External iliac

There are many different procedures used for pancreas transplantation, and there is no one standard protocol used in all transplant centers. The important considerations, however, are that the arterial blood flow supply to the pancreas and duodenal segment, and venous outflow from the pancreas via the portal vein should be adequate. The recipient s right common or external iliac artery is used to restore vascularization of the artery in the pancreas. The Y graft of the tissue is anastomosed end-to-side and the venous vascularization is performed either systemically or portally, but mostly it is done with systemic venous drainage. 

Eleven patients referred for neurological evaluation after cisplatin infusion into the internal or external iliac arteries for pelvic or lower limb tumors aU developed symptoms within 48 hours of nerve or plexus dysfunction within the territory supplied by the cannulated artery (108). The lumbosacral plexus was affected in nine patients, the femoral nerve in one, and the peroneal nerve in one. The doses of cisplatin ranged from 50 to 160 mg/m and they did not correlate with the severity or course of the neuropathy. Small-vessel injury and infarction or a direct toxic effect are likely explanations. 

The middle uterine, utero-ovarian or external iliac arteries may rupture during pregnancy or parturition, leading to signs of shock and colic or to the death of the mare. The therapy of rupture of these major blood vessels is somewhat controversial and may range from drugs that reduce blood pressure to those that increase circulating blood volume and pressure (Vivrette 1997). 

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... 

Subfascial veins connect external iliac vein and subclavian vein via internal thoracic and inferior epigastric veins. Internal thoracic veins (TTV) are tributaries of brachiocephalic veins. They are formed by junction of musculophrenic veins and superior epigastric veins. Internal thoracic veins anastomose at the posterior surface of sternum. Parietal tributaries of ITV are anterior intercostal veins, which provide anastomosis with the azygos sysem, by means of posterior intercostals. Additional tributaries of brachiocephalic veins, frequently widened in patients with SVC syndrome, are pericardiophrenic veins. 

Fig. 15.2. Retroperitoneal lymph nodes. 1, coelical lymph nodes 2 and 3, mesenterial lymph nodes 4, paracaval lymph nodes 5, precaval lymph nodes 6, interaortocaval lymph nodes 7, preaortic lymph nodes 8, paraaortic lymph nodes 9, external iliac lymph nodes 10, internal iliac lymph nodes...

Fig. 15.4a,b. Abnormally enlarged metastatic lymph node on the left immediately posterior to the external iliac vein (arrow). Axial images obtained with (a) T2w TSE sequence and (b) Tlw TSE sequence in a patient with advanced cervical cancer. The T2w image depicts the central necrosis with fluid signal intensity... 

Fig. 15.5a,b. Large lymph node metastasis at the left pelvic wall with encasement of the external iliac vessels, (a) Coronal T2w TSE image and (b) axial Tlw TSE image in a patient with advanced cervical cancer... 

Fig. 17.5a,b. Peritonitis in tuboovarian abscess. Transaxial CT sans in the mid pelvis (a, b). A left-sided tuboovarian abscess is located adjacent to the pelvic sidewall (arrow) between internal and external iliac vessels (a). It presents as a cystic peripherally enhancing lesion with a fluid-fluid level (arrowhead) presenting debris (a). Associated flndings include ascites, linear peritoneal enhancement (small arrows), and a netlike involvement of the pelvic fat and the omentum (arrow) (b)... 

For the external (iliac) oblique view, the pelvis is rotated in the opposite direction, allowing visualisation of the ilio-ischial line and anterior wall of the acetabulum. 

Anatomic Considerations The internal pudendal artery, a terminal branch of the anterior division of the internal iliac artery supplies the external genitalia. With extension to inguinal and iliac lymph nodes, additional supply originates from the obturator branch of the internal iliac artery, the inferior epigastric artery from the external iliac artery and the superficial epigastric artery and the superficial and deep external pudendal branches of the common femoral arteries. 

LA. Infusion Our experience with percutaneous intraarterial transcatheter chemotherapy in patients with recurrent carcinoma of the vulva and penis is limited. Therapy is usually delivered through the internal pudendal branch of the internal iliac artery, the external pudendal branch of the external iliac artery, and the external pudendal branch of the deep femoral artery. The chemotherapy regimen consisted of mitomycin C (10 mg/m over 24 h), bleomycin (20-40 mg/m over 24 h), and dsplatin (100 mg/m over 2 h). Although the number of patients treated under this regimen is too small for analysis, dramatic responses have been observed in several patients. 

The main blood supply to osteosarcomas in the proximal femur arises from the femoral circumflex and branches of the deep femoral arteries. Frequently, the segment of the deep femoral artery proximal to the origin of the circumflex arteries is so short that a catheter in this position is unstable and may dislodge into the superficial femoral artery resulting in inadequate infusion. This is best avoided by placing the catheter tip in the external iliac segment (Fig. 9.16). 

The main source of blood supply to the penis (Fig. 2.2a) is usually through the internal pudendal artery, a branch of the internal iliac artery. In many instances, however, accessory arteries arise from the external iliac, obturator, vesical, and/or femoral arteries, and may occasionally become the dominant or only arterial supply to the corpus cavernosum (Breza et al. 1989). Damage to these accessory arteries during radical prostatectomy or cystectomy may result in vasculogenic erectile dysfunction (ED) after surgery (Aboseif et al. 1994 Kim et al. 1994). 

Retrograde lymphatic spread occurs in a similar way. The posterior portion of the prostate, the bladder base and the penis have the same lymphatic drainage into the external iliac nodes. This route of spread primarily brings metastases to the penile skin, rather than to the corpora or the glans. Arterial dissemination is uncommon. It can occur by direct tumor infiltration of arterial vessels, or by secondary tumor emboli originating from lung metastases. 

Fig. 25.4. Standard set of postprocessed images of a lower-extremity CT angiogram obtained in patient with bilateral iliac artery stents, as displayed on a standard PACS viewing station with side-by-side display of MIP, mpCPR, and single-path CPR. fma e on the left Ml (anteroposterior view) shows bilateral stents in the common and external iliac arteries. Note, that the patency of the stents cannot be assessed on the MIP images. Middle image mpCPR allows simultaneous display of longitu-...

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-... 

Balogh Z, Voros E et al. (2003) Stent graft treatment of an external iliac artery injury associated with pelvic fracture. A case report. J Bone Joint Surg Am 85-A(5) 919-22... 

The arterial axis is first palpated to evaluate the quality of its wall. Arterial and venous dissection is limited to segments to be used for anastomoses. In most cases, the renal vein is attached to the external iliac vein. The arterial anastomosis is more variable end-to-side to the external iliac, most often above the venous implantation, or to the primary iliac artery sometimes end-to-end to the hypogastric artery, when taken from a living donor, because the graft s artery does not have an aortic patch. All these sites can be used in combination when multiple arteries are reimplanted, even the epigastric artery for the small isolated polar branches. 

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