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Kidney transplantation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The distal inferior vena cava and aorta are used for vascular reconstruction in children weighing less than approximately 20 kg. Dissection of the distal vena cava is accomplished first. Lumbar veins are divided as needed between fine silk ligatures to free a segment of vena cava approximately 2–3 cm in length. The distal aorta below the inferior mesenteric artery and proximal common iliac arteries are controlled with rubber vessel loops. At least one set of lumbar arteries is generally encountered. These vessels are left intact and controlled with Pott's ties as needed (Figure 87.3). Care should be exercised during dissection of the aorta to avoid disruption of the abdominal lymphatic trunk. In larger children, the recipient common iliac vessels may be utilized. In choosing the site for the anastomoses, thoughtful consideration needs to be given for the fit of the kidney in the recipient. Particular attention needs to be focused on the length of the renal vessels and their orientation, considering the ultimate position of the kidney after it is perfused, the retractor is removed, and the fascia are closed.
Anatomy of the Anterior Abdominal Wall
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The abdominal aorta gives rise to four pairs of lumbar arteries adjacent to the upper four lumbar vertebrae. They pass between the vertebral bodies and psoas muscle, anterior to the quadratus lumborum, and continue with the spinal nerves to supply the postero-lateral zone. They freely anastomose with each other and with the subcostal, iliolumbar, deep circumflex iliac and inferior epigastric arteries.
Vascular Anatomy Related to the Intervertebral Disc
Published in Peter Ghosh, The Biology of the Intervertebral Disc, 2019
Henry V. Crock, Miron Goldwasser, Hidezo Yoshizawa
Paired lumbar arteries arise from the posterior wall of the abdominal aorta and each courses around the “waist” or equatorial zone of the vertebral body. These arteries and their multitudinous branches lie “on” and not “in” the periosteum of the vertebra (Figures 3, 4, 5, and 6). Between their origins from the aorta and their point of migration posteriorly away from the vertebral body under the psoas muscles, these arteries give off three sets of branches: (1) the centrum branches (Figures 3 and 4); (2) ascending branches (Figure 7); and (3) descending branches (Figure 7).
Paraplegia following transarterial chemoembolisation for hepatocellular carcinoma: a case report
Published in Acta Chirurgica Belgica, 2021
The risk of spinal cord injury associated with ICA intervention exists because the spinal cord artery originates from the proximal ICA. The spinal cord is supplied primarily by one anterior and two posterior spinal arteries, which are augmented by radicular arteries derived from spinal branches of cervical, intercostal, and lumbar arteries [9]. The anterior spinal artery (ASA) supplies blood to the anterior two-thirds of the cord, including the anterior horns of the grey matter, spinothalamic tracts, and corticospinal tracts, which primarily dominate the motor nuclei. The two posterior spinal arteries (PSA) supply the dorsal columns and the posterior horns, which mainly process sensory information [10]. Therefore, because of anatomy and neurological distribution, the embolic materials created as part of TACE may bring about an embolic event with possible serious manifestations, even though the blood supply network of the spinal cord encompasses multiple anastomoses.
The impact of type 1a endoleak on the long-term outcome after EVAR
Published in Acta Chirurgica Belgica, 2021
Jan Van Slambrouck, Hozan Mufty, Geert Maleux, Sabrina Houthoofd, Anne Devooght, Charlotte Slots, Kim Daenens, Inge Fourneau
In nine patients (64.3%), reintervention with the placement of an aortic cuff was performed. In one patient it was combined with the placement of a Palmaz stent and in another patient, it was combined with endo stapling. In one case, placement of the aortic cuff did not resolve the type 1a endoleak that was visualised on the next follow-up CTA. Subsequent efforts to perform transarterial embolisation of the endoleak also failed. Another one of the nine patients initially suffered from a type 3 endoleak that was treated with an endovascular relining four years after EVAR. Sixteen years after EVAR a proximal type 1 endoleak occurred that was successfully treated with an aortic cuff. In two cases (14.3%), transarterial coil and glue embolisation of the proximal attachment site was used to resolve the type 1a endoleak. Open wrapping and ligation of the lumbar arteries were done in one of these patients because of continuous growth.
A fatal and unusual iatrogenic fourth right lumbar artery injury complicating wrong-level hemilaminectomy: a case report and literature review
Published in British Journal of Neurosurgery, 2019
Francesco Ventura, Rosario Barranco, Carlo Bernabei, Lara Castelletti, Lucio Castellan
Vascular damage is most commonly related to L4-L5 and L5-S1 level laminectomy.12–14 Within these levels, the inferior vena cava is interposed between the disc and the right or common iliac arteries.12 The left common iliac artery is susceptible to injury due to its medial course and intimate relationship with the L4-L5 intervertebral disc. The aorta and inferior vena cava are subject to surgical injury at the level comprised within the second and fourth lumbar vertebrae, whereas the distal segments of the iliac vessels are exposed to any injury at the level of the fourth lumbar vertebra.15 Finally, the internal iliac veins, lumbar arteries, inferior mesenteric artery, median sacral artery and the superior rectal artery are other vessels that may also be injured during lumbar disc surgery.5,16