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Background：To evaluate the feasibility of a new surgeon-modified iliac branch device （IBD） technique to maintain pelvic perfusion in the management of common iliac artery （CIA） aneurysm during endovascular aneurysm repair （EVAR）.Methods：From January 2011 to December 2013,a new surgeon-modified IBD technique was performed in department of vascular surgery of Peking Union Medical College Hospital in five patients treated for CIA aneurysm with or without abdominal aortic aneurysm.A stent-graft limb was initially deployed in vitro,anastomosed with vascular graft,creating a modified IBD reloaded into a larger sheath,with or without a guidewire preloaded into the side branch.The reloaded IBD was then placed in the iliac artery,with a covered stent bridging internal iliac artery and the branch.Finally,a bifurcated stent-graft was deployed,and a limb device was used to connect the main body and IBD.Results：Technical successes were obtained in all patients.The mean follow-up length was 24 months （range：6-38 months）.All grafts remained patent without any sign of endoleaks.There were no aneurysm ruptures,deaths,or other complications related to pelvic flow.Conclusions：Using the surgeon-modified IBD to preserve pelvic flow is a feasible endovascular technique and an appealing solution for personalized treatment of CIA aneurysm during EVAR.

This study investigated anatomical and procedural factors influencing iliac limb migration and its correlation with late type 1b and type 3 endoleaks. We analyzed data of 141 iliac limbs from 91 patients who underwent endovascular aneurysm repair for infrarenal abdominal aortic aneurysm between 2005 and 2017. Iliac limb migration was measured using initial and follow-up computed tomography angiography scans conducted at least three years post-procedure, with significant migration defined as a change of ≥ 5 mm. The iliac limbs were classified into Group 1 (G1; n  = 34 limbs, 26 patients) with significant migration and Group 2 (G2; n  = 107 limbs, 65 patients) without significant migration. The median follow-up periods were 70.5 months (interquartile range 49.7–91.8 months) for G1 and 57.6 months (interquartile range 44.2–73.2 months) for G2. Multivariable analysis confirmed that significant migration correlated with larger common iliac artery (CIA) diameters and lower iliac limb oversizing. Significant iliac limb migration was associated with a higher risk of type 1b endoleak development. Our findings suggest that careful iliac limb oversizing is essential for patients with a CIA diameter > 20 mm, and vigilant monitoring of the iliac landing zone is crucial during postoperative surveillance.

BACKGROUND: The internal iliac artery (IIA) originates from the common iliac artery at the level of the sacroiliac joint and bifurcates between the L5 and S1 vertebrae. The aim of the present meta-analysis was to demonstrate the most up-to-date and evidence-based data regarding the general anatomy of the IIA, including their variations, length, and diameter. MATERIALS AND METHODS: Major online medical databases such as PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to find all studies considering the anatomy of the IIA. Eligibility assessment and data extraction stages were performed. RESULTS: In the general population the pooled prevalence of Type I (The superior gluteal artery arises independently with the inferior gluteal and internal pudendal arteries arising from a common trunk which dividing inside [Type IA] or outside [Type IB] pelvic cavity) was found to be 56.57% (95% CI: 53.00–60.10%). The pooled mean length of the IIA was 39.95 mm (SE = 1.79) in the overall population. The pooled mean diameter of the IIA was found to be 6.86 mm (SE = 0.27). CONCLUSIONS: The IIA is responsible for supplying most of the structures located in the pelvis. Hence, it is crucial to be aware of the possible variants of the said vessel. The results presented in our study may be highly significant in various surgical procedures performed in that region.

PurposeMeasure out of the standard interval in the aorta diameter is a clue for aortic aneurysm or hypoplasia. Pediatric studies focusing specifically on the normal diameter of the abdominal aorta (AA) were limited in the literature. Therefore, the main goal of this work was to determine changes in the effective diameter of AA in healthy children aged 1–18 years for diagnosis of vascular diseases.MethodsThis retrospective work focused on abdominopelvic computed tomography views of 180 children (sex: 90 males / 90 females, average age: 9.50 ± 5.20 years) without any abdominopelvic disease to measure diameters of AA, common iliac artery (CIA), external iliac artery (EIA), and first lumbar vertebra (L1).ResultsVessel and vertebra diameters increased in pediatric subjects between 1 and 18 years (p < 0.001). Considering pediatric age periods, vessel diameters increased steadily, but L1 diameter showed an irregular growth pattern between age periods. All parameters were greater in males than females (p < 0.05), except from effective diameters of AA over the coeliac trunk (p = 0.084) and over the renal artery (p = 0.051). The ratios of diameters of vessels to L1 increased depending on ages between 1 and 18 years. Considering pediatric age periods, the ratios increased from infancy period to postpubescent period in irregular pattern; however, the ratios for right and left CIA, and AA over the aortic bifurcation did not alter after late childhood period. All ratios for males were similar to females (p > 0.05).ConclusionOur age-specific ratios may be beneficial for surgeons and radiologists for the diagnosis of vascular disorders such as aortic aneurysm.

PurposeCatheter angiography remains essential to detect, characterize, and treat many vascular, traumatic, and neoplastic conditions affecting the pelvis, but the angiographic literature rarely mentions the common iliac artery (CIA) and its branches. The “normal” branches of the CIA principally consist of subangiographic rami supplying neighboring structures. Larger branches participate in the vascularization of the psoas muscle and the ureter. Less often, the CIA provides anomalous branches that complement or replace critical neighboring vessels. This study investigates the prevalence, type, and clinical relevance of CIA branches detectable during pelvic angiography.MethodsThis study analyzes the prevalence of CIA branches in 100 consecutive angiograms that included bilateral CIA injections as well as selective catheterizations of the median sacral artery, both L4 ISAs, and both internal iliac arteries. CIA branches were classified as normal (i.e., neither supplementing nor replacing a normal artery), accessory (i.e., supplementing a normal artery), or aberrant (i.e., replacing a normal artery).ResultsForty-three branches arose from 38 CIAs (19% of CIAs) in 30 patients (30% of patients), including 20 normal branches (46.5%), 21 aberrant branches (48.8%), and 2 accessory branches (4.7%). Each of the 15 patients with aberrant branches had at least one anomalous vessel capable of providing a radicular or radiculomedullary artery.ConclusionsCIA branches were present in 30% of patients undergoing spinal angiography. While most normal branches were diminutive and clinically irrelevant, CIAs also provided vessels able to vascularize pelvic and vertebral structures, including the spinal cord or a spinal vascular malformation in 16% of cases. Our study therefore confirms that CIA injections represent an essential component of pelvic and spinal angiography.

PurposeTo describe a case of an anomalous common iliac artery (CIA) arising from the aorta as the fourth lumbar artery (4th LA) and following a retro-psoas course as the continuation of the 4th LA.MethodsContrast-enhanced abdominopelvic computed tomography (CT) findings of an incidentally detected anomalous CIA are described in an 8-year-old girl.Case reportCT showed that the right CIA originated from the distal aorta at the L3–L4 level with an acute angle and continued posteriorly in the course of the 4th LA. The right CIA descended into the iliac fossa as a single artery, lying posterior to the psoas muscle. It gave off the internal iliac artery (IIA) low in the iliac fossa and continued as the external iliac artery (EIA). The median sacral artery (MSA) originated from the left proximal CIA and joined the posterior division of the right IIA.DiscussionFourth LA continuation of the CIA is a rare vascular anomaly with a few published reports to date. The anomaly occurs far more on the right side than the left and is mostly asymptomatic. An abnormal connection between the umbilical artery and the distal aorta probably results in this anomaly, as well as in another group of CIA anomalies that are characterized by the absence of one or two CIAs with trifurcation or quadrifurcation of the distal aorta.ConclusionAlthough the vascular anomaly is mostly asymptomatic, knowledge of it is important in the interventions of the area to prevent complications.

Bilateral isolated common iliac artery aneurysms (CIAAs) are rare, and endovascular repair of CIAAs has emerged as an alternative to traditional open surgical repair. The primary goal of therapy is to exclude the aneurysm sac while maintaining perfusion of at least one internal iliac artery (IIA) to prevent pelvic ischemia. Although the iliac branch device (IBD) has improved the feasibility of preserving the IIA, its applicability is limited to a specific subset of aneurysm anatomy. We present a case series of three patients with bilateral isolated CIAAs in whom preoperative CT scans revealed an absence of a landing zone, the diameter of proximal CIA diameter was less than 13.0 mm, and normal diameter of the nonaneurysmal infrarenal aorta, making it challenging to use an IBD alone or a standard bifurcated aortic endograft to provide a proximal landing zone for iliac artery stenting. To overcome the small diameter of the infrarenal aorta, we implanted an aortic bifurcated unibody endograft. Then, we utilized a balloon-expandable covered stent-graft with overdilation as a modified sandwich technique to create an “eye of the tiger” configuration to prevent gutter leakage. The final angiography performed during the procedure revealed successful exclusion of the aneurysms, with blood flow to the right IIA and no type III endoleak. During the postoperative follow-up period, no patients exhibited symptoms associated with pelvic ischemia. There were no endoleaks or sac expansions on the two-year follow-up CT scans, and all external and internal iliac graft limbs were patent. This study demonstrated that a combination of an aortic bifurcated unibody endograft and a modified sandwich technique can effectively treat bilateral isolated CIAAs with certain anatomical constraints.

Among Kawasaki disease patients with systemic artery aneurysms, the brachial and internal iliac arteries are the most commonly affected, and occlusions of both arteries are often found. However, the long-term fate of large common iliac artery aneurysms remains unknown, because their prevalence is very low. The long-term outcomes of common iliac artery aneurysms caused by Kawasaki disease in four patients (three females, one male) were investigated retrospectively based on their medical records and angiograms. Their ages ranged from 30 to 36 years-old. The onset age of Kawasaki disease ranged from 4 to 8 months, and the interval from the onset of Kawasaki disease to the latest angiogram ranged from 17 to 21 years. All patients had bilateral large coronary aneurysms and common iliac artery aneurysms with maximal diameters greater than 10 mm. Although all patients had multi-vessel coronary artery stenotic lesions and systemic artery aneurysms, they were asymptomatic. The three female patients underwent coronary artery bypass grafting, and the male patient underwent replacement of artificial vessels for large bilateral common iliac artery aneurysms at 3 years old of age. Over the long-term, common iliac artery aneurysms greater than 10 mm persisted as calcified aneurysms. However, they had no symptoms due to their common iliac artery aneurysms, and their ankle brachial pressure index was preserved, even if the stenosis of the common iliac artery developed as a late outcome, because the collateral arteries were well developed. The progression of stenosis of the common iliac artery after Kawasaki disease was slower.

Purpose: To assess the feasibility and midterm outcomes of iliac branch devices (IBD) for the treatment of aneurysmal distal seal zones after endovascular aneurysm repair (EVAR). Methods: Between January 2005 and January 2014, 188 patients with aortic aneurysms involving the iliac bifurcation underwent IBD implantation; of these, 18 consecutive patients (17 men; mean age 70±10 years) were treated for aneurysmal degeneration of 22 distal seal zones (mean 36±6-mm diameter) after EVAR. The main outcome measure was technical success. Further outcomes were primary and assisted primary patency of the internal iliac branch, types Ib/III endoleaks, reintervention, and all-cause mortality. Results: The technical success rate was 100%. The primary patency rate was 100% over a median follow-up of 15 months (interquartile range 4-25). None of the patients developed type Ib or III endoleak. During surveillance, two device-related reinterventions were performed (thrombectomy of an occluded external iliac artery and angioplasty with stenting of a stenotic common iliac artery). One patient died due to metastatic prostate cancer. Conclusion: Iliac side branch endografting showed excellent feasibility and encouraging midterm outcomes for the challenging endovascular repair of aneurysmal distal seal zones post EVAR.

Anatomical localization of the ureter comes along psoas major muscle and crosses over common iliac artery bifurcation. Common iliac artery aneurysm and impacted atherosclerosis are a rare condition that should be differed from the impacted ureter stone to avoid from undesirable complication. In this case, we present a very unusual anatomical variation and complication of common iliac artery and ureter in retroperitonoscopic ureterolithotomy.