Iliac vessels

Greater than 120° angulation of the proximal neck Critical inferior mesenteric artery Significant iliac occlusive disease Tortuosity of iliac vessels... 

The donor kidney is usually placed extraperitoneaUy in the right or left iliac fossa. Anastomoses are constructed joining the transplant renal artery and vein to the recipient s respective iliac vessels. The ureter is joined to the bladder. The recipient native kidneys are left in situ in the majority of cases. 

What is situated outside the rectal fascia and therefore outside the perirectal subcompartment Dorsally, the presacral subcompartment is loosely attached to the perirectal compartment (see above). Laterally the supplying structures (autonomic nerves and branches of the iliac vessels) of the urogenital organs constitute a nerve-vessel plate (Fig. 1.3c). The latter is accompanied by connective tissue and fills the remaining space between the perirectal compartment... 

The uterine tubes lie on each side of the uterus in the upper margin of the broad Ugament (see Table 1.1 broad ligament). Each tube is attached on its inferior surface to a double fold of peritoneum called mesosalpinx (see Table 1.1). The lateral and superior part of the tube is the ampulla that opens into the funnel-shaped infimdibulum with its fimbria at the abdominal orifice. The ovaries lie in the ovarian fossa, i.e. close to the lateral pelvic wall and are suspended by a double fold of peritoneum, the mesovarium (see Table 1.1). The latter is attached to the broad ligament posteriorly. Behind the ovarian fossa are extraperitoneal structures, especially the ureter and the internal iliac vessels as well as the origin of the uterine artery (Fig. 1.14). 

Fig.8.1a,b. Ovarian fossa. Transaxial (a) and coronal T2-weighted (b) images in a 28-year-old female. Normal ovaries (arrows) are demonstrated in the ovarian fossa, which is a shallow peritoneal groove between external and internal iliac vessels. The ovaries are of ovoid shape and can be well identified due to follicles which display very high signal on the T2-weighting... 

Fig. 8.8. Postmenopausal ovaries on CT. The ovaries (arrows) appear as bandlike soft tissue structures and are located between the iliac vessels and bowel loops. Without bowel opacification identification of normal postmenopausal ovaries is usually not possible. Uterus (U) with a calcified fibroid of the fundus...

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. 

Fig. 9.4. Medial displacement of the iliac vessels. Transaxial CT in a patient with sonographically suspected bilateral ovarian cancer. Bilateral cystic lesions (asterisks) with mural thickening are simulating ovarian lesions. The displacement pattern of the iliac vessels, however, is typical for an origin from the pelvic sidewalls. The lesions present bilateral bursitis iliopectinea in a patient with rheumatoid arthritis...

Fig. 10.12. Pelvic sidewall invasion. Transaxial CT at the level of the iliac bifurcation. A mixed solid and cystic adnexal tumor, which was nondifferen-tiated ovarian cancer at histopathology, is located in the pelvis. The left pelvic sidewall, including iliac vessels and psoas muscle, are clearly separated by fat. The right pelvic sidewall (arrow) is in direct contact with the solid tumor component. Furthermore, external and internal iliac arteries are displaced, the latter is encased by tumor (arrowhead)...

Secondary cytoreduction, which is usually performed in pelvic recurrence, is only considered successful when complete resection without a residual tiunor is possible. Preoperatively, it is crucial to assess pelvic side wall invasion rather than tmnor size [44]. Pelvic side-wall invasion can be excluded when the tumor shows a distance of 3 mm or more to the pelvic sidewall and no involvement of the iliac vessels is found [24]. 

In the pelvic region,lymph nodes maybe difficult to distinguish from elongated iliac vessels on nonan-... 

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)... 

Extrinsic compression on the colon can result from multiple structures such as the iliac vessels, liver, renal masses, and stomach (Macari and Megibow 2001). Compression by one of the iliac arteries is a relatively common finding, and results in a linear extrinsic compression on the sigmoid colon (Fig. 14.21). 

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. 37.7a,b. Patient (supine position) with a history of diffuse large B-cell lymphoma (DLCL). Preinterventional CT showed a moderately enhancing nodule (large arrow) next to the iliac vessels (small arrows) (a). The 18-G (13 cm) Tru-Cut biopsy needle was introduced under CTF guidance next to the left iliac crest through the peritoneal fat (b). Histopathology revealed recurrence of DLCL... 

Some teams systematically implant the first graft on the right because of the more superficial iliac vessels others prefer implanting a right kidney on the left and left kidney on the right so that the renal pelvis and ureter are placed anteriorly, thereby facilitating subsequent nephrostomy should it be necessary. Epigastric vessels are dissected and conserved should reimplantation of a polar artery be required. 

Pseudothrombosis of the iliac vein (Fig. 7.28) has been described following simultaneous pancreas-kidney transplantation with bilateral revascularization to the respective iliac vessels (Gupta et al. 2002). Pseudothrombosis results from delayed venous opacification of the iliac vein ipsilateral to the pancreatic graft as compared to the contralateral side of the renal graft. This phenomenon results from longer transit time and reduced blood flow to the pancreas as compared to the kidney. Pseudothrombosis can also involve the ipsilateral iliac vein below the vascular anastomoses of the pancre-... 

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