Common iliac

Find and hold common iliac artery as recognized as downwards Y shape, down the kidney and trim adhered tissue around the aorta and go up by cutting off artery branches. 

The advance of endovascular therapy for aorto-iliac aneurysmal disease has also brought about yet another flourishing application of embolotherapy. Embolization of the internal iliac artery plays an important adjunct initial modality to allow endovascular treatment of aortic aneurysms with extension into the common iliac arteries [78-80], It also plays an crucial role in the secondary management of complications related to endoleaks [81-84],... 

An alternative way of catheterizing the uterine artery using selective catheters is described by Andrews [30]. Following an aortogram, the flush catheter is used to direct a wire over the iliac bifurcation. A 4-F Berenstein catheter (or another selective catheter such as a C2) is then placed into the contralateral common iliac artery. Repeat imaging... 

Type IC leaks occur in cases where an aorto-uni-iliac stentgraft has been deployed, in conjunction with a femoral-femoral bypass graft. An occluder device is then placed in the contra-lateral common iliac artery. Its function is to prevent back filling of the aneurysm from the excluded common iliac artery. The treatment of these leaks requires completion of the intended thrombosis of the common iliac artery. Embolization is the simplest way to complete this, either by passing the occluder and embolizing cranial to it, or, by placing a second occluder device caudal to the original device. 

The occlusion of the iliac artery is usually sufficient to treat the leak. However, in cases of long-term type IC endoleak, many outflow vessels may have developed and the leak may communicate with multiple lumbar arteries and the IMA. These enlarged vessels might be source of late type II endoleak. Thus, we usually embolize both the outflow vessels and the sac before occluding the iliac artery. Another attractive technique to achieve the occlusion of the common iliac artery is to perform an endovascular internal to external iliac artery bypass using stentgraft. This technique can allow the exclusion of the common iliac preserving the internal iliac artery. 

As mentioned above, status of the internal iliac arteries is an important anatomic consideration in the treatment of aortoiliac aneurysms. Indications for embolization of IIA in association with EVAR include aneurysm of the IIA or ectatic or aneurysmal common iliac artery (CIA) involving the origin of IIA. Additionally, extension of stent-graft into the external iliac artery (El A) may become necessary if the CIA is judged to be too short for adequate or safe anchoring of the device or if there is a distal type-I endoleak. This will lead to loss of antegrade flow in the IIA. 

Fig. 15.2a-c. Embolization of IIA before aortic stent graft implantation (courtesy of Dr Luc Stockx). a Right common iliac angiogram demonstrating the internal and external iliac arteries. b,c Coil embolization of the proximal llA. Note the extension of the aneurysm to the level of iliac bifurcation... 

Fig. 7.34a-d. Lymph node staging. Stages of metastatic spread to the lymph nodes in cervical cancer, a Parametrial nodes, b Nodes along the external and common iliac arteries, c Presacral nodes, d Para-aortic nodes (regarded as distant metastases) (from [134])... 

The suspensory ligament of the ovary is located at the superior lateral aspect of the broad ligament [6]. It extends from the ovary anterolaterally over the external and common iliac vessels and blends with coimective tissue over the psoas muscle [15]. Ovarian blood vessels and lymphatics traverse the suspensory ligament to reach the ovarian hilum along the mesovarium. 

The ovarian artery originates from the lumbar aorta near the renal hilum. It is accompanied along its retroperitoneal course by the ovarian vein and the ureter on the anterior surface of the psoas muscle. It then crosses the ureter and common iliac vessels near the pelvic brim to enter the suspensory ligament of the ovary. The ovarian artery courses inferiorly and medially between the two layers of the broad ligament near the mesovarian border [4]. It forms multiple branches that reach the ovarian hilum via the mesovarium. It has a tortuous course that is most pronounced near the ovary. 

The ovarian lymphatics ascend with the ovarian vessels along the psoas muscle and drain almost exclusively into the para-aortal lymph nodes at the level of the lower pole of the kidneys. In some patients, accessory channels pass the broad ligament and drain into the internal and common iliac and interaortic... 

Fig. 7. Anterior exposure of L4/L5 and mobilization of the right and left common iliac artery and vein...

Lymphatic tumor spread. The main location of tumor spread in ovarian cancer is the ovarian vessels, the common iliac vessels, and the para-aortic lymph nodes. The threshold for diagnosing a metastatic lymph node is about 1 cm, with a sensitivity of about 40% and a specificity of about 90% (Tempany et al. 2000). 

Fig. 2. Significant stenosis in peripheral arteries. (A) Stenosis in the common iliac artery. Both the peak systolic and end diastolic velocities are significantly increased. The V2I 1 was 3.9 (456/117) indicating a >50% diameter stenosis. (B) Stenosis in the anterior tibial artery. The prestenotic (36 cm/s) and the poststenotic (145 cm/s) velocities are obtained to estimate the V2/V1 ratio (4.0).

Fig. 4. Low amplitude waveform with absence of end diastolic velocity is common in patients with oecluded arterial segments above and below the segment under investigation. (A) Low amplitude and absence of end diastolic velocity in the superficial femoral artery in the mid-thigh in a patient with common iliac significant stenosis and distal superficial femoral artery occlusion. (B) Very low velocities and a monophasic waveform in the posterior tibial artery of a patient with multiple stenoses and occlusions proximal and distal to the site of measurement.

Fig. 5. Acute thrombosis of the right external iliac artery (solid arrow) in a patient with atrial fibrillation. The common iliac and internal iliac arteries are patent. The patient presented with aeute lower ischemia. A thrombectomy was performed and the symptoms were resolved.

Angiography may reveal injuries to larger more proximal vessels, such as the common iliac or external iliac arteries, traditionally treated surgically. However, with the advent of covered stents, inter-... 

They reported the successful direct needle-injection of thrombin to thrombose peripheral pseudoaneurysms such as common iliac, peroneal, and hepatic pseudoaneurysms. Despite this interesting report, it was not until a decade later that the first report of ultrasound-guided direct thrombin-injection to close iatrogenic groin pseudoaneurysms was published, by Liau et al. [16]. 

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