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The article discusses the use of transanal or transperineal surgery for rectal cancer, focusing on the benefits of visualizing the tumor directly and facilitating safe distal margins. It highlights the potential for shorter operating times and smaller blood loss with lateral lymph node dissection using this approach. The video vignette demonstrates a two-team surgery using the transperineal approach for locally advanced rectal cancer with bulky lateral lymph node metastasis. The authors emphasize the importance of achieving a safe 'lateral margin' for complete resection without severe perioperative complications. [Extracted from the article]

Herein, we describe our surgical technique and outcome of a kidney transplant in a patient with failing vascular access. A right donor kidney was transplanted into the right iliac fossa with an end‐to‐side arterial anastomosis to the ipsilateral right common iliac artery and end‐to‐side venous anastomosis to the contralateral left common iliac vein. The possibility of performing an ipsilateral arterial and contralateral venous anastomosis has been shown here to be successful. No post‐operative surgical complications were encountered. [ABSTRACT FROM AUTHOR]

The article focuses on the effectiveness of an all-in-one procedure, combining iliac vein stenting with endovenous laser treatment, for recurrent varicose veins associated with iliac vein compression. It study compares outcomes between patients undergoing endovenous laser ablation alone and those undergoing the combined procedure, showing that the combination is safe and effective, providing symptom relief, improved quality of life, and faster ulcer healing.

A 72-year-old man receiving anticoagulation therapy for chronic bilateral deep vein thromboses presented with acute right leg swelling. Right-sided imaging showed deep femoral vein thrombosis, chronic partial femoral vein thrombosis, and 4.8-cm distal external iliac vein dilation with possible right iliac vein stenosis. Venography confirmed common iliac vein occlusion and an aneurysm, with a fistula to the right internal iliac artery found by angiography. Aneurysm obliteration was achieved via arterial embolization with coils and an Amplatzer plug (Abbott, Chicago, IL). The patient continued with anticoagulation therapy, with patent common and external iliac arteries and a stable right external iliac vein aneurysm without arterial waveforms found on follow-up. His clinical manifestations were improved.

Introduction. Large thrombi in the inferior vena cava pose a high risk for a pulmonary embolism. Percutaneous extracorporeal circulation-based vacuum-assisted thrombus aspiration is a viable option for removal. Wall adherence of thrombotic material can compromise procedural success. Case Report. A 46-year-old female presented with a subtotal thrombotic occlusion of the inferior vena cava and the proximal right common iliac vein after weaning from extracorporeal life support. Due to severe wall adherence of the thrombotic material, the patient was treated with the combination of percutaneous extracorporeal circulation-based thrombus aspiration using the AngioVac system and a rotational thrombectomy device. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous iliac vein rupture is a rare, but frequently lethal condition. It is important to timely recognize its clinical features and immediately start adequate treatment. We aimed to increase awareness to clinical features, specific diagnostics, and treatment strategies of spontaneous iliac vein rupture by evaluating the current literature. Methods: A systematic search was conducted in EMBASE, Ovid MEDLINE, Cochrane, Web of Science, and Google Scholar from inception until January 23, 2023, without any restrictions. Two reviewers independently screened for eligibility and selected studies describing a spontaneous iliac vein rupture. Patient characteristics, clinical features, diagnostics, treatment strategies, and survival outcomes were collected from included studies. Results: We included 76 cases (64 studies) from the literature, mostly presenting with left-sided spontaneous iliac vein rupture (96.1%). Patients were predominantly female (84.2%), had a mean age of 61 years, and frequently presented with a concomitant deep vein thrombosis (DVT) (84.2%). After various follow-up times, 77.6% of the patients survived, either after conservative, endovascular, or open treatment. Endovenous or hybrid procedures were frequently performed if the diagnose was made before treatment, and almost all survived. Open treatment was common if the venous rupture was missed, for some cases leading to death. Conclusion: Spontaneous iliac vein rupture is rare and easily missed. The diagnose should at least be considered for middle-aged and elderly females presenting with hemorrhagic shock and concomitant left-sided DVT. There are various treatment strategies for spontaneous iliac vein rupture. An early diagnose brings options for endovenous treatment, which seems to have good survival outcomes based on previously described cases. [ABSTRACT FROM AUTHOR]

Introduction: Congenital malformations of the inferior vena cava are rare and remain an under recognised cause of spontaneous deep venous thrombosis (DVT). The purpose of this case report is to highlight the rare occurrence of a concomitant iliac vein aneurysm and the feasibility of endovascular reconstruction in the presence of extensive iliocaval thrombus burden, especially in cases where other treatment modalities have been unsuccessful. Report: This is the report of a 25-year-old male who presented with acute onset left lower limb pain/swelling secondary to extensive iliocaval DVT. This was due to multiple abnormalities of the venous system including hypoplasia of the IVC with aneurysmal dilatation of the iliac veins. He failed an initial management strategy of anticoagulation and thrombolysis but subsequently underwent endovascular reconstruction of the iliocaval system via venoplasty and stenting. Complete symptom resolution and venous patency, including resolution of venous aneurysmal disease, were maintained at twelve-month follow-up. Discussion: Reduction of the iliac vein diameter so early after successful reconstruction suggests that the iliac venous aneurysm was secondary to significant venous hypertension, and that if the obstruction causing it is treated, the vein can return to a normal vessel diameter. [ABSTRACT FROM AUTHOR]

We report an unusual case of a 40-year-old male patient who experienced painful swelling of the left lower limb that persisted for 1 week. Imaging modalities not only confirmed the diagnosis of acute iliofemoral venous thrombosis and pulmonary embolism (PE), but also an incidental finding of interrupted inferior vena cava (IVC). This congenital anomaly is uncommon but rarely associated with venous thromboembolism (VTE). The azygos continuation was compressed by the descending aorta against the 11th thoracic vertebrae, which was identified as the cause of VTE. He was treated successfully with anticoagulation and compression therapy. The patient was discharged with lifelong oral Rivaroxaban and remained asymptomatic. In the literature, only 9 cases of interrupted IVC-associated PE were identified but none was due to significant venous compression. [ABSTRACT FROM AUTHOR]

Objective: Iatrogenic injury to the large abdominopelvic veins can he highly morbid, and open surgical repair is technically challenging. Endovascular repair with covered stenting across the injured segment offers an alternative to open surgical management. We present a series of patients with operative injury to the inferior vena cava (IVC) and iliac veins who were treated utilizing an endovascular approach and review the available literature on this technique. Methods: A PubMed keyword and MeSH term search was performed, and titles were reviewed for relevance by the first author. Studies related to endovascular repair of iatrogenic injury to the IVC and iliac veins were then read in detail for possible inclusion in the review. Those deemed appropriate were further analyzed for interventional approach, stent type and size, technical success, post-procedural pharmacologic management, complications and surveillance strategy. Results: The initial search resulted in 6221 publications. A total of 17 met criteria for inclusion, all of which were case reports or series. Twenty-six patients were described as suffering iatrogenic injury to the IVC or iliac veins, treated with various types and sizes of stents. All cases achieved technical success with hemorrhage control. Procedural complications occurred in 15.4% of cases, including 3 cases of acute thrombus formation and 1 case of stenosis caudal to the initial stent edge requiring additional stenting. Two additional patients experienced stent occlusion in the surveillance period. Conclusions: Endovascular repair of iatrogenic injury to the IVC and iliac veins can be an effective management option. However, due to limited data regarding this approach, many technical questions remain, including ideal size and type of stent graft, necessity and duration of post-procedural anticoagulant or antiplatelet therapy and appropriate surveillance. Additionally, long term outcomes in this population have not yet been described. [ABSTRACT FROM AUTHOR]

Spontaneous iliac vein rupture (SIVR) is extremely rare and can lead to serious complications, including death. Etiologies include inflammatory processes and hormonal and mechanical triggers, with concomitant May–Thurner syndrome (MTS) being a rare cause. Management can be challenging due to the difficult balance between reducing thrombotic burden and life-threatening hemorrhage that can result from aggressive anticoagulation. Furthermore, surgical interventions are associated with high mortality, making conservative management more desirable. We report a case of SIVR with retroperitoneal hematoma and concurrent MTS that was successfully managed using conservative measures. We further provide a narrative review of the current literature addressing the diagnosis, management, and outcome of SIVR focusing on cases with concurrent MTS. [ABSTRACT FROM AUTHOR]

Purpose: To determine the diagnostic accuracy of preinterventional imaging modalities in patients being evaluated for iliocaval venous recanalization and stent placement. Methods: Consecutive patients with iliocaval postthrombotic obstructions or nonthrombotic iliac vein lesions (NIVL), who were scheduled for recanalization, underwent duplex ultrasound (DUS), magnetic resonance venography (MRV), multiplanar venography (MPV), and intravascular ultrasound (IVUS). The diagnostic accuracies of DUS, MRV, and MPV were analyzed using IVUS as reference. Results: A total of 216 limbs in 108 patients (80 patients with postthrombotic obstructions, 28 patients with NIVL) were examined. In patients with postthrombotic obstructions, the diagnostic sensitivities for the detection of lesions of the common femoral vein were 81% (95% CI 71–89%) for DUS, 76% (95% CI 65–85%) for MRV, and 86% (95% CI 76–93%) for MPV. The sensitivities for detecting lesions of the iliac veins were 96% (95% CI 89–99%) for DUS, 99% (95% CI 92–100%) for MRV, and 100% (95% CI 94–100%) for MPV. Regarding the inferior vena cava, the sensitivities were 44% (95% CI 24–65%) for DUS, 52% (95% CI 31–73%) for MRV, and 70% (95% CI 47–86%) for MPV. The sensitivities for detecting NIVL were 58% (95% CI 34–79%) for DUS, 90% (95% CI 68–97%) for MRV, and 95% (95% CI 73–99%) for MPV. Conclusion: In patients scheduled for recanalization of iliocaval postthrombotic obstructions, the sensitivities of DUS, MRV, and MPV were similar. In patients with suspected inferior vena cava involvement and in patients with NIVL, additional imaging with MR or conventional venography is required. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about gender's role in chronic venous insufficiency (CVI). The aim of this study was to evaluate the impact of gender on outcomes of iliac vein stenting(IVS) for CVI. Methods: 866 patients who underwent vein stenting for CVI at one institution from August 2011 to June 2021 were analyzed via retrospective review. Patients were followed up to 5 years after initial stent placement. Presenting symptoms were quantified using Venous Clinical Severity Score(VCSS), Clinical Assessment Score(CAS), and Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class. Reoperations after initial IVS were recorded. Major reoperations were defined as iliac interventions using venography. Minor reoperations were defined as thermal ablation. Multivariate logistic regression models were used determine odds of any and major reintervention. Results: Compared to females, males pre-operatively presented with a higher mean CEAP class (3.6 vs.3.3; P <.001), VCSS composite (11.3 vs.9.9; P <.001), and smoking history (134 vs.49; P <.001). The 2 groups were similar in age (P =.125), BMI(P =.898), previous DVT (P =.085), diabetes (P =.386), hypertension (P = 1.0), and CAD (P =.499). Multivariate analyses revealed no association between gender and any reintervention (OR, 1.02; 95%CI,.71-1.46; P =.935) or gender and major reintervention (OR, 1.39; 95% CI,.86-2.23 P =.177). There were no differences in number of stents placed (P =.736) or symptomatic improvement at 1 month (P =.951), 3 months (P =.233), 6 months(P =.068), and greater than 1 year (P =.287). At the 1 year follow-up, the male cohort had higher CAS values than females P =.034). Males had larger reduction in composite VCSS than women at 1 year (5.1 vs. 3.8; P =.003) and 3 years (5.3 vs.3.7; P =.031) of follow-up and similar levels of improvement in post-op (4.0 vs.3.5; P =.059), 2 years (4.3 vs.3.8; P =.295), 4-years (5.1 vs.4.6; P =.529), 5 years (5.6 vs.4.2; P =.174), and 6 years (5.93vs.3.3 P =.089). Conclusions: In a single site study of IVS in patients with CVI, males tended to present worse symptoms than females. After surgery, however, both cohorts showed improvement, and both seemed to improve to the same degree of residual symptoms. [ABSTRACT FROM AUTHOR]

Aim: To investigate the influence of iliac vein stenosis on the clinical course and recurrence of primary varicose veins after surgery. Materials and methods: Thirty-three patients with primary varicose veins qualified for great saphenous vein stripping were analysed. The stenosis of the common (CIV) and external (EIV) iliac vein was measured by IVUS and defined in three categories as minimal lumen area <90 mm² for CIV and <75 mm² for EIV, minimal lumen diameter <10 mm for CIV and <7.5 mm for EIV and area reduction >50%. The patients were assessed clinically and by duplex ultrasound 48 to 72 months after the procedure. Any recurrence, recurrence in the saphenofemoral junction (SFJ), change in Venous Clinical Severity Score (Δ VCSS), were analyzed in relation to the stenosis in CIV and EIV. Results: The follow-up was completed in 27 patients. Any recurrence and recurrence in SFJ were observed in 70% and 18.5% of patients, respectively. There were no statistically significant differences in any recurrence, recurrence in SFJ and Δ VCSS in relation to CIV and EIV stenosis in any category. Conclusions: Iliac vein stenosis does not influence the clinical course or recurrence of primary varicose veins after surgery [ABSTRACT FROM AUTHOR]

Objective To explore the distribution of iliac vessels in the anterior lower lumbar spine using CT angiography, and to provide vascular anatomical references for anterior lower lumbar surgery. Methods Select 100 male and 100 female patients who underwent abdominal CT angiography at Guizhou Provincial People′s Hospital from June 2016 to November 2018 for observation and measurement research;（1）Observe and record the distribution of the bifurcation points of the abdominal aorta and the confluence points of the common iliac vein;（2）Measure the distance from the vertex of the angle between the left common iliac vein and the right common iliac artery to the upper edge of the L5-S1 intervertebral space, and the distance between the left common iliac vein and the inner edge of the right common iliac artery at the upper and lower edges of the L5-S1 intervertebral space. Results （1）64% of the L4 vertebral body is flat at the bifurcation point of the abdominal aorta. The confluence point of the common iliac vein accounts for 42% of the L4 vertebral body and 40% of the L4-5 intervertebral space.（2）Abdominal aortic bifurcation angle：（51.01 ± 9.24）° for males, （50.51 ± 7.92）° for females;The confluence angle of the common iliac vein is（58.82 ± 11.81）° for males and（62.47 ± 12.46）° for females;The angle between the left common iliac vein and the right common iliac artery is（64.92 ± 12.07）° for males and（68.73 ± 13.87）° for females. （3）When the confluence point of the common iliac vein is level with the L4 vertebral body, L4 5 intervertebral space, and L5 vertebral body：① The distance from the vertex of the angle between the left common iliac vein and the right common iliac artery to the upper edge of the L5-S1 intervertebral space is（26.51 ± 8.11）mm, （16.18 ± 6.70）mm, and（7.82 ± 4.26）mm, respectively;② The distances between the left common iliac vein and the medial edge of the right common iliac artery from the L5-S1 intervertebral space are（32.52 ± 9.95）mm, （28.63 ± 11.48）mm, and（16.27 ± 7.71）mm, respectively The distance between the left common iliac vein and the inner edge of the right common iliac artery at the lower edge of the L5-S1intervertebral space is（43.88 ± 9.86）mm, （41.55 ± 11.05） mm, and（33.17 ± 9.40） mm, respectively. ④ The area of the "iliac vascular triangle" is （486.32 ± 246.26）mm2, （263.94 ± 178.47）mm2, and（85.49 ± 71.45）mm2, respectively The surgical windows for the L5-S1 intervertebral space are（496.98 ± 114.48）mm2, （488.89 ± 127.69）mm2, and（344.32 ± 166.63）mm2, respectively. Conclusion （1）There are significant anatomical changes at the bifurcation point of the abdominal aorta and the confluence point of the common iliac vein;The bifurcation point of the abdominal aorta is mostly flat on the L4 vertebral body, and the confluence point of the common iliac vein is mostly flat on the L4 vertebral body and the L4-5 intervertebral space.（2）When the confluence point of the common iliac vein is level with the L4 vertebral body, there is sufficient vascular safety zone in front of the lower lumbar spine for surgical operation;When the confluence point of the common iliac vein is located in the L4-5 intervertebral space, there is a certain vascular safety zone in front of the lower lumbar spine for surgical operation;When the confluence point of the common iliac vein is flat on the L5 vertebral body, the safety zone of the anterior blood vessels of the lower lumbar spine cannot meet the surgical requirements at this time.（3）When the confluence point of the common iliac vein is level with the L4 vertebral body and the L4-5 intervertebral space, there is sufficient surgical vascular safety zone in the anterior L5-S1 intervertebral space, but the vascular safety zone is gradually reduced. Preoperative CT angiography examination to clarify the vascular safety zone is helpful for surgical safety. [ABSTRACT FROM AUTHOR]

The anterior approach at L5-S1 has many advantages, however, vascular complications are challenging for spinal surgeons who may not be familiar with the variability of vascular anatomy. There are three different anterior approaches (intra-bifurcation approach and extra-bifurcation: left-, and right-sided prepsoas approaches) described in previous studies to respond to the variability of anterior vascular anatomy for reduction in vascular injury, while no guidance for the choice of approach preoperatively. To analyze the anatomical feasibility of three anterior approaches to access the L5-S1 disc space according to a practical framework. Retrospective study. Lumbar magnetic resonance imaging (MRI) from patients who visited our outpatient clinic were reviewed, with 150 cases meeting the inclusion criteria. The following radiographic parameters were measured on axial T2-weighted MRI at the lower endplate of L5 and the upper endplate of S1: width of the vascular corridor, position of the left and right common iliac vein (CIV), and presence of perivascular adipose tissue (PAT). Moreover, we designed a safe line to evaluate the feasibility of left- and right-sided prepsoas approaches. Cases of lumbosacral transitional vertebrae were identified. The feasibility of the intra-bifurcation approach was determined by the width of the vascular corridor, presence of PAT, and the position of the CIV. The feasibility of the prepsoas approach was determined by the relative position of the CIV to the safe line, presence of PAT, and the intersection point of the CIV and vertebral body. Sixty-eight percent, 64.7%, and 75.3% cases allowed the intra-bifurcation, left-, and right-sided prepsoas approach to L5-S1, respectively. The cases in this study had at least one of three anterior approaches to access L5-S1 disc space, and 74% of cases had more than one anatomical feasibility of anterior approach. The right-sided prepsoas approach was feasible in the majority of cases because of the vertical course of the right CIV with a significantly higher proportion of presence of PAT. Patients with lumbosacral transitional vertebrae (24 cases) may prefer the prepsoas approaches, and only six cases (25.0%) were determined to be feasible for the intra-bifurcation approach. Our study proposes a practical framework to determine whether the three different anterior approaches are feasible access at L5-S1. According to the framework, all cases had the anatomical feasibility of using an anterior approach to access L5-S1, and three-fourths of cases had a replaceable anterior approach when encountering intraoperative difficulties. [ABSTRACT FROM AUTHOR]

Most pancreatoduodenectomy (PD) procedures for locally advanced pancreatic head adenocarcinoma (PDAC) require superior mesenteric/portal vein (SMV/PV) axis resection and reconstruction. Here we describe the inverted Y‐shaped as a new technique for complex SMV/PV reconstruction and aimed at evaluating its safety and effectiveness. Among 287 patients who underwent PD for locally advanced PDAC from April, 2007 to December, 2020 at our hospital, 11 patients (3.8%) who underwent PV/SMV reconstruction with this technique were enrolled. Briefly, two distal veins were slit‐wedged, sutured, resulting in one orifice, then reconstruction was completed with (n = 6) or without (n = 5) interposed autologous right external iliac vein (REIV) grafts, respectively. Operation time and blood loss were 649 (502–822) min and 1782 (475–6680) mL, respectively. The median length of resected SMV/PV was 40 (20–70) mm, 50 (50–70) mm for REIV grafts, and the splenic vein was resected in eight patients. No patient developed pancreatic fistula; mild leg edema was observed in the six graft patients and the median hospital stay was 36.0 d. PV patency rate at 2 mo after PD was 91% (10/11) and no 90‐d mortality was recorded. R0 resection rate was 91% (10/11). It is feasible to safely reconstruct the SMV/PV using the inverted Y‐shaped technique in appropriately selected PDAC patients. [ABSTRACT FROM AUTHOR]

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Background: Visualization of key anatomical landmarks is required during surgical Trans Abdominal Pre Peritoneal repair (TAPP) of inguinal hernia. The Critical View of the MyoPectineal Orifice (CVMPO) was proposed to ensure correct dissection. An artificial intelligence (AI) system that automatically validates the presence of key and marks during the procedure is a critical step towards automatic dissection quality assessment and video-based competency evaluation. The aim of this study was to develop an AI system that automatically recognizes the TAPP key CVMPO landmarks in hernia repair videos. Methods: Surgical videos of 160 TAPP procedures were used in this single-center study. A deep neural network-based object detector was developed to automatically recognize the pubic symphysis, direct hernia orifice, Cooper's ligament, the iliac vein, triangle of Doom, deep inguinal ring, and iliopsoas muscle. The system was trained using 130 videos, annotated and verified by two board-certified surgeons. Performance was evaluated in 30 videos of new patients excluded from the training data. Results: Performance was validated in 2 ways: first, single-image validation where the AI model detected landmarks in a single laparoscopic image (mean average precision (MAP) of 51.2%). The second validation is video evaluation where the model detected landmarks throughout the myopectineal orifice visual inspection phase (mean accuracy and F-score of 77.1 and 75.4% respectively). Annotation objectivity was assessed between 2 surgeons in video evaluation, showing a high agreement of 88.3%. Conclusion: This study establishes the first AI-based automated recognition of critical structures in TAPP surgical videos, and a major step towards automatic CVMPO validation with AI. Strong performance was achieved in the video evaluation. The high inter-rater agreement confirms annotation quality and task objectivity. [ABSTRACT FROM AUTHOR]

Iliac vein compression syndrome (IVCS, or May–Thurner syndrome) occurs due to the compression of the left common iliac vein between the lumbar spine and right common iliac artery. Because most patients with compression are asymptomatic, the syndrome is difficult to diagnose based on the degree of anatomical compression. In this study, we investigated how the tilt angle of the left common iliac vein affects the flow patterns in the compressed blood vessel using three-dimensional computational fluid dynamic (CFD) simulations to determine the flow fields generated after compression sites. A patient-specific iliac venous CFD model was created to verify the boundary conditions and hemodynamic parameter set in this study. Thirty-one patient-specific CFD models with various iliac venous angles were developed using computed tomography (CT) angiograms. The angles between the right or left common iliac vein and inferior vena cava at the confluence level of the common iliac vein were defined as α1 and α2. Flow fields and vortex locations after compression were calculated and compared according to the tilt angle of the veins. Our results showed that α2 affected the incidence of flow field disturbance. At α2 angles greater than 60 degrees, the incidence rate of blood flow disturbance was 90%. In addition, when α2 and α1 + α2 angles were used as indicators, significant differences in tilt angle were found between veins with laminar, transitional, and turbulent flow (p < 0.05). Using this mathematical simulation, we concluded that the tilt angle of the left common iliac vein can be used as an auxiliary indicator to determine IVCS and its severity, and as a reference for clinical decision making. [ABSTRACT FROM AUTHOR]

Abstract Background Pregnancy is known to be a risk factor for venous thromboembolism (VTE). We report the case of a pregnant patient with difficult to diagnose iliac vein thrombosis, establishing a definite diagnosis by clues of great saphenous vein reflux. Case presentation A 37-year-old G1P0 woman at 35 weeks of assisted twin gestation presented with a complaint of persistent left lower limb edema and tenderness. A vascular ultrasound was used to examine the bilateral lower limb. Doppler of left lower extremity revealed continuous great saphenous vein reflux. Right saphenofemoral veins demonstrated venous stasis and no reflux. Unilateral continuous great saphenous vein reflux suggested left iliac veins obstruction or extrinsic compression. Anterograde venography showed a completely occlusive filling defect of the left external iliac vein, which is the definitive diagnosis of acute deep venous thrombosis. The patient underwent a cesarean delivery following inferior vena cava filter (IVCF) placement, and no signs of deep venous thrombosis (DVT) or pulmonary embolism (PE) were reported after delivery. Conclusion In pregnant women with suspected deep vein thrombosis, it is imperative to assess the presence of unilateral continuous great saphenous vein reflux.

Venous stent migration to the heart is considered to be a rare complication of a common procedure. Therefore, many physicians do not include this complication in their differential diagnosis. We explain why this complication is likely more common than currently thought and why it should be considered as a potential diagnosis. This case describes migration of bilateral iliac vein stents into the right ventricular outflow tract and right interlobar pulmonary artery. We provide multiple imaging modalities demonstrating the migrated stents. We believe radiologists should be cognizant of this complication and consider it as a potential diagnosis. Hopefully, this will create a greater awareness of this life-threatening complication of venous stent placement.

Aneurysms of the iliac veins are very rare; thus, the best approach to management has not yet been defined. We have presented the case of a 17-year-old boy with incidentally identified large bilateral external iliac vein aneurysms. Given the risks of potentially fatal thromboembolism or rupture, he underwent definitive repair of his aneurysms using staple aneurysmorrhaphy combined with additional vein tailoring by suture venoplasty, a technique not previously described for these aneurysms. We have also discussed the etiology, presentation, and our surgical technique to manage this rare condition.

Simple Summary: The complete duplication of the caudal vena cava (CVC) in a 10-year-old male cat is presented based on a vascular corrosion cast. The literature search shows that views on the development of the pre-hepatic part of the CVC both in domestic mammals and of the inferior vena cava in humans vary considerably. Recent research using 3D reconstructions has brought new insight into the meaning of the caudal cardinal veins into this process. The highest incidence of this anomaly was found in rats, cats, and small breeds of dogs (3–27%), while in many more examined humans it was lower, estimated at 0.2–3.0%. In addition, the concomitant pathologies vary—in small domestic mammals the presence of a double CVC was often connected with the ureteral malposition, while in young adults the double inferior vena cava increased the risk of deep venous thrombosis. In 50% of bilateral venous thrombosis cases, coincidental congenital defects of the cardiovascular system were rare. We believe that the presented case and literature review can contribute to better knowledge regarding the deep abdominal veins—their development, variability, concomitant pathologies, and accurate diagnosis. Precise knowledge of the species-/breed-specific anatomy is important for accurate diagnosis and treatment. Existing literature has also been increasing in accordance with the growing demands of biomedical research, wherein mammals, including cats, have been used worldwide. Based on a vascular corrosion cast, complete duplication of the caudal vena cava (dCVC) was accidentally found in a 10-year-old male cat. The two separate symmetric veins corresponding to two caudal venae cavae cranially directed on both sides of the aorta; their first tributaries were the duplicated right and left deep circumflex iliac veins, and the median sacral vein ended in the right common iliac vein. At the L4 vertebra level, the left caudal vena cava crossed the aorta ventrally. It united with the right CVC immediately above the renal veins at the level of the cranial mesenteric artery (L2–L3). Embryologic knowledge is essential to understand the differences between the CVC variants in domestic mammals and the inferior vena cava in humans. However, views regarding the post-hepatic segment of the CVC during development vary considerably. Therefore, our case report also includes a summary of the CVC developmental theories and their clinical impact. We believe that this case and literature review contribute to the knowledge regarding the deep abdominal veins' variability, concomitant pathologies, and accurate diagnosis and surgery. Additionally, the latest robust studies demonstrating the exclusive participation of the caudal cardinal veins in the CVC development are discussed. [ABSTRACT FROM AUTHOR]

Aim: Deep vein thrombosis (DVT) is an important disease that may cause serious morbidity and mortality. In the current study, we aimed to evaluate the employability of the mechanical thrombectomy and combination of it with catheter-directed thrombolysis in selected patients with acute and/or subacute DVT. Material and Methods: We applied mechanical thrombectomy and catheterdirected thrombolysis in the patients who admitted with an index diagnosis of lower extremity acute and/or subacute DVT. The thrombus in the femoral vein and iliac vein was intervened by intervention from the popliteal vein. Afterwards, mechanical thrombectomy and catheter-directed tPA infusion for 24 hours were applied. In follow-up, patients were evaluated through physical examination and Doppler ultrasonography on the 1st_, 6th_, 12th_, and 18th_month follow up, and scored with Villalta. Results: The mean age was 59.9 years. Twenty-six and 21 of the 47 patients were male and female, respectively. In the 1st-month follow-up visit, there was =50% patency in 43 patients, and =90% patency in 30 patients. During the 18-month follow-up period, while three patients had recurrent DVT, one patient had a new DVT episode in the contralateral extremity. According to Villalta score, three patients were found to have post-thrombotic syndrome (PTS) at the end of 18 months. Conclusion: We think that; pulmonary embolism (PE) and PTS rates would decrease with the concomitant application of percutaneous interventions to medical treatment in patients with index DVT diagnosis. Additionally, although the cost of percutaneous interventions seems to be high, it would be much more cost effective in the long-term when the complications related to DVT are taken into account. We also think that lowering the burden of thrombus in the acute period would preclude development of long-term complications. [ABSTRACT FROM AUTHOR]

Purpose: This study compares the performance of a 4-min multi-echo in steady-state acquisition (MENSA) with a 6-min fast spin echo with variable flip angle (CUBE) protocol for the assessment of lumbosacral plexus nerve root lesions. Methods: Seventy-two subjects underwent MENSA and CUBE sequences on a 3.0-T MRI scanner. Two musculoskeletal radiologists independently assessed the images for quality and diagnostic capability. A qualitative assessment scoring system for image quality and quantitative nerve signal-to-noise ratio (SNR) and iliac vein and muscle contrast-to-noise ratios (CNR) was applied. Using surgical reports as the reference, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curves (AUC) were evaluated. Intraclass correlation coefficients (ICC) and weighted kappa were used to calculate reliability. Results: MENSA image quality rating (3.679 ± 0.47) was higher than for CUBE images (3.038 ± 0.68), and MENSA showed higher mean nerve root SNR (36.935 ± 8.33 vs. 27.777 ± 7.41), iliac vein CNR (24.678 ± 6.63 vs. 5.210 ± 3.93), and muscle CNR (19.414 ± 6.07 vs. 13.531 ± 0.65) than CUBE (P < 0.05). Weighted kappa and ICC values indicated good reliability. Sensitivity, specificity, and accuracy of diagnosis based on MENSA images were 96.23%, 89.47%, and 94.44%, respectively, and AUC was 0.929, compared with 92.45%, 84.21%, 90.28%, and 0.883 for CUBE images. The two correlated ROC curves were not significantly different. Weighted kappa values for intraobserver (0.758) and interobserver (0.768–0.818) reliability were substantial to perfect. Conclusion: A time-efficient 4-min MENSA protocol exhibits superior image quality and high vascular contrast with the potential to produce high-resolution lumbosacral nerve root images. [ABSTRACT FROM AUTHOR]

Spontaneous rupture of the iliac vein is a rare cause of retroperitoneal hematoma. A misdiagnosis may delay the treatment and consequently put the patient in a life-threatening emergency. We report the case of a 73-year-old woman who presented with hemorrhagic shock from bleeding caused by a large left retroperitoneal hematoma. She was successfully treated with an endovascular approach by using a double bare stent technique. An extensive review of the literature was conducted and a total 44 articles with 50 patients were identified. Among these patients, 88.2% were women, 94.1% presented with a left-sided rupture, and the mortality rate was 13.7%. Spontaneous iliac vein rupture was more likely to occur in the left side in female patients. Conservative treatment was an option in hemodynamically stable patients. Exploratory laparotomy and surgical iliac vein repair was necessitated in most patients. Endovascular treatment including placement of covered stent and coil embolization had been widely used to treat spontaneous vein rupture since 2003. Double bare stent technique was also an effective alternative if a suitable covered stent was unavailable. [ABSTRACT FROM AUTHOR]

Introduction: Femoral bone fracture is the predominant, lower limb orthopedic surgery that is associated with severe acute and persistent chronic pain that needs better postoperative pain management. Untreated postoperative pain results inability to do physiotherapy resulting in stiffens of joints and immobility. This study aimed to compare the postoperative analgesic efficacy of three-in-one-block versus fascia iliaca block in patients who underwent surgically treated femoral fractured patients under spinal anesthesia. Methods: A prospective cohort study was conducted on 110 elective surgically treated femoral fractured orthopedic patients from January to October 2021. Data were entered into epi-data 4.4.2 and imported into a statistical package of social science version 22 for analysis. Shapiro–Wilk normality test was used to check the normality of the data and normally distributed data were analyzed using Student's independent t-test, whereas non-normally distributed variables were analyzed with Mann–Whitney U-test. The comparisons of categorical parameters were analyzed using the chi-square test and Fisher's exact test. Finally p-value < 0.05 was declared to be statistically significant. Result: The median and interquartile range of the postoperative numerical rating scale at rest and on movement was significantly less in three-in-one-block (3IN1B) as compared with fascia-iliaca block (FICB). But at 30 min no significantly different between the two pain management modalities. Moreover, the meantime to seek the first request of analgesia was significantly prolonged in 3IN1B compared with FICB. Regarding the total analgesic consumption, the mean total tramadol consumption was 97. 27 ± 53. 07 and 180 ± 72.96 (p < 0.001) and Diclofenac 53.18 ± 29.28 and 72 ± 43.54 (p < 0. 001) in 3IN1 and FICB, respectively. Conclusion: The present study concludes that three-in-one-block provides more effective analgesia, reduced postoperative analgesic requirements, and prolonged first analgesics requests compared with fascia iliaca block, and Landmark technique fascia-iliaca block (FICB) is an alternative pain management modality in a resource-limited setting. [ABSTRACT FROM AUTHOR]

Introduction: Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. Material and methods: We assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group. Results: Patients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group. Conclusions: For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the timing of iliac vein stent implantation on catheter-directed thrombolysis (CDT) in acute lower extremity deep venous thrombosis (DVT) patients with severe iliac vein stenosis. Methods: The clinical data of 66 patients with acute lower extremity DVT complicated with severe iliac vein stenosis from May 2017 to May 2020 were retrospectively analyzed. Patients were divided into two groups by timing of iliac vein stent implantation: group A (iliac vein stent implantation before CDT treatment) for 34 and group B (iliac vein stent implantation after CDT treatment) for 32. The detumescence rate of affected limb, the thrombus clearance rate, the thrombolytic efficiency, the complication rate, the hospitalization cost, the stent patency rate within 1 year, and the scores (venous clinical severity score, Villalta, and chronic venous insufficiency questionnaire (CIVIQ) score) at 1 year postoperatively were compared between the two groups. Results: The thrombolytic efficiency of group A was higher than that of group B, while the incidence of complications and hospitalization expenses in group A were lower than those in group B. There was no statistical significance in the detumescence rate of affected limb, the thrombus clearance rate, the stent patency rate within 1 year, and the scores (VCSS, Villalta, and CIVIQ score) at 1 year postoperatively between the two groups. Conclusions: For acute lower extremity DVT patients with severe iliac vein stenosis, iliac vein stent implantation before CDT treatment can improve the thrombolytic efficiency, and reduce the incidence of complications and hospitalization costs. [ABSTRACT FROM AUTHOR]

• Renoportal inflow is an option for portal vein thrombosis and splenorenal shunt. • Renocaval shunts can cause portal steal and thrombosis after renoportal anastomosis. • Embolization of the renocaval shunt to combat portal steal leads to portal vein patency. Orthotopic liver transplantation (OLT) in patients with cirrhosis complicated by portal hypertension, portosystemic shunts, and chronic portal vein thrombosis (PVT) has long been challenging. Spontaneous spleno-renal shunts (SRS) allow new surgical techniques to restore portal vein patency and hepatopetal flow. Renoportal anastomosis (RPA) has emerged as an accepted method for transplanting these patients, with good long-term patient and graft survival. Orthotopic liver transplantation with RPA is known to be complicated by recurrent PVT, with few details discussed in the literature. We present a case of a 56-year-old woman with decompensated cirrhosis who underwent deceased donor whole graft OLT using RPA with iliac vein conduit. The postoperative course was complicated by occlusive thrombosis in the portal vein and iliac vein conduit. Venography revealed enlarged left gonadal and lumbar vein varices acting as reno-caval shunts with hepatofugal flow. Embolization of the varices re-established durable venous patency that was confirmed on post-transplant day 68 with no other hemodynamic complications. This showcases an interesting mechanism by which recurrent PVT may occur in patients undergoing OLT with RPA. Because durable portal vein patency can be achieved with Interventional Radiology embolization of reno-caval varices, assessing these communications is an important preoperative consideration for planned OLT with RPA. [ABSTRACT FROM AUTHOR]

Background: Lower extremity ischemia due to extrinsic arterial compression by venous stent placement is a rare but increasingly recognized occurrence. Given the rise of complex venous interventions, awareness of this entity is becoming increasingly important to avoid serious complications. Case Presentation: A 26-year-old with progressively enlarging pelvic sarcoma despite chemoradiation developed recurrent symptomatic right lower extremity deep venous thrombosis due to worsening mass effect on a previously placed right common iliac vein stent. This was treated with thrombectomy and stent revision, with extension of the right common iliac vein stent to the external iliac vein. During the immediate post-procedure period the patient developed symptoms of acute right lower extremity arterial ischemia including diminished pulses, pain, and motorsensory loss. Imaging confirmed extrinsic compression of the external iliac artery by the newly placed adjacent venous stent. The patient underwent stenting of the compressed artery with complete resolution of ischemic symptoms. Conclusions: Awareness and early recognition of arterial ischemia following venous stent placement is important to prevent serious complication. Potential risk factors include patients with active pelvis malignancy, prior radiation, or scarring from surgery or other inflammatory processes. In cases of threatened limb, prompt treatment with arterial stenting is recommended. Further study is warranted to optimize detection and management of this complication. [ABSTRACT FROM AUTHOR]

Obstruction involving the iliac veins and/or inferior vena cava is highly comorbid in patients with chronic venous leg ulcers and is a barrier to healing. Intervention with venous stenting is recommended to promote wound healing; however, there is limited data to quantify the effects of venous outflow restoration on wound healing. We retrospectively identified patients with venous ulcers and comorbid venous outflow obstruction. Data regarding demographics, wound size, degree of obstruction, interventions, wound healing and recurrence were collected. Intervention was performed when possible and patients were grouped based on whether or not the venous outflow was reopened successfully and maintained for at least 1 year. Outcomes, including time to wound healing, wound recurrence, stent patency and ulcer‐free time, were measured. Patients who maintained a patent venous outflow tract experienced higher rates of wound healing (79.3%) compared to those with persistent outflow obstruction (22.6%) at 12 months (p < 0.001). Ulcer‐free time for the first year was also greater with patent venous outflow (7.6 ± 4.4 months versus 1.8 ± 3.0 months, p < 0.0025). Patients with severe obstruction of the venous outflow tract experience poor healing of VLUs despite appropriate wound care. Healing time is improved and ulcer‐free time increased after venous intervention with stenting to eliminate obstruction. [ABSTRACT FROM AUTHOR]

Purpose: To explore the risk factors of failure for modified single-session Angiojet rheolytic thrombectomy combined with directed iliac vein stenting, directed filter retrieval in the treatment of iliac vein compression with iliofemoral vein thrombosis. Methods: During September 2017 to September 2021, 278 patients with DVT were retrospectively analyzed and 203 were eligible for inclusion. All patients were tried to take modified single-session Angiojet rheolytic thrombectomy combined with directed iliac vein stenting, directed filter retrieval treatment. The perioperative factors were analyzed between groups: group 1—modified single-session therapy succeed, and group 2—modified single-session therapy failed. The high risk factors of failure group were evaluated by logistic regression analysis. Results: 48 patients failed in modified single-session therapy, up to 23.64%. Single factor analysis indicated that there were five independent risk factors related with the failure (p < 0.05), including course of disease longer than 7 days, lumbar degeneration-related iliac vein compression syndrome (dIVCS), antegrade vein access, balloon-assisted cracking thrombus, and suction time. Logistic regression analysis indicated that course of disease longer than 7 days (OR = 19.642.95%CI:6.776∼56.933), dIVCS (OR = 11.586.95%CI:4.016∼33.427) were high risk factors for modified single-session therapy failed, antegrade vein access (OR = 0.171.95%CI:0.047∼0.614) and balloon-assisted cracking thrombus (OR = 0.157.95%CI:0.045∼0.542) were protective factors for therapy failure (p < 0.05). Conclusions: Long course of disease and dIVCS are the high risk factors for failure of modified single-session Angiojet rheolytic thrombectomy combined with directed iliac vein stenting, directed filter retrieval in the treatment of iliac vein compression syndrome (IVCS). But, antegrade vein access and balloon-assisted cracking thrombus intraoperatively may improve the success rate of modified single-session treatment. [ABSTRACT FROM AUTHOR]

Corona Mortise is the name given to the anastomotic vessels forming a communication between external and internal iliac vascular systems. These channels have a high tendency to cause uncontrollable bleeding if injured and are particularly at risk during the anterior approach to acetabulum. While previous studies have described them as arterial or venous connections or both, there is still a lack of consensus regarding exact nature and location of these vessels, which make their timely identification all the more challenging. The present review is aimed at performing a comprehensive review of existing literature and discuss the anatomy and implications of correct identification of Corona Mortise in pelvic-acetabular surgery. Corona Mortise is more commonly venous than arterial. This not only makes haemorrhage control more challenging but also precludes the use of pre-operative angiography. However, most authors do not recommend a change in surgical approach for fear of damaging these vessels. [ABSTRACT FROM AUTHOR]

A 47-year-old male with a remote renal transplant due to pediatric glomerulonephritis on oral anticoagulation for symptomatic deep venous thrombosis and pulmonary emboli presented with sudden hip and groin pain. The patient was found to have a spinal epidural hematoma, underwent reversal of anticoagulation, and subsequently developed worsening renal function. Imaging revealed occlusive iliocaval venous thrombosis with extension to the renal allograft. Given risk of epidural hematoma expansion, the patient was deemed high risk for thrombolysis. The AngioVac system was used for single session thrombus removal. The patient's renal function improved and no focal neurologic sequelae was noted postprocedure. Six-month follow-up showed persistent vessel patency.

Isolated external iliac vein aneurysm is exceedingly rare, not well-described in the literature, and presents several potential surgical approaches. Herein, we describe the case of a 72-year-old woman who presented with incidentally found 4.3 cm × 3.4 cm × 5.6 cm right external iliac vein aneurysm after undergoing magnetic resonance imaging for orthopedic work-up. She was treated via parallel supra- and infra-inguinal incisions and novel combination of primary aneurysmorrhaphy with intraluminal balloon mandrel-assisted closure. The patient was discharged on postoperative day two, and 6-month follow-up ultrasound showed a normal caliber vessel with normal compressibility, suggesting this technique is safe and effective for appropriately selected patients.

This article discusses the relationship between capillary malformations (CMs) and venous malformations, specifically focusing on the severity of venous malformations based on the type of associated CM. The study examined patients with segmental CMs and identified three groups based on the characteristics of their venous malformations. The findings suggest that ectatic deep veins and venous insufficiency, which are associated with a risk of pulmonary thromboembolism, may be more frequent and severe in cases of geographic CM. The study recommends investigating venous anomalies with Doppler ultrasound during follow-up to assess their specific risk. [Extracted from the article]

This article, published in the journal Colorectal Disease, discusses the technique of bleeding control at the internal iliac vein tributary during laparoscopic resection of a presacral schwannoma. The authors describe a case study of a 66-year-old woman who underwent laparoscopic resection of a presacral tumor. The surgeons successfully achieved bleeding control at the internal iliac vein tributary and the patient had an uneventful recovery. The article concludes that laparoscopic bleeding control at this site can be performed safely during the resection of a presacral schwannoma. [Extracted from the article]

Traumatic arteriovenous fistulas are usually the evolution of non-treated contiguous arterial and venous injuries inflicted by firearm projectiles. As time passes, these fistulas can lead to systemic and local repercussions. Endovas-cular management offers great benefit in reducing the risks of open surgery for correcting these fistulas, but unfor-tunately some endovascular resources are not always available.In this situation, a hybrid management offering an endovascular strategy to control bleeding, while allowing an open disconnection of the affected artery and vein, may be useful in dealing with these complex injuries. In this article, the authors report a case of traumatic arteriovenous fistula between the common iliac vessels, managed with a hybrid strategy and make comments about practical issues regarding planning the open part of the procedure and anticipating possible complications when treating such injuries.

Background: Pregnancy is known to be a risk factor for venous thromboembolism (VTE). We report the case of a pregnant patient with difficult to diagnose iliac vein thrombosis, establishing a definite diagnosis by clues of great saphenous vein reflux. Case presentation: A 37-year-old G1P0 woman at 35 weeks of assisted twin gestation presented with a complaint of persistent left lower limb edema and tenderness. A vascular ultrasound was used to examine the bilateral lower limb. Doppler of left lower extremity revealed continuous great saphenous vein reflux. Right saphenofemoral veins demonstrated venous stasis and no reflux. Unilateral continuous great saphenous vein reflux suggested left iliac veins obstruction or extrinsic compression. Anterograde venography showed a completely occlusive filling defect of the left external iliac vein, which is the definitive diagnosis of acute deep venous thrombosis. The patient underwent a cesarean delivery following inferior vena cava filter (IVCF) placement, and no signs of deep venous thrombosis (DVT) or pulmonary embolism (PE) were reported after delivery. Conclusion: In pregnant women with suspected deep vein thrombosis, it is imperative to assess the presence of unilateral continuous great saphenous vein reflux. [ABSTRACT FROM AUTHOR]

The presentation of symptomatic inferior vena cava (IVC) occlusion is variable, and no clear guidance exists on indications for invasive treatment. We describe the first documented case in the literature of IVC occlusion and venous congestion of the spine with associated neurological symptoms, successfully treated with endovascular IVC reconstruction. Case report: A 31 year-old male presented with a long history of reduced sensation and motor function in his lower limbs upon waking every morning, lasting 30-50 minutes during which he was unable to ambulate. He was involved in a severe road traffic accident as a child, and was born prematurely requiring prolonged neonatal hospitalisation. Both duplex ultrasonography and magnetic resonance venography identified an occlusion of the IVC, with patent common femoral and iliac veins draining into large spinal collaterals. No other cause was identified for his symptoms. After appropriate multidisciplinary team discussion and patient counselling, the patient proceeded to have endovenous recanalization of his IVC and common iliac veins with dedicated venous stents. Post-operatively, the patient reported an immediate resolution of neurological symptoms, with an improvement in quality of life questionnaire scores and with stent patency at 9-month follow up. Conclusion: IVC occlusion with symptomatic spinal venous congestion is a rare condition which may be successfully treated with endovascular iliocaval recanalization, although long-term outcomes of this treatment are still unknown. [ABSTRACT FROM AUTHOR]

The occurrence of hematuria during a right heart catheterization can be a sign of renal perforation, a rare but life‐threatening complication that could be developed due to the misdirection of wire into the abdominopelvic venous plexus. We showed this complication could be managed with venoplasty of the common iliac vein. [ABSTRACT FROM AUTHOR]

• Camel-related vascular injuries may have a poor clinical outcome due to the complexity of the biomechanism of injury. • Although the skin injuries of camel bites are small, the long canine teeth of a camel can penetrate deeply. • The elongated jaws of the camel having strong masseter muscles increases the strength of the bite grip of the canine teeth. • The carotid is the most common injured artery because the camel can have a strong grip on the thin regions of its victims like the neck. • Neck wounds of camel bites can be closed primarily after debridement. Majority of human animal-related injuries in the United Arab Emirates are caused by camels. These may involve major vessels and can be life-threatening. We aimed to study the biomechanism, injured regions, management, and outcome of major camel-related human vascular injuries. We retrospectively studied all patients who were admitted to Al-Ain Hospital with camel-related major vascular injury during January 2001 to January 2020. Studied variables included demography, mechanism of injury, injured structures, clinical presentation, vital signs on arrival, associated injuries, surgical management, ICU stay, length of hospital stay, complications, and outcome. Seven patients were studied; all were males having a median age of 26 years. Five out of six bite injuries (83%) occured during the camel rutting season. The injuries were severe and life-threatening. A camel bite causes four small elliptical wounds of the canine teeth which resembles two stab wounds of 8 cm long, penetrating deeply and injuring major vessels. Four involved the carotid artery, one the femoral artery and vein, one the external iliac vein and one the aorta which was due to a fall from a camel. Although the standard of surgical care was high, the outcome was poor. Six patients were admitted to the ICU for a median of 5 days. One patient died, one became vegetative, and one had arm paralysis. Major camel-related vascular injuries have a poor clinical outcome. This is related to the biomechanism of injury which combines penetrating, crushing and blunt trauma. Neck wounds of camel bites can be closed primarily after debridement. [ABSTRACT FROM AUTHOR]

The treatment of choice for patients with symptomatic venous compression syndrome is venous stenting. However, this treatment has well-documented complications and, although rare, contralateral deep venous thrombosis is one of these complications. Our objective is to present a case of deep venous thrombosis of the contralateral iliac vein resulting from placement of the stent beyond the recommended position and the therapeutic challenge is to recanalize the vein with reconstruction of the iliocaval confluence. [ABSTRACT FROM AUTHOR]

An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar and inferior mesenteric arteries because of the need to simultaneously exclude the hypogastric arteries. Dynamic fluid balance phenomena provoked by closure of the AVF are described. The patient had a benign postoperative course with normalization of the severe hemodynamic changes presented prior to the intervention and resolution of respiratory symptoms attributed to pulmonary arterial hypertension. [ABSTRACT FROM AUTHOR]

Retroperitoneal sarcoma is relatively uncommon. We share our experience in encountering retroperitoneal sarcoma with vascular and urethral adhesion in a 46‐year‐old woman. Given the rarity of these tumors, evaluation and management should ideally be performed in a center equipped with multidisciplinary expertise in treating sarcomas. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive lateral lumbar interbody fusion (LLIF) is an increasingly popular surgical technique that facilitates minimally invasive exposure, attenuated blood loss, and potentially improved arthrodesis rates. However, there is a paucity of evidence elucidating the risk of vascular injury associated with LLIF, and no previous studies have evaluated the distance from the lumbar intervertebral space (IVS) to the abdominal vascular structures in a side-bend lateral decubitus position. Therefore, the purpose of this study is to evaluate the average distance, and changes in distance, from the lumbar IVS to the major vessels from supine to side-bend right and left lateral decubitus (RLD and LLD) positions simulating operating room positioning utilizing magnetic resonance imaging (MRI). Methods: We independently evaluated lumbar MRI scans of 10 adult patients in the supine, RLD, and LLD positions, calculating the distance from each lumbar IVS to adjacent major vascular structures. Results: At the cephalad lumbar levels (L1-L3), the aorta lies in closer proximity to the IVS in the RLD position, in contrast to the inferior vena cava (IVC), which is further from the IVS in the RLD. At the L3-S1 vertebral levels, the right and left common iliac arteries (CIA) are both further from the IVS in the LLD position, with the notable exception of the right CIA, which lies further from the IVS in the RLD at the L5-S1 level. At both the L4-5 and L5-S1 levels, the right common iliac vein (CIV) is further from the IVS in the RLD. In contrast, the left CIV is further from the IVS at the L4-5 and L5-S1 levels. Conclusion: Our results suggest that RLD positioning may be safer for LLIF as it affords greater distance away from critical venous structures, however, surgical positioning should be assessed at the discretion of the spine surgeon on a patient-specific basis. [ABSTRACT FROM AUTHOR]

To investigate the possible risk factors for proximal pulmonary embolism (PE) in patients with lower extremity deep vein thrombosis (LEDVT). A single-center, retrospective cohort study was conducted. Consecutive patients diagnosed with unilateral LEDVT and confirmed PE by computed tomography (CT) pulmonary angiography and indirect CT venography between September 2015 and January 2022 were included. Patient demographics, presentation of LEDVT, laboratory examination, thrombus characteristics, comorbidities and risk factors for LEDVT, and imaging findings were analyzed to determine the univariable and multivariable associations. The associations between thrombus location, stenosis, and proximal PE were assessed using a stratified analysis. A total of 115 eligible patients (60.08 ± 15.18 years, 59.1% male) were included. Of these patients, 40 (34.8%) were in the proximal PE group (proximal thrombus involved main or lobar pulmonary artery), and 75 (65.2%) were in the distal PE group (without main and labor pulmonary artery involvement). The univariable analysis showed that onset time of LEDVT symptoms≤7 days (P = .041), inferior vena cava (IVC) involvement (P = .035), and severe iliac vein stenosis (IVS) (stenosis ratio > 61.3%) (P = .010) were associated with the occurrence of proximal PE. Further multivariant analysis showed that IVC involvement was associated with an increased odds of proximal PE (OR: 4.45, 95% CI: 1.083-18.248, P = .038), whereas severe IVS (stenosis ratio > 61.3%) was associated with a decreased odds of proximal PE (OR: 0.294, 95% CI: 0.110-0.783, P = .014). Among patients with unilateral LEDVT, IVC involvement increased the risk of proximal PE; patients with severe IVS (stenosis ratio > 61.3%) had a lower risk of developing proximal PE compared with distal PE; and severe IVS seemed to be a protective factor for proximal PE. [ABSTRACT FROM AUTHOR]

Spontaneous iliac vein rupture is a rare cause of retroperitoneal hemorrhage that may present to the forensic pathologist. It has been reported in association with venous thrombosis, anatomical variants such as May-Thurner syndrome, and as a complication of a long-term indwelling IVC filter. It has a female predominance and most often occurs due to rupture of the left iliac vein. This is the first report of the use of post-mortem computed tomography (PMCT) and post-mortem computed tomography angiography (PMCTA) as an adjunct to a conventional autopsy to diagnose rupture of the left iliac vein causing retroperitoneal hemorrhage arising as a complication of an inferior vena cava (IVC) thrombus. We discuss the use of PMCTA as a useful tool in the diagnosis of vascular injury and how it can be used to assist the forensic pathologist. The use of PMCT with PMCTA is an invaluable adjunct to conventional autopsy to diagnose the site of vascular rupture. [ABSTRACT FROM AUTHOR]