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Specific Management of PPH
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Internal iliac artery ligation [4]: Bilateral internal iliac artery ligation reduces the pulse pressure by 85% and the blood flow by 50% and can drastically reduce the bleeding. However, many collaterals with deep femoral arteries and the ovarian arteries rescue the blood supply and prevent ischaemic damage to other organs. It is a necessary procedure when one is desperate to preserve the uterus. It needs expertise as well as takes time and reasonable assistance for proper exposure. The retroperitoneum is exposed by pulling the uterus anteriorly and to the opposite side. The posterior peritoneum over the psoas major muscle between the round ligament and the infundibulopelvic ligament is incised. The incision is extended longitudinally until the pelvic brim parallel to the infundibulopelvic ligament, keeping the ureter in the medial flap. Identify the bifurcation of the common iliac artery. The internal iliac artery is inferiomedial as it enters the pelvis. The external iliac artery continues laterally along with the psoas muscle.
The infrainguinal arteries: Advice about balloon angioplasty and stent placement
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
In some patients, ipsilateral iliac artery occlusive disease, which the operator may prefer to treat secondarily, must be treated primarily, because it is causing a significant decrease in maneuverability or increased resistance to sheath placement. Therefore, the ipsilateral iliac artery occlusive disease may be treated before contralateral access is achieved. In this case a stiff wire is inserted on the ipsilateral side, extending into the infrarenal aorta, and a 6-Fr or 7-Fr sheath advanced retrograde into the iliac artery. After treatment of the iliac artery, the sheath can then be advanced so that its tip is in the proximal ipsilateral common iliac artery. The hook-shaped catheter is then passed through the sheath and used to cannulate the contralateral side. The ipsilateral sheath is used as a platform for cannulation of the aortic bifurcation.
Vascular
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Iliac artery aneurysm tends to refer to aneurysm of the common and/or internal iliac arteries. The external iliac artery is seldom aneurysmal. Common iliac artery aneurysms often occur in conjunction with AAA, and the two are repaired together using a bifurcated graft. Occasionally common iliac aneurysms occur in isolation, or are associated with a small AAA, and merit repair because they have reached a size at risk of rupture or are associated with distal embolisation. Internal iliac aneurysms are less common but may also rupture or embolise. Repair of these aneurysms is important because the blood supply to the bowel has to be considered.
The Altura endograft system for endovascular aneurysm repair: presentation of its unique design with clinical implications
Published in Expert Review of Medical Devices, 2022
Efstratios Georgakarakos, Konstantinos Dimitriadis, Gioultzan Memet Efenti, Georgios I Karaolanis, Christos Argyriou, George S. Georgiadis
Two interesting cases report on the Altura device were also presented in the literature recently. Kakkos et al. used the Altura stent-graft in a patient with bilateral common iliac artery aneurysms of 6.1 and 3.1 cm and a concomitant 3.2 cm infrarenal AAA [15]. The anatomy of abdominal aorta was not suitable for most commercially available bifurcated endografts, since the length from the lowest renal artery to the aortic bifurcation was only 6.7 cm, highlighting the advantage of the Altura endograft system for use in short infrarenal AAA. The Altura parts were deployed successfully with no postoperative complications. At 6-month follow-up neither endoleak nor migration was detected, while the aneurysm sacs were reduced. Another case report from Volpe et al. presents the successful deployment of the Altura in a patient with kissing stent-grafts implanted in the past for the treatment of common iliac artery aneurysms, developing afterward type Ia and IIIb endoleaks due to enlargement of the infrarenal aorta and stent fractures. Since the deployment of single-body bifurcated endografts was not an option and open surgery was excluded due to serious comorbidities, the Altura endograft was used with no complication at 1 and 6-months follow-up [16].
Dynamic observation on collateral circulation construction of patient with vertebral artery restenosis after stenting: case report
Published in International Journal of Neuroscience, 2021
Yan-Wei Yin, Qian-Qian Sun, Da-Wei Chen, Fa-Guo Zhao, Jin Shi
Twelve months later, the patient was readmitted to our unit following intermittent claudication. During that time he still suffered from the loss of consciousness, but notably the frequency was decreasing. Then the ultrasound examination revealed a severe stenosis of the right common iliac artery. DSA confirmed the stenosis of at least 80%, and a stent was successfully implanted. In this process, we also rechecked the left vertebral artery. Although the stenosis still exist, another collateral circulation involving thyrocervical trunk was found supplying flow to the left vertebral artery (V3 segment) (Figure 3a, b). Furthermore, the collateral circulation fed by external carotid collateral branches (occipital artery) was constructed more better than before (Figure 3c). In this process, the frequency of loss of consciousness gradually decreased with the collateral circulation construction.
Treatment of infantile fibrosarcoma associated to an abdominal aortic aneurysm with larotrectinib: a case report
Published in Pediatric Hematology and Oncology, 2021
María Dolores Corral Sánchez, Víctor Galán Gómez, Ana Sastre Urgelles, Diego Plaza López de Sabando, Pedro Rubio Aparicio, Leopoldo Martínez Martínez, Eduardo Alonso Gamarra, José Juan Pozo Kreilinger, Rita María Regojo Zapata, Juan Carlos López Gutiérrez, Eugenia Antolín Alvarado, Felipe Gómez Martín, Ana María Sánchez Torres, Elena Marín Manzano, Luis González del Valle, Antonio Pérez-Martínez
A female infant was born at 40 gestation weeks (GW) by eutocic delivery (weight 3,240 g). At 35 GW, fetal ultrasound (US) showed an abdominal mass with an arteriovenous fistula which, although not with the usual aspect, was compatible with abdominal teratoma. No genetic study nor antenatal magnetic resonance imaging (MRI) was performed. At birth, the presence of a retroperitoneal mass was confirmed by imaging (US, MRI and computed tomography [CT] angiogram) (Figure 1). The mass was heterogeneous, with contrast uptake and with a large size (anteroposterior = 4.6 cm; transversal = 4.8 cm; craniocaudal = 6.6 cm). The mass encompassed the aorta, abdominal arteries, inferior vena cava, and was adjacent to the diaphragm pillars. It was also associated with a giant infrarenal abdominal aortic aneurysm (anteroposterior = 3.3 cm; transversal = 2.9 cm) with an endoluminal anterolateral thrombus of 0.25 cm that subsequently would block the left common iliac artery. The artery had distal re-permeabilization due to collateral circulation.