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PubMed1975

Thoracic arteriovenous fistula: venous connection to right iliac vein.

A 5-year-old boy had clinical, cardiac catheterization, and operative findings of a thoracic arteriovenous fistula arising from the right subclavian artery. The venous connection was to the paravertebral plexus with eventual drainage into the inferior vena cava through the right common iliac vein. To our knowledge, this type of fistula has not been reported previously and is believed to represent embryological defects of the first or second posterior intercostal arteries as well as maldevelopment of the venous connections of azygos vein to the superior vena cava, which resulted in the observed caudal venous pathways becoming operative.

Arteriovenous Malformations↗
PubMed1984

[Potency disorders before and after pelvic artery reconstruction: objectification by measuring penile artery pressure].

Penile artery pressure was measured in 38 patients before and after aorto-iliac reconstruction using the Doppler technique. In 14 patients a markedly reduced penile pressure was found preoperatively which was significantly enhanced in 71% after operation. In 16% of all cases postoperative penile pressure was lower than the preoperative value. An improvement of sexual impairment was observed in 37% of the patients, while 26% reported a decrease of sexual function after operation. The reason seems to be an operative damage to the preaortal nerve plexus in most cases. Therefore, in younger patients with unilateral iliac artery occlusive disease an extraanatomical reconstruction is recommended.

Adult↗
PubMed1991

Effects of sympathetic nerves on collateral vessels in the limb of atherosclerotic primates.

This study was performed to examine effects of sympathetic nerves on collateral vessels in the limb. We studied normal (N) and atherosclerotic (AS) cynomolgus monkeys that were fed atherogenic diet for 21 months. A common iliac artery was ligated 13 months before hemodynamic measurements. Using histofluorescence microscopy, a plexus of noradrenergic nerves was identified in the adventitia of collateral vessels. We measured blood flow to the limb with microspheres, and the pressure gradient from aorta to the iliac artery beyond the occlusion. The lumbar sympathetic chain was stimulated electrically at 3 Hz (SNS-3) and 15 Hz (SNS-15). In normal monkeys, conductance of collateral vessels (in ml/min per 100 g per 100 mm Hg) was 19 +/- 3.6 (mean +/- SE) during control, 14 +/- 1.6 during SNS-3, and 9.8 +/- 0.9 during SNS-15 (P less than 0.05 vs control). In AS monkeys, collateral conductance was 12 +/- 2.9 during control, 7.5 +/- 1.7 during SNS-3 and 3.9 +/- 1.8 during SNS-15 (P less than 0.05). In summary, collateral vessels in the limb are innervated and sympathetic stimulation produces pronounced constriction of collateral vessels in both normal and atherosclerotic monkeys. Thus, the effectiveness of collateral vessels in maintaining blood flow to the limb may be compromised by increased activity of sympathetic nerves.

Animals↗
PubMed1997

Persistent primitive sciatic artery associated with other various anomalies of vessels.

A left persistent primitive sciatic artery was observed in a Japanese male cadaver. The sciatic artery arose from the internal iliac artery and perforated the ventral division of the sacral plexus. The sciatic artery did not anastomose with the perforating arteries nor the popliteal artery. The left femoral artery was incompletely developed, attenuating and terminating as the saphenous artery. Instead of the femoral artery, direct continuation of the profunda femoris artery, which probably corresponded to the fourth perforating artery, became the popliteal artery. Other vessel anomalies were observed in various regions. They included; (1) the retroesophageal right subclavian artery; (2) the left vertebral artery entering the transverse foramen of the 4th cervical vertebra; (3) bilateral occurrence of the superficial brachial artery; (4) the left gastric artery independently arising from the abdominal aorta; (5) a hepatolienomesenteric trunk; (6) three accessory renal arteries; (7) double testicular arteries; (8) the arteria intermesenterica; (9) a venous ring termed the 'renal collar', and (10) paired thoracic ducts. The present cadaver was considered to be a very rare case in which many primitive vascular systems had extensively persisted in various parts of the body.

Abnormalities, Multiple↗
PubMed2005

Consideration of the potential courses of the common iliac artery.

We encountered a rare case of the left common iliac artery in a 92-year-old Japanese female cadaver during dissection practice for medical students. The artery entered into the small pelvis without branching to the external iliac artery. There, it went down slightly medially and then turned laterally and passed behind the first sacral nerve. The artery ran anterolaterally further and returned to the greater pelvis and became the external iliac artery, which continued to the femoral artery as usual. During the course in the small pelvis, the artery branched to give rise to each branch of the internal iliac artery. We speculate that in the present case, a communication between the median sacral artery and the superior gluteal artery, passing behind the first sacral nerve, enlarged and compensated the usual common iliac artery.

Aged↗
PubMed1990

[Developments in the surgical treatment of rectal cancer in view of the quality of life].

The quality of life of patients who had undergone a primary radical resection of the rectum for cancer was restricted by colostomy, urinary incontinence or sexual disturbance. This paper describes the developments and surgical results of sphincter saving operation and nerve preserving operation for rectal cancer. 1) Sphincter saving operation: With the advent of modern sphincter saving techniques such as low anterior resection and stapling technique, abdomino-perineal resection of the rectum are no longer necessary for the treatment of nearly all tumors of rectosigmoid, three of four tumors of the upper rectum and one of five tumors of the lower rectum. At low anterior resection of the rectum, in general principle, the affected parts of the diseased rectum were resected with a macroscopically free margin of at least 3 cm on anal side of the cancer. Recurrence rates of anterior resection were fewer than those of abdomino-perineal resection, and five year survival rates after AR were better than those of after APR. 2) Autonomic nerve preserving operation: As it is impossible to remove the internal iliac lymph-nodes completely without disturbing the underlying pelvic plexus, an autonomic nerve preserving operation was done unless there was microscopic lymphatic gland involvement by frozen section. Urinary bladder function was impaired in 80% of patients after extended lateral dissection without nerve preservation whereas it was unaffected in 14 of 16 patients after nerve preserving operation. Six of seven male patients with nerve preserving operation retained potency, but only one was capable of ejaculation.

Humans↗
PubMed1996

[Complications of radical hysterectomy during management of stage Ib and IIa cervix uteri cancer. Experience with 145 patients].

Perioperative morbidity and mortality were studied in 145 patients who underwent radical hysterectomy wit pelvic lymphadenectomy, as treatment of choice for cervical cancer, stages Ib and IIa at The Oncology Service on The General Hospital of México, SSA, with special emphasis in urinary complications when superior bladder arteries were preserved, (99 cases) or not, (46 cases). There was no operative death. There were 20, (13.7%) intraoperative complications: 10 (6.8%) injuries to hypogastric plexus; 5 (3.4%) ureteral sections and 2 (1.3%) injuries to iliac veins. Thirty nine patients, (26.8%) developed postoperative complications, (1 to 30 days): Bladder dysfunction, 30 (20.6%); wound infection, 5 (3.4%); ureterovaginal fistula, 3 (2.0%) and vesicovaginal fistula, 3 (2.0%). After 30 days, we observed 5 complications, (3.4%): ureterovaginal fistula, 3 (2.0); bowel obstruction, 1 (0.6%) and lymphocyst, 1 (0.6%). Surgical time was an hour longer, (4.15 hs vs. 3.15 hs) and bleeding increased a little bit, (1,125 c.c. vs. 980 c.c.) when superior bladder arteries were preserved. However, in these cases, there were less postoperative complications, (29/99, 29.2% vs. 19/46, 41.3%; P < 0.05), including ureterovaginal fistula, (1/99, 1.0% vs. 5/46, 10.8%).

Adenocarcinoma↗
PubMed2003

Diagnosis of pregnancy-associated uterine venous plexus thrombosis on the basis of transvaginal sonography.

OBJECTIVE: To describe the sonographic signs of uterine venous plexus thrombosis. METHODS: Four pregnant patients had a diagnosis of uterine venous plexus thrombosis in the first half of gestation. The diagnosis was based on transvaginal sonography only in 3 cases, and the fourth had magnetic resonance imaging corroboration. RESULTS: All 4 patients had similar sonographic features of uterine venous plexus thrombosis on transvaginal sonographic examination. The thrombi within the dilated veins were shown as elongated echogenic structures along the lumen that appeared round on transverse views of the affected veins. They showed swinging movements provoked by gentle transducer pressure. Power and color Doppler sonography enhanced the uterine venous plexus thrombosis diagnosis by showing blood flow around the thrombi. There were no signs of thromboembolic disease. Sonographic findings in deep leg veins and iliac veins were normal in all cases. Complete thrombophilia studies did not reveal any abnormalities. The uterine venous plexus thrombosis could not be detected on transabdominal sonography and was shown better by transvaginal sonography compared with magnetic resonance imaging. During 3 months of anticoagulation therapy, the thrombi gradually disappeared in all cases. CONCLUSIONS: Focusing on the pelvic veins while performing a transvaginal sonographic study during pregnancy may reveal important findings, which may have clinical implications. The therapeutic treatment of uterine venous plexus thrombosis is controversial and still empirical.

Adult↗
PubMed1982

[Serum sex steroid hormones in women with aging, and in the patients of climacteric syndrome and squamous cell carcinoma of the uterus].

The endocrinological studies were conducted in 116 normal women with aging, 16 women with climacteric syndrome and 31 patients of cervical cancer. The levels of serum estrone, estradiol and estriol had a tendency of gradual decline after the age of 40, and decreased rapidly 3 years after menopause, but still remained in a certain level thereafter throughout the senile period. The serum progesterone tended to decrease after the age of 40. While the serum testosterone showed no particular change before menopause, began to decrease after menopause. Women with climacteric syndrome were found to have a significant low serum estrogen and testosterone than in normal women, while a relative low tendency of serum progesterone in the premenopausal women of climacteric syndrome were observed. There was a relative high serum progesterone and testosterone found in adult and premenopausal patients of cervical cancer than in normal women, but showed no any difference of estrogen between them. The serum estrogen/testosterone ratio in cervical cancer group, was higher than that in the normal. Serum estrogen from the ovarian plexus was found several ten times higher than that in the iliac artery. However, progesterone and testosterone were found a slightly higher in the former.

Adult↗
PubMed1984

Blood supply of the abdomen revisited, with emphasis on the superficial inferior epigastric artery.

The key to understanding the blood supply of the anterior hemiabdomen is knowledge of the central superficial inferior epigastric artery system and the peripheral contribution of the epigastric, deep and superficial circumflex, and iliac arteries and external oblique perforators. These systems all feed into the subdermal plexus of the anterior abdominal wall. Angiographic confirmation of multiple communications between the superficial inferior epigastric artery and other major sources of abdominal wall blood supply has been obtained. Experience using the superficial inferior epigastric artery flap as a pedicled and microsurgical transfer has been described.

Abdomen↗
PubMedDate not supplied

Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly.

BACKGROUND AND OBJECTIVES: This prospective randomized study was designed to determine the hemodynamic effects and quality of combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia in the elderly for repair of proximal femoral fractures. METHODS: Twenty-nine elderly patients ranging in age from 68 to 97 years were randomly assigned to 2 groups: a spinal anesthesia group with single-shot 3 mL 0.5% plain bupivacaine, and a combined block group with 30 mL lidocaine 1.33% with epinephrine for the posterior lumbar plexus block and 10 mL same mixture for the parasacral block and an iliac crest block with 5 mL lidocaine 1%. RESULTS: No need for general anesthesia was encountered in either group. Anesthesia was judged unsatisfactory in 1 of 15 patients in the combined block group. The initial decrease of mean arterial pressure was 38% in the spinal group and 27% in the block group and was not significantly different. A more prolonged hemodynamic effect was found in the spinal group, indicated by the more frequent use of ephedrine to stabilize blood pressure (P<.05). Patients over 85 years had a significantly larger decrease in blood pressure than younger patients (P<.01). CONCLUSIONS: Plain bupivacaine spinal anesthesia and combined lumbar/sacral plexus block provided adequate anesthesia for repair of hip fracture in the elderly. Hypotension was induced by both the combined peripheral nerve block and plain bupivacaine spinal anesthesia in aged patients; hypotension was found to be longer lasting after spinal anesthesia and of a larger magnitude in patients over 85 years of age.

Age Factors↗
PubMed1982

Ruptured abdominal aortic aneurysms presenting as radicular compression syndromes.

Two patients are described: one with an aneurysm of the infrarenal aorta and common iliac artery that ruptured posteriorly into the iliac vein, the other with an aneurysm of the distal abdominal aorta that ruptured posteriorly into the iliopsoas muscle. Both patients had symptoms compatible with a radicular compression syndrome. Ruptured aneurysm of one of the major abdominal arteries should be considered in the differential diagnosis of affections of the lumbosacral neural outflow, because immediate operation can be life-saving.

Aorta, Abdominal↗
PubMed1999

Iliac artery pseudoaneurysm following renal transplantation presenting as lumbosacral plexopathy.

A renal transplant patient developed chronic and progressive back and lower extremity pain followed by foot weakness. The correct diagnosis of lumbosacral plexopathy was made after electromyography and nerve conduction studies and the etiology of radiculopathy due to nerve root compression was excluded. This prompted further investigations that led to the discovery of a large internal iliac artery pseudoaneurysm. We emphasize the use of electrodiagnostic studies to investigate patients with back and limb pain for correctly localizing responsible pathology. In this case a potentially lethal situation was correctly identified in a transplant patient.

Aneurysm, False↗
PubMed1976

Lumbar epidural venography in the diagnosis of disc herniations.

Epidural venography is a relatively simple and highly accurate method of diagnosing disc herniations in the lumbar region. Good opacification of the epidural venous plexus can be obtained by selective catheterization of ascending lumbar and/or internal iliac veins. Experience with 227 cases is described. The examination appears to be at least as accurate as myelography at the L4-L5 level and more reliable than myelography in cases of lateral disc herniations at L5-SI. Epidural venography is recommended as the examination of choice in patients with suspected lumbar disc herniation.

Catheterization↗
PubMed2006

Use of fluoroscopy to evaluate iliac screw position.

Iliac screw fixation is often used for long fusions to the sacropelvis. Maximum iliac screw purchase is obtained both by placing the screws within 1.5 cm of the greater sciatic notch and by extending them anterior to the axis of rotation in flexion-extension. Screw insertion is "blinded" or dependent on tactile feedback, and hence extreme care is necessary to avoid incorrect placement and damage to vital neurovascular structures in the pelvis and sciatic notch. Long screws may violate the hip joint while medial placement may injure the lumbosacral plexus and the nearby vessels. To explore the best intraoperative fluoroscopic method of determining optimal iliac screw placement, we used a synthetic pelvis model to investigate screw placement conditions: (1) optimal anatomic placement, (2) violation of the sciatic notch, (3) hip joint violation, (4) medial wall violation, and (5) lateral wall violation. Each condition was examined utilizing fluoroscopy with posteroanterior, inlet, outlet, lateral, iliac oblique, and obturator oblique Judet views to simulate operative conditions. These views were obtained to evaluate critical malposition of iliac screws. We found that, for a sciatic notch violation, the obturator oblique view best demonstrated the cortical breech, while for a hip joint violation, the inlet and outlet views were best. For a medial wall violation, the iliac oblique view best showed the violation. For a lateral wall violation, we were unable to demonstrate the cortical breech using these fluoroscopic views. Fluoroscopy is an effective method to determine sciatic notch, hip joint, and medial wall violations after iliac screw placement; however, it is not effective in identifying a lateral wall violation.

Bone Screws↗
PubMedDate not supplied

[Spiral computed tomography in the assessment of vascular lesions of the pelvis due to blunt trauma].

PURPOSE: We investigated the role of Helical Computed Tomography (CT) in the evaluation of low or high flow vascular injuries in patients with blunt pelvic trauma. MATERIAL AND METHODS: From May 1998 to December 1999, forty-nine patients (32 men and 17 women, ranging in age 14-59 years) with acute symptoms from blunt pelvic trauma were submitted to Computed Tomography (CT). A conventional radiography of the pelvis had been performed in all cases. CT was performed with a helical unit (thickness 8 mm, reconstruction interval 8 mm, pitch 1.5) after intravenous contrast agent (150-180 mL) rapid infusion (4-5 mL/s, 60 s acquisition delay from bolus starting) and using a power injector. A second spiral acquisition was performed in all cases from the iliac roofs to the inferior border of the pubic symphysis. Vascular hemorrhage was considered as low flow when the hematoma appeared as a focal homogeneous density area and as high flow when associated with contrast agent extravasation. Moreover, traumatic assessment included evaluation of the hematoma, of the leakage site and of the involved vessel. RESULTS: Radiologic examination of the pelvis revealed fractures in 35/49 patients (71.4%). Helical CT allowed us to identify low flow hemorrhage in 37 patients, affected with hematomas from fracture of the iliac wing or of the sacrum (14 cases), tear of the pelvic (3 cases) or extrapelvic (4 cases) muscular structures, or injury of the venous plexus (20 cases). In four patients two vascular injuries were detected. High flow hemorrhage was seen in 12 patients, who had Helical CT findings of contrast agent extravasation along the common iliac vein (3 cases), external iliac artery (3 cases), internal iliac artery (4 cases), internal pudendal artery (1 case), obturator artery (1 case), inferior epigastric artery (2 cases), superior gluteal artery (2 cases), inferior gluteal artery (1 case), cremasteric artery (1 case). In 6 patients with high flow hemorrhage, two vascular injuries were shown. In all these patients, an extraperitoneal hematoma was associated with the contrast agent extravasation. DISCUSSION AND CONCLUSIONS: Fractures of the pelvic ring generally result from severe trauma. Management of these injuries must include not only treatment of the skeletal trauma but also of the associated shock and complications. Major blood loss usually occurs as a result of bleeding from the branches of the internal iliac artery. With respect to pelvic plain radiography, CT provides superior detailing of fractures, position of fracture fragments and extent of diastasis of the sacroiliac joints and pubic symphysis. Moreover CT provides diagnostic information regarding the presence or absence of pelvic bleeding and can identify the site of bleeding. In our experience, Helical CT allows us to distinguish high flow hemorrhage, where vascular injuries must be treated first, from low flow hemorrhage which can be managed differently.

Adolescent↗