Vascular Trauma of the Lower Extremity
Armstrong Milton B. in Lower extremity Trauma, 2006
Making a longitudinal incision directly over the palpable pulse exposes the common femoral artery. If the pulse cannot be appreciated, the incision is centered over the midpoint between the anterior superior iliac spine and the pubic tubercle. When the need to control the external iliac artery becomes necessary, the incision can be extended proximally and the inguinal ligament divided. Inferior extension of the incision along the course of the vessel exposes the proximal superficial femoral artery (SFA) and the profunda femoris. In this region, it is essential to identify and ligate the short, broad lateral circumflex femoral vein, because its inadvertent injury will result in troublesome hemorrhage. In the thigh, the SFA is accessed by an oblique incision made along the course of the sartorius muscle, which is then retracted medially to access the vessel because it lies in the adductor canal. Exposure of the distal-most portion of the SFA requires transection of the adductor magnus tendon.
Arteropathies, Microcirculation and Vasculitis
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
Endofibrosis is a rare disease affecting mainly highly trained cyclists. However, it is now found in many other endurance athletes of both genders. Exercise-induced arterial endofibrosis was first described in competitive cyclists in 1985. It was previously known as ‘external iliac artery endofibrosis’ as this was affected in 90% of the cases.9 The term was changed later since other locations were affected such as the common iliac artery, the common femoral artery, the profunda femoris and quadricipital artery. It consists of intraluminal nonatheromatous fibrous thickening and is due to repeated trauma associated with vigorous exercise. The internal elastic membrane, media and adventitia are usually normal, but the elastic membrane may be duplicated. It is now treated primarily with drug-coated balloon angioplasty.9
Complex lower extremity revascularization
Peter A. Schneider in Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
After the occlusion has been traversed, whether it is in the common iliac artery or the external iliac artery, or both, the operator has a choice of how to reconstruct the lesion. In general, after recanalizing iliac artery occlusions, most experts advise stenting the lesion or placing stent–grafts. In the external iliac artery, the entire occluded segment should be stented using self-expanding stents. Accurate stent placement is required on the distal end of the occlusion because stent placement too far into the common femoral artery should be avoided. This is facilitated by an over-the-bifurcation approach, because the self-expanding stents are deployed from the tip end to the hub end. In the common iliac artery, there is a broader choice of self-expanding or balloon-expandable stents. If the aortic bifurcation is heavily calcified and/or there is a lot of distal aortic disease, balloon-expandable stents are used. Self-expanding stents are a reasonable choice for longer occlusions or in arteries that are somewhat tortuous, especially if there is less aortic disease. If the stents extend into the aorta, they must be placed carefully so that they are equal on the bilateral sides. If there is a fair degree of disease in the distal aorta and/or the aortic bifurcation must be raised a bit, self-expanding stents do not work as well. It is not uncommon to stent across the origin of the internal iliac artery with bare metal stents. This usually does not negatively affect the patency of the internal iliac artery. A covered stent across the internal iliac artery would necessarily exclude it from the circulation and is generally avoided.
Uterine transplantation
Published in Climacteric, 2019
V. Gomel
A second team of surgeons prepared the recipient in an adjacent operating room. A midline incision from the pubis to the umbilicus permitted adequate entry to the abdomen. The vaginal vault was dissected free from the bladder and rectum. For the subsequent organ fixation, 1–0 polypropylene sutures were applied to the uterine rudiment. The external iliac artery and vein were bilaterally separated from each other and from adjacent tissue to a distance of 60 mm. The uterine vessels were placed in their normal position in the pelvis and bilateral end-to-side vascular anastomoses were performed between the graft vessels and the external iliac vessels of the recipient with the use of continuous 7–0 polypropylene sutures for arterial anastomosis and 8–0 sutures for venous anastomosis. The vaginal rim of the graft was anastomosed to the top of the recipient’s vagina with a continuous absorbable 2–0 suture1,17,18.
External iliac artery injury following total hip arthroplasty via the direct anterior approach—a case report
Published in Acta Orthopaedica, 2020
Ellen Burlage, Jasper G Gerbers, Bob R H Geelkerken, Wiebe C Verra
THA via the lateral and posterolateral approach and their association with vascular injuries has been well described in the literature. Shoenfeld et al. (1990) identified 63 cases via the lateral approach and found the external iliac artery to have the highest injury rate with 36 injuries. Injuries of the external iliac artery consisted of 11 pseudoaneurysms and 17 thromboembolic complications. For the remaining 8 external iliac artery injuries the type of injury was not specified. The causes of the vascular injuries were cement related (one-third), misplacement of a retractor (one-third) or excessive traction on the vessel (one-tenth). Emergent vascular intervention at the time of the THA was necessary in 27 cases. In half of these cases the external iliac artery was involved. The causes of the external iliac artery injury needing emergency intervention were not specified.
Technical success and outcomes using a flexible bifurcated stent graft (AorfixTM) in abdominal aortic aneurysms: a systematic review
Published in Expert Review of Medical Devices, 2021
Aazeb Khan, Emily Khoo, Vivak Hansrani, Mohamed Banihani, Haisum Qayyum, George A. Antoniou, Bella Huasen
The majority of the complications listed in Table 3 occurred due to partial or complete coverage of a visceral aortic branch by the endograft, or limb occlusion. There were four reported cases of acute limb ischemia, requiring intervention, of which three were within 2 days of the primary procedure [12,13], and the fourth patient presented on day 14 post procedure due to endograft limb occlusion [16]. Internal iliac artery occlusion reported in 12 patients (planned in one only) had mild buttock claudication symptoms and required no intervention. One author reports an ipsilateral external iliac artery occlusion occurring due to damage from the delivery system [7]. There were two reported cases of bowel ischemia, one managed conservatively [13], and the other patient died due to bowel infarction found on laparotomy [12]. Out of the four patients reported to have renal impairment, only one required renal artery stenting [13], but none of them required any renal support.