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Summary: Intimal sarcoma of arteries is a rare malignant tumor, which often mimics other vascular disorders; therefore, preoperative diagnosis is often challenging. We herein report a 71-year-old man who presented with fever and elevated inflammatory markers who had a mass in the left internal iliac artery with rapid growth. Based on clinical findings, a diagnosis of mycotic aneurysm was made. We performed surgical intervention, including resection of the affected vessels with omentopexy, although intraoperative findings were not typical of a mycotic aneurysm. Microscopic and immunohistochemical examination demonstrated undifferentiated intimal sarcoma. The patient died of multiorgan failure two months after the surgery. The vascular surgeon should consider the possibility of a diagnosis of intimal sarcoma for patients with atypical findings and the importance of histological and immunohistochemical examination for precise diagnosis in surgical vascular cases.

Giant aortoiliac aneurysm is a rare nosological entity. Owing to the increased diameter, the risk of rupture is extremely high and, similarly, the repair is extremely challenging. In this article, open surgical repair of a ruptured giant aortoiliac aneurysm in a 72-year-old male is described. A bifurcated Dacron graft was used with left internal iliac artery revascularization, while the contralateral internal iliac artery was ligated. The patient had an uneventful recovery.

Background Salmonella species commonly causes infection in humans and on occasion leads to serious complications, such as mycotic aneurysms. Here, we present the first case reported of a patient with a mycotic aneurysm likely secondary to Salmonella Rissen infection. Case presentation The patient presented with 4 weeks of lower back pain, chills and a single episode of diarrhoea 2 months prior during a 14-day trip to Hong Kong and Taiwan. Magnetic resonance imaging revealed an aneurysmal left internal iliac artery with adjacent left iliacus rim-enhancing collection. A stool culture was positive for Salmonella Rissen ST 469 EBG 66 on whole genome sequencing. The patient underwent an emergency bifurcated graft of his internal iliac aneurysm and was successfully treated with appropriate antibiotics. Conclusions This case highlights the importance of considering the diagnosis of a mycotic aneurysm in an unusual presentation of back pain with features of infection.

A 68-year-old man presented with a chief complaint of left leg pain; he was later diagnosed with an infected left internal iliac artery aneurysm. Multiple mononeuropathy was suspected. Since the aneurysm had a high risk of rupture, emergency Y-graft replacement was performed. Bacteroides vulgatus was then detected from the pus of the aneurysm. With continuous oral antimicrobial agents following intravenous antimicrobial agents, the patient was noted to have no recurrence. However, his leg pain symptoms continued postoperatively; thus, a supporting device was needed. It should be noted that even neurological symptoms may indicate the presence of aortoiliac aneurysms.

A 16-year-old female presented with left iliac fossa pain. In January 2021, she was admitted to her local hospital with severe lower abdominal pain and the pelvic ultrasound demonstrated a 13-cm left internal iliac artery dissecting aneurysm with its partial thrombosis. On examination, she had a high-arched palate, multiple skin stretch marks, flat feet and a soft systolic ejection murmur at the left 5th mid-clavicular line. She had a mildly tender abdomen in the left iliac fossa. Computed tomography angiography demonstrated a 12.2 cm × 10.4 cm × 12.5 cm left internal iliac artery aneurysm. During surgery, the aneurysm was incised and the proximal and distal orifices of the internal iliac artery were ligated. Genetic testing yielded 2 mutations in the SMAD3 gene characteristic for Loeys–Dietz syndrome.

Resumo Os aneurismas isolados das artérias ilíacas representam menos de 2% de todos os aneurismas abdominais. A artéria ilíaca interna é acometida em 10-30% dos casos. Na maioria dos casos os pacientes são assintomáticos, exceto se houver ruptura. Os aneurismas podem ser diagnosticados por ultrassom Doppler, ressonância magnética ou, preferencialmente, angiotomografia. As indicações cirúrgicas são expansão significativa, 3 ou mais cm de diâmetro ou casos sintomáticos. Apresentamos o caso de um paciente com achado ultrassonográfico incidental de aneurisma bilateral das artérias ilíacas internas, ambos com indicação cirúrgica. O paciente foi submetido a tratamento endovascular com sucesso, primeiramente com preservação da artéria ilíaca interna direita com endoprótese ramificada de ilíaca, seguida de embolização da artéria ilíaca interna esquerda. O conhecimento das diversas técnicas e dispositivos, assim como suas limitações, é fundamental para um adequado planejamento terapêutico endovascular, mesmo em casos pouco frequentes, como o aqui apresentado.

RESUMO Introducao : Os aneurismas de arterias iliacas (AAI) isolados sao condicoes raras, ocorrendo em somente 1% dos aneurismas perifericos. O tratamento endovascular e atualmente a opcao de escolha a cirurgia aberta, porem ainda e sujeito a complicacoes no intra e pos-procedimento. Relato : Sexo masculino, 77 anos, hipertenso, portador de AAI comuns simultâneos foi submetido a correcao endovascular atraves de implante de extensoes iliacas de endoproteses de aorta abdominal e embolizacao da arteria iliaca interna esquerda. Apos 50 dias houve trombose de todo o segmento iliaco esquerdo e embolizacao distal. Realizada fibrinolise intra-arterial (sem sucesso), implante de stents auto expansiveis no segmento iliaco esquerdo e trombectomia atraves de acesso femoral superficial. O paciente manteve-se assintomatico, sem sequelas neurologicas, com pulso distal presente apos um ano de acompanhamento. Conclusao : O tratamento endovascular dos AAI e a correcao de suas complicacoes atraves de tecnicas hibridas sao opcoes factiveis, com bons resultados a curto e medio prazo. Palavras-chave: Aneurisma iliaco, Angiografia digital, Implante de protese vascular. ABSTRACT Introduction: Isolated iliac arteries aneurysms (IAA) are rare conditions, occurring in only 1% of all peripheral aneurysms. Endovascular treatment is currently the preferred method compared to open surgery, but it is still prone to intra- and post-procedure complications. Case report: Male, 77 years, hypertension, with simultaneous common isolated IAA, underwent endovascular repair through implantation of two iliac extensions of abdominal aortic stent graft, and coil embolization of the left internal iliac artery. After 50 days thrombosis of the entire left iliac segment and distal embolization was observed. Intra-arterial fibrinolysis was performed (unsuccessfully), followed by implantation of self-expanding stents in the left iliac segment and thrombectomy through superficial femoral access. The patient remained asymptomatic without neurological sequelae, with palpable distal pulses after one year of follow-up. Conclusion: Endovascular treatment of IAA and treatment of its complications through hybrid techniques are feasible options, with good results in the short and medium-term. Keywords: Iliac aneurysm, Digital subtraction angiography, Blood vessel prosthesis implantation

Profunda femoris artery aneurysm is a rare vascular disorder, which is often diagnosed incidentally on identification of synchronous aneurysms. Herein, we report the case of a 63-year-old man, presenting with a hepatic cyst, who had left profunda femoris artery and left internal iliac artery aneurysms. We performed surgical intervention, including resection of the aneurysm and reconstruction of the profunda femoris artery using a prosthetic graft. The postoperative course was uneventful, and computed tomography revealed good graft patency. We believe surgical reconstruction of the profunda femoris artery should be completed except in complicated cases, such as rupture or aneurysm in the distal segment of the profunda femoris artery.

We report the case of a patient who developed paraparesis 2 days after endovascular aneurysm repair for a right common iliac aneurysm. The patient had undergone thoracic endovascular aortic repair. The left subclavian artery was occluded, but the left internal iliac artery was preserved. The patient fully recovered from the paralysis within 3 months. This case illustrates the importance of collateral blood supply to the spinal cord from the lumbosacral region, especially when other sources are occluded.

Iatrogenic intra-abdominal vascular injury can result from lumbar discectomy via the posterior approach. Although it is well known and documented in the literature, few anesthesiologists have personal experience with this life-threatening incident. Here, we report a patient who sustained perforation of the left internal iliac artery at the L 4-5 level during posterior lumbar discectomy. The patient experienced refractory hypotension with tachycardia at the end of surgery, even with prompt fluid resuscitation and medical treatment. Abdominal distension and tenderness of the left lower abdominal quadrant were also noted. Emergency laparotomy was performed by the consulting vascular surgeon and revealed perforation of the left internal iliac artery. The vascular injury was successfully repaired. It is important that, as anesthesiologists, we must be aware of this potentially fatal complication. Prompt diagnosis and immediate laparotomy to control hemorrhage can result in favorable outcomes.

As minimally invasive techniques have gained popularity across surgical specialties, microendoscopic discectomy has been hailed as one of the newest and best methods for disc removal. Although problems are unusual and infrequent, the complications that can be associated with this procedure should be realized. Iatrogenic major vascular injury is a rare but serious complication during microendoscopic discectomy, and early detection is difficult due to the surgical positions, the specific anatomy of the spine, and the subtle changes of signs and symptoms the patient manifests. Here, we present a female patient who suffered from left internal iliac artery and vein tear during microendoscopic lumbar discectomy. We conclude that both surgeons and anesthesiologists should be aware of the possibility of this complication during surgery. When this complication occurs, it is vitally important that the correct crisis resolution protocols, such as proper massive transfusion algorithm and successful surgical interventions, be applied immediately during the critical period.

Purpose: To describe a modular stent-graft for cases of bilateral common iliac aneurysm. Technique: The aortic aneurysm is repaired using a standard bifurcated modular system (Zenith). A modified bifurcated component is deployed with its trunk in one limb of the original aortic stent-graft, its long limb in the external iliac artery, and its short limb in the iliac aneurysm just above the internal iliac orifice. A flexible extension is introduced from the right brachial artery and used to bridge the gap between the short limb of the modified bifurcated component and the left internal iliac artery. Conclusions: Endovascular repair of bilateral iliac aneurysm is feasible using a modular stent-graft with separate branches to the internal and external iliac arteries.

Purpose To provide a technical description of robot-assisted uterine artery embolization and to investigate the safety and feasibility of the Magellan (Hansen Medical, Mountain View, California, USA) robotic catheter in this complex arterial bed. Materials and Methods Five women (mean age, 48.8 y) underwent robot-assisted bilateral uterine artery embolization over a 10-month period using the Magellan robotic catheter. Demographic, clinicopathologic, and endovascular performance metric data (fluoroscopy and cannulation times) were recorded as well as short-term outcomes. Results Robotic cannulation of bilateral internal iliac and uterine arteries was successful in all cases. Median right and left internal iliac artery cannulation and total fluoroscopy times were 3 minutes (interquartile range [IQR], 1.5–4 min), 2 minutes (IQR, 1.5–4 min), and 11 minutes (IQR, 9.5–14 min). Median right and left uterine artery cannulation times were both 11 minutes (IQR, 6.5–15 min and 8–12 min, respectively). Technical success was 100%. All patients were discharged on postoperative day 1, and there were no major or access site complications. At 6 months after the procedure, all patients reported significant improvement of symptoms, with a median increase in health-related quality-of-life score of 58% (48.5%–61.75%). Conclusions The use of the new-generation Magellan system in uterine artery embolization is feasible and appears to be safe. The additional navigational capability and added maneuverability of the NorthStar catheter (Hansen Medical, Mountain View, California) may facilitate selective catheterization of small iliac artery divisions and may be useful in any procedure where complex arterial selection is needed.

A new endovascular procedure is reported to treat bilateral common iliac artery (CIA) aneurysms extending to both iliac bifurcations.The left internal iliac artery (IIA) was first embolised, two overlapped Viabahn endografts were delivered from the right IIA to the distal aorta and, finally, CIA aneurysms excluded using iliac contralateral leg and extension endografts from the distal aorta to both external iliac arteries, applying a combined 'chimney-graft/double-barrel' technique.This procedure may extend the limits of conventional iliac endografting by preserving blow flow to at least one IIA using off-label commercially available devices, avoiding associated open surgical procedures. © 2010 European Society for Vascular Surgery.

A 51-year-old man was admitted with acute ischemic pain in the left leg. An angiogram demonstrated a well-developed left internal iliac artery that appeared to be continuous with the left common femoral artery, but no left external iliac artery. The left superficial and proximal deep femoral arteries were obstructed with thrombi. At surgery it was revealed that the distal end of the left common iliac artery was continuous with the dilated left internal iliac artery, forming the continuation with the left common femoral artery in the pelvic cavity. The left external iliac artery was absent between the common iliac and femoral arteries. (J Vasc Surg 2003;37:683-5.)

In this chapter, two cases of iliac artery aneurysms are presented. The first one is a “classic” bilateral common iliac artery aneurysm associated with a left internal iliac artery aneurysm that was managed with an iliac branch device on the right and an embolization of the contralateral internal iliac. The latter case is a more complex one: due to the extreme tortuosity of the iliac axes, a retroperitoneal approach was performed to straighten the access arteries, allowing a smoother advancement of the endograft.

Irritation of the left common iliac vein by the overlying right common iliac artery may result in intraluminal obstruction and symptomatic venous occlusion of the left lower extremity. We recently treated a 39-year-old patient with such an obstruction of the left common iliac vein as a result of compression by the left internal iliac artery. This case stresses the need to consider etiologies of external venous obstruction of the left lower extremity other than the commonly reported right common iliac artery when planning surgical intervention.

Although internal iliac artery aneurysms are uncommon, their timely recognition and surgical treatment are important since, like all other abdominal aneurysms, they tend to enlarge and rupture, often without warning, and the outcome is usually fatal. An aneurysm of the left internal iliac artery, in a seventy-six-year-old obese man, which ruptured into the rectum, was successfully treated by partial removal, distal aneurysmorrhaphy, and positioning of an aortofemoral prosthetic bypass.

This paper reports a successful endoaneurysmorrhaphy performed in a 68-year-old man with ruptured isolated internal iliac artery aneurysm, based on a sumilation picture of three demension designated from enhanced CT which greatly contributed to making the diagnosis. Isolated internal iliac aneurysm is so rare that only 31 cases have been reported in the Japanese literature. The mortality rate in ruptured cases is high. Early diagnosis and appropriate surgical treatment are mandatory.

Isolated aneurysm of internal iliac artery is infrequent, but often leads to the rupture with a high rate compared to another peripheral aneurysms. We reported a case of ruptured aneurysm of internal iliac artery treated with ligation and embolization. A 84-year-old man complained of abdominal pain and lumbago, and was found to have a ruptured, isolated left iliac artery aneurysm by ultrasonography. Transcatheter embolization tried first was failed because of severe arteriosclerosis. Then we carried out laparotomy and ligated the proximal part of the left iliac artery. However, the pulsation of the aneurysm was still continued, which obliged us to occulude aneurysm with coils and Gelfoam, resulting in the disappearance of pulsation and successful embolization. This procedure recommended when the proximal ligation offers an unsatisfactory effect for the ruptured aneurysm of the internal iliac artery.

This case report describes isolated aneurysm of the left internal iliac artery with neurofibroma. A 72-year-old man was seen at the hospital because of a left inguinal mass, and was found to have a strangulated hernia and an isolated aneurysm of the left internal iliac artery. The patient was admitted to the hospital for treatment. At operation, the inguinal tumor so strongly adhered to the surrounding tissue that we were obliged to select resection of the ilioinguinal nerve, testicular artery, and vein in order to remove the tumor. Intraoperative frozen section diagnosis of the tumor was neurofibroma, and so the tumor was left intact. Then the left internal iliac artery was freed, its central side was ligated to its peripheral side, and the aneurysm was removed. This case of isolated internal iliac aneurysm coexisted with neurofibroma is relatively rare. The anatomical location of the aneurysm make the early detection difficult, and it is often found after rupture has occurred. We could resect the aneurysm before rupture. This patient has been in good condition for postoperative 12 months.

Estudou-se em 30 galinhas da linhagem Hubbard, com idade variando de 10 a 12 semanas, a origem, o número e a ordenação dos vasos arteriais da Bolsa Cloacal mediante injeção do sistema vascular com solução aquosa a 50% de Neoprene Látex 450 e posterior dissecação. Os resultados mostraram a participação das artérias pudenternas esquerda e direita em todos os casos, às quais associavam-se as artérias mesentérica caudal (33,33%), caudal mediana (3,33%) e ilíaca interna esquerda (3,33%). O número total de ramos, independentemente da sua origem, variou de 2 a 9 com maior freqüência de 4 ramos. A distribuição dos vasos se fez de maneira própria para cada peça. _______________________________________________________________________________ ABSTRACT The Cloacal Bursa's arteries of 30 females Hubbard were injected with 50% Neoprene Latex 450 solution, and submited to dissection. The ages of the birds was to 10 to 12 weeks. The vessel's origin, number and sequence were studied The results showed the participation of the left and right internal pudendal artery in all cases, witch the association of the cranial mesenteric artery (333,33%), to median caudal artery (3,33%), and to left internal iliac artery (3,33%). The total branches number, without considering its origin, varied in 2 to 9, being 4 branches the major frequency. The vessels distribuition was the same in each bird.

Figure 1. Unenhanced computed tomography of the abdomen and pelvis showing a left internal iliac artery aneurysm compressing the left ureter with attendant hydroureteronephrosis. including a creatinine level of 1.1 mg/dL and a blood urea nitrogen level of 28 mg/dL. The patient’s mental status improved after the adjustment of his narcotics. However, on day 4 of hospitalization, the patient developed anuria and his creatinine and blood urea nitrogen levels increased to 5.5 mg/dL and 60.0 mg/dL, respectively (Figures 1e3).

Pheochromocytomas of the prostate are rare, with only 3 cases in adults reported in the literature. We present the case of an 8-year-old boy with a pheochromocytoma of the prostate and a second tumor in the region of the left internal iliac artery. (J. Urol., 144: 1219–1221, 1990)

A 65-year-old man developed bilateral buttock claudication due to stenosis of the main stem of the left internal iliac artery and stenoses of the left and right superior gluteal branches of the internal iliac arteries. These stenoses were successfully dilated by percutaneous angioplasty using coronary angioplasty equipment. Percutaneous angioplasty is shown to be an effective method of treatment of buttock claudication caused by stenoses of the internal iliac and superior gluteal arteries.

In this case, we describe a case of a 76-year-old male with extensive aortoiliac aneurysms treated by endovascular aneurysm repair using the sandwich technique in order to preserve left internal iliac artery perfusion. The sandwich technique refers to the deployment of multiple paralleled stent grafts into main distal and side branches in overlapping with a single proximal stent graft. The procedure was successfully performed without complications. Post-procedural CT angiography demonstrated patent stent grafts without any endoleak. The strengths and limitations of the sandwich technique need to be investigated in large-scale, long-term clinical trials.

Fewer than 100 internal iliac artery aneurysms have been reported in the English literature. Of these the incidence of true aneurysms occurring after aortic reconstruction is exceedingly low. A 73-year-old man presented with a 7 cm asymptomatic left internal iliac artery aneurysm 12 years after repair of an abdominal aortic aneurysm with a bifurcation graft. We report our experience with this patient along with a review of the literature and recommendations for aneurysm surveillance.

A rare case is reported of a fistula between the left internal iliac artery and the left ureter in a patient whose left kidney was the only functioning kidney. Internal iliac artery embolization was initially successful in stopping the bleeding, but the fistula recurred when the ureteral stent was removed. Even after embolization, the tissue surrounding a fistula remains very fragile, so the fistula may easily recur as a result of slight injury or inflammation.

Transcatheter arterial occlusion was performed in five patients with recurrent rectosigmoidal bleeding. Four had malignant neoplasms, and the fifth, an arteriovenous malformation. The superior hemorrhoidal artery was embolized in two patients, the inferior mesenteric artery in two, and the left internal iliac artery in one patient. In four patients, immediate and complete control of rectal bleeding was achieved, and gradual control was accomplished in the fifth patient. Left lower quadrant pain and fever developed in three patients. The possibility of rectosigmoidal bleeding from the internal iliac artery is stressed.

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We present a 64-year-old woman with left leg swelling for 1 year. Computed tomography imaging showed a large pelvic arteriovenous malformation that consisted of multiple fine shunts between the left internal iliac artery and the long segment of the left external iliac vein. A stent graft was inserted within the left external iliac vein to occlude the arteriovenous shunts with consecutive transarterial sclerotherapy using absolute ethanol. This resulted in complete resolution of the pelvic arteriovenous malformation. To our knowledge, this is the first reported case of stent graft insertion within a large vein for treating arteriovenous malformation.

Isolated aneurysms of the iliac arteries are rare and can be difficult to diagnose. The diagnosis is frequently delayed. One patient with a ruptured aneurysm of the left internal iliac artery is presented, and the computed tomography findings are compared to those of a case of a ruptured aortic aneurysm. The hemorrhages had much in common, and we want to stress the importance of including the iliac arteries when no cause of a retroperitoneal hemorrhage is found higher up.

Congenital anomalies of the iliac arterial system are rare and can be associated with ischemia. With an increase in vascular imaging and interventions, such anomalies are likely to be encountered with greater frequency. We present the case of a 25-year-old female who was incidentally found to have absence of the common iliac arteries bilaterally and the left internal iliac artery, a constellation not previously reported in the literature. We present relevant imaging findings, review embryonic vascular development, and discuss potential clinical implications.