scholarly journals Anterior Rectal Resection in a Patient with Aortoiliac Occlusive Disease and Coexisting Collateral Pathways: Management and Pitfalls

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Floryn Cherbanyk ◽  
Jean-Loup Gassend ◽  
Olivier Martinet ◽  
Snezana Andrejevic-Blant ◽  
Henri-Marcel Hoogewoud
Keyword(s):  
Multidisciplinary Approach ◽  
Occlusive Disease ◽  
Uneventful Recovery ◽  
Aortoiliac Occlusive Disease ◽  
Rectosigmoid Junction ◽  
Iliac Arteries ◽  
Anterior Rectal Resection ◽  
Collateral Network ◽  
Collateral Pathways ◽  
The Common

Chronic aortoiliac occlusive disease most often affects the common iliac arteries and distal aorta but can progress all the way to the renal arteries, occluding the inferior mesenteric artery. A compensatory collateral network typically develops to preserve lower body perfusion. Inadvertent compression or ligation of such collaterals during surgery can have catastrophic consequences. In this article, we present the case of a 63-year-old patient with aortoiliac occlusive disease, requiring surgery for an adenocarcinoma of the rectosigmoid junction. A CT angiography was performed in order to map out the collateral pathways that had developed and Doppler ultrasound was used to mark their positions. The surgical procedure was adapted to his specific anatomy. A successful anterior resection was performed, and the patient made an uneventful recovery. In cases of aortoiliac obliteration, the existence of collaterals must be kept in mind and investigated with a multidisciplinary approach before any surgery is considered.

scholarly journals Aortoiliac Occlusive Disease: When the Development of Arterial Collateral Network Takes Over

Aorta ◽  
2020 ◽  
Vol 08 (04) ◽  
pp. 116-117
Author(s):  
Efstratios Georgakarakos ◽  
Ioannis Katsaros ◽  
Aliki Fiska
Keyword(s):  
Occlusive Disease ◽  
Aortoiliac Occlusive Disease ◽  
Arterial Circulation ◽  
Collateral Network ◽  
Collateral Pathways

AbstractThis report describes the collateral pathways that restore arterial circulation in cases of aortoiliac occlusive disease and discusses the clinical and surgical importance of these systemic-systemic, visceral-systemic, and visceral-visceral anastomoses.

Arterial collateral circulation pathways in patients with aortoiliac occlusive disease

Vascular ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 677-683
Author(s):  
Ioannis Katsaros ◽  
Efstratios Georgakarakos ◽  
Konstantinos Frigkas ◽  
Kalliopi-Maria Tasopoulou ◽  
Vasileios Souftas ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Blood Supply ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Occlusive Disease ◽  
Arterial Blood Supply ◽  
Aortoiliac Occlusive Disease ◽  
Iliac Arteries ◽  
Arterial Blood ◽  
Collateral Pathways

Objectives Aortoiliac occlusive disease is a leading cause of morbidity and mortality worldwide. Patients typically present with intermittent claudication or critical limb ischemia but the majority of them remain asymptomatic. Collateral arterial pathways restore the arterial blood supply distal to the lesions. The objective of this study is the description of collateral pathways’ patterns of aortoiliac occlusive disease. Methods Records from the Department of Vascular Surgery of University General Hospital of Alexandroupolis were retrospectively searched from March 2016 to August 2018 for patients suffering from aortoiliac occlusive disease. Results Thirty-three patients (24 males, 9 females) with a mean age of 64.2 ± 11.8 years were included in this study. Twenty-two patients had diabetes mellitus, 25 hypertension, and 16 dyslipidemia. Twenty-two were active smokers. Seventeen patients suffered from intermittent claudication and 16 patients presented with critical limb ischemia. Seven patients had TASC-II B lesions, 10 TASC-II C lesions, and 16 patients had TASC-II D lesions. Systemic collateral pathways were dominant in 17 patients, whereas visceral pathways were prominent in 16 patients. While 62.5% of patients having lesions in the abdominal aorta presented systemic pathways, the lesions located only in the iliac arteries followed visceral patterns or systematic patterns equally. Conclusions Collateral anastomotic networks provide blood supply to regions distal to aortoiliac occlusive lesions. Their pattern is defined mainly by the location of the lesion and does not seem to associate with comorbid factors or the extent of the lesion. Failure to recognize these networks during surgery could lead to limb threatening situations.

scholarly journals Mathematical modeling of an optimal mini-access for reconstruction of arteries of the aortofemoral segment

2012 ◽  
Vol 93 (4) ◽  
pp. 611-616
Author(s):  
A V Maksimov ◽  
S D Mayanskaya ◽  
M V Plotnikov ◽  
E A Gaysina
Keyword(s):  
Mathematical Modeling ◽  
Aortic Aneurysm ◽  
Occlusive Disease ◽  
Optimal Size ◽  
Infrarenal Aorta ◽  
Aneurysmal Dilatation ◽  
Iliac Arteries ◽  
Abdominal Aortic ◽  
The Common ◽  
Mini Laparotomy

Aim. To determine the optimal size and location of the mini-laparotomic access for the reconstruction of arteries of the aortofemoral segment. Methods. The method of mathematical modeling was used. The parameters of the mini-access were calculated depending on the sex of the patient, as well as for a variety of clinical situations (operations for occlusive disease, for abdominal aortic aneurysm, including the propagation of the aneurysmal dilatation to the iliac arteries). Topography of the aorta and iliac arteries was determined on the basis of computer tomograms of 155 patients (61 of them with an aneurysm of the infrarenal aorta). Results. It was established that for the purpose of creation of an adequate access an incision of 6.8-7.0 cm in length at the level of the umbilicus and above is sufficient during surgery for occlusive disease. No significant gender differences were found. During aortic aneurysm the required length of the mini-laparotomic access is significantly increased up to 7.6 cm (p=0.003), and in cases of propagation of the aneurysmal dilatation on to the common iliac arteries - up to 8.5 cm (p=0.001). In the latter case its location also changes: approximately half of the length of the access incision is located below the umbilicus. Conclusion. Mathematical modeling of the optimal mini-access makes it possible to optimize the use of mini-laparotomy in various clinical situations.

Common and Rare Collateral Pathways in Aortoiliac Occlusive Disease: A Pictorial Essay

2011 ◽  
Vol 197 (3) ◽  
pp. W519-W524 ◽  
Author(s):  
Rulon L. Hardman ◽  
Jorge E. Lopera ◽  
Rex A. Cardan ◽  
Clayton K. Trimmer ◽  
Shellie C. Josephs
Keyword(s):  
Occlusive Disease ◽  
Aortoiliac Occlusive Disease ◽  
Pictorial Essay ◽  
Collateral Pathways

Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes

Vascular ◽  
2021 ◽  
pp. 170853812110232
Author(s):  
Peixian Gao ◽  
Changliang Li ◽  
Xuejun Wu ◽  
Gang Li ◽  
Dianning Dong ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Bare Metal Stents ◽  
Covered Stent ◽  
Occlusive Disease ◽  
Metal Stents ◽  
Infrarenal Aorta ◽  
Bare Metal ◽  
Stent Grafts ◽  
Aortoiliac Occlusive Disease

Purpose To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. Methods In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. Results A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( n = 7), kissing bare-metal stents ( n = 2), covered stent grafts ( n = 2), bare-metal stents ( n = 1), or the off-label use of iliac limb stent grafts ( n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1–54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan–Meier method. Conclusions Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.

Effect of conservative treatment in aortoiliac occlusive disease

2019 ◽  
Vol 120 (4) ◽  
pp. 231-237
Author(s):  
W. Wen ◽  
G. H. Ho ◽  
E. J. Veen ◽  
H. G. W. de Groot ◽  
M. G. Buimer ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Occlusive Disease ◽  
Aortoiliac Occlusive Disease
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