation of the rectum and anus. The study by Liedberg and colleagues [1] does not allow for analysis of this issue but according to their data, most of their patients had lymph node dissection up to the aortic bifurcation. More aggressive lymph node dissection including presacral dissection further increases the risk for damage to the autonomic innervation of the rectum and anus. In view of the possible relationship between extent of lymph node dissection and impaired anorectal function, larger prospective trials designed to investigate the benefits of different degrees of lymph node dissection in radical cystectomy are needed, and these must also include evaluation of anorectal side-effects.
The Incraft stent graft for the treatment of abdominal aortic aneurysms: an iliac-friendly device with an effective conventional proximal sealing mechanism
Published in Expert Review of Medical Devices, 2022
Nikolaos Schoretsanitis, Efstratios Georgakarakos, Christos Argyriou, Miltos Lazarides, Kiriakos Ktenidis, Nikolaos Papanas, Savas Deftereos, George S. Georgiadis
The device was initially tested in the first in human INNOVATION trial, which was conducted in Italy and Germany and enrolled 60 patients between 2010 and 2011. Clinical and technical success was assessed with follow/up visits and computed tomography (CT) at 1 month, 6 months, and 12 months after implantation and annually through 5 years thereafter. Two patients presented type-Ia endoleaks and other two Ib endoleaks. Both type-Ia endoleaks were identified in the first month postoperatively. There were no late type Ia endoleak and no migration was observed through the 5-year follow-up. Both type-Ib endoleaks were late endoleaks accounting for an incidence of 3.3% (2/60). Occlusion of the aortic bifurcation with both iliac limbs occurred in one patient (1.66%). There were three patients (5%) with aneurysm sac enlargement >5 mm through 5 years, each associated with a type II endoleak. There were no aneurysm-related deaths in this series [12].
Progression-free survival in patients with 68Ga-PSMA-PET-directed SBRT for lymph node oligometastases
Published in Acta Oncologica, 2021
Anita M. Werensteijn-Honingh, Anne F. J. Wevers, Max Peters, Petra S. Kroon, Martijn Intven, Wietse S. C. Eppinga, Ina M. Jürgenliemk-Schulz
Oligometastatic disease classification was according to the European Society for Radiotherapy and Oncology (ESTRO)-EORTC recommendation [25]. Pelvic region was defined as caudal of the aortic bifurcation. Primary therapy was categorised into robotic-assisted laparoscopic prostatectomy (RALP), with or without salvage radiotherapy; and radiotherapy, either external beam radiotherapy (EBRT) or brachytherapy (BT). Previous lymph node dissection was investigated as a combination of lymph node dissections at the time of primary therapy and salvage lymph node dissections. Therapeutic free interval was time between the last treatment and current diagnosis. Time to first oligometastasis was measured from primary tumour diagnosis (date of biopsy, if available) to the first oligometastasis. PSA doubling time (PSADT) was calculated using the Memorial Sloan Kettering Cancer Centre tool (www.mskcc.org/nomograms/prostate/psa-doubling-time), with ≥3 PSA measurements over a period of ≥3 months and individual measurements ≥4 weeks apart [26].