There have been a few reports on deep vein thrombosis (DVT) associated with compression of the left common iliac vein by the right common iliac artery, referred to as May-Thurner syndrome (MTS). However, there have been no reports on DVT associated with MTS in amyotrophic lateral sclerosis (ALS) patients exhibiting similar clinical features to paraplegic spinal cord injury patients. We hereby report a case of DVT associated with MTS in an ALS patient, who was treated successfully.
Amyotrophic Lateral Sclerosis ; Humans ; Iliac Artery ; Iliac Vein ; May-Thurner Syndrome ; Spinal Cord Injuries ; Venous Thrombosis

Vascular injury during lumbar disc surgery is a rare but potentially life-threatening complication. It has been managed by open vascular surgical repair. With recent technologic advance, endovascular treatment became one of effective treatment modalities. We present a case of a 32-year-old woman who suffered with common iliac artery injury during lumbar disc surgery that was treated successfully by endovascular repair with temporary balloon occlusion and subsequent insertion of a covered stent. Temporary balloon occlusion for 1.5 hours could stop bleeding, but growing pseudoaneurysm was identified at the injury site during the following 13 days. It seems that the temporary balloon occlusion can stall bleeding from arterial injury for considerable time duration, but cannot be a single treatment modality and requires subsequent insertion of a covered stent.
Adult ; Aneurysm, False ; Balloon Occlusion ; Female ; Hemorrhage ; Humans ; Iliac Artery ; Stents ; Vascular System Injuries

PURPOSE: The role of vascular and interventional radiology in trauma patients is evolving. Endovascular treatments are helpful in treating vascular injuries in trauma patients. In some situations, endovascular treatments are as effective or more effective than surgery, but less invasive. We performed this study to evaluate the efficacy of endovascular treatments in the trauma patients with vascular injury. METHOD: Between September 2000 and September 2003, a total of 10 consecutive trauma patients with vascular injury who received endovascular treatments were included in this study. RESULT: Of the 10 patients, the most common injured arteries were the iliac arteries (5 patients), and the most common associated injuries were pelvic (8 patients) and long bone (6 patients) fractures. Transarterial embolization was performed in 9 patients, and stent-graft placement in 1. Clinical success was achieved in all 10 patients. After endovascular treatments, 3 patients with fluid collections were treated with ultrasound-guided, percutaneous drainage. Two of 10 patients died of complications other than hemorrhage. CONCLUSION: This initial experience suggests that endovascular treatment for trauma patients with vascular injury is safe and effective, and that it can also reduce the unnecessary laparotomies in these difficult cases.
Arteries ; Drainage ; Hemorrhage ; Humans ; Iliac Artery ; Laparotomy ; Radiology, Interventional ; Stents ; Vascular System Injuries*

OBJECTIVE AND METHODS: To evaluate the effect of hypercholesterolemia on apoptosis (APOP) & proliferation (PROL) after vascular injury, we examined iliac arteries on 1, 3, 7 & 14 days after balloon injury (N=5 at each time) in rabbits with hypercholesterolemia (HC) and normocholesterolemia (NC). RESULTS: In media im-mediately after injury, APOP occurred massively & then decreased (TUNEL index=6.3+/-1.3 at D1, 0.9+/-0.7% at D14). HC did not affect early massive APOP but significantly (p<0.01) increased APOP, 3.3+/-1.5% at D14. Massive early APOP in media was followed by active PROL (PCNA index=6.0+/-3.3 at D7, 3.9+/-2.8% at D14). HC sustained the high activity of PROL upto D14 (8.9+/-2.7% at D14) (p<0.01). In intima where cells were scanty initially, PROL activity reached peak at D7 and then decreased (6.4+/-1.8% at D7, 2.5+/-1.8% at D14). HC significantly (p<0.05) enhanced PROL at D14 (5.8+/-2.2% at D14). In intima PROL was accompanied by low-grade APOP (1.3+/-1.1% at D7, 0.3+/-0.2% at D14). HC significantly (p<0.05) enhanced this low-grade APOP at D14 (0.9+/-0.4%). These effects of HC on APOP & PROL result in a significantly increased area of intima (0.4+/-0.2 in HC, 0.2+/-0.1 in NC) & media (0.5+/-0.1 in HC, 0.4+/-0.1 in NC) (p<0.01). Fundamental difference between HC & NC was infiltration of macrophage in HC, which was colocalized with APOP & PROL activities. CONCLUSIONS: Balloon injury induces early massive APOP followed by PROL in media, whereas in intima, it induces active PROL followed by low-grade APOP. Hypercholesterolemia does not affect early massive APOP, but enhances PROL & low-grade APOP at late phase, which results in intimal & medial hyperplasia.
Apoptosis* ; Cell Proliferation* ; Hypercholesterolemia* ; Hyperplasia ; Iliac Artery* ; Macrophages ; Rabbits ; Vascular System Injuries

OBJECTIVE AND METHODS: To evaluate the effect of hypercholesterolemia on apoptosis (APOP) & proliferation (PROL) after vascular injury, we examined iliac arteries on 1, 3, 7 & 14 days after balloon injury (N=5 at each time) in rabbits with hypercholesterolemia (HC) and normocholesterolemia (NC). RESULTS: In media im-mediately after injury, APOP occurred massively & then decreased (TUNEL index=6.3+/-1.3 at D1, 0.9+/-0.7% at D14). HC did not affect early massive APOP but significantly (p<0.01) increased APOP, 3.3+/-1.5% at D14. Massive early APOP in media was followed by active PROL (PCNA index=6.0+/-3.3 at D7, 3.9+/-2.8% at D14). HC sustained the high activity of PROL upto D14 (8.9+/-2.7% at D14) (p<0.01). In intima where cells were scanty initially, PROL activity reached peak at D7 and then decreased (6.4+/-1.8% at D7, 2.5+/-1.8% at D14). HC significantly (p<0.05) enhanced PROL at D14 (5.8+/-2.2% at D14). In intima PROL was accompanied by low-grade APOP (1.3+/-1.1% at D7, 0.3+/-0.2% at D14). HC significantly (p<0.05) enhanced this low-grade APOP at D14 (0.9+/-0.4%). These effects of HC on APOP & PROL result in a significantly increased area of intima (0.4+/-0.2 in HC, 0.2+/-0.1 in NC) & media (0.5+/-0.1 in HC, 0.4+/-0.1 in NC) (p<0.01). Fundamental difference between HC & NC was infiltration of macrophage in HC, which was colocalized with APOP & PROL activities. CONCLUSIONS: Balloon injury induces early massive APOP followed by PROL in media, whereas in intima, it induces active PROL followed by low-grade APOP. Hypercholesterolemia does not affect early massive APOP, but enhances PROL & low-grade APOP at late phase, which results in intimal & medial hyperplasia.
Apoptosis* ; Cell Proliferation* ; Hypercholesterolemia* ; Hyperplasia ; Iliac Artery* ; Macrophages ; Rabbits ; Vascular System Injuries

OBJECTIVE: The purpose of this study is to evaluate the level of lumbar spine corresponding to the prevertebral major vascular structures and the distance of the prevertebral available disc space (DPADS) of L5-S1 between the common iliac arteries and veins with preoperative magnetic resonance imaging (MRI) study. METHODS: Three hundred and forty seven lumbar MRI films (200males and 147females) from spinal disorder patients were reviewed. The patients' age ranged 14 to 86 years (mean 45 years). The patients were divided into eight groups by 10-year interval from a teen to the eighties. There were evaluated age-related locational changes in the level of lumbar spine corresponding to the aortic bifurcation (AB) and the origin of inferior vena cava (OIVC). In addition, DPADS of L5-S1 between the common iliac arteries and veins were measured. RESULTS: The common sites of the AB for the entire subject group were at the upper body of L4 (from the upper body of L3 to the lower body of L5). The common sites of the OIVC for the entire subject group were at the level of the L4-L5 disc space (from the upper body of L4 to the lower body of L5). The age-related changes in the location of the AB with a downward shift were statistically significant (p< 0.05). Similarly, age-related changes were observed in the OIVC, although this was more prominent in females (p<0.05). The average DPADS of L5-S1 was 34.48+/-10.00 mm. There were 27 cases(7.8%) who had the DPADS less than 20mm, and this narrow DPADS could make it very difficult to access the anterior disc space of L5-S1 because recently the popularly used anterior lumbar fusion materials were over 10 mm in diameter. CONCLUSION: These results may be helpful to minimize potential vascular injury and morbidity in anterior lumbar spinal surgery.
Adolescent ; Female ; Humans ; Iliac Artery ; Magnetic Resonance Imaging ; Spine ; Vascular System Injuries ; Veins ; Vena Cava, Inferior

Iatrogenic vascular injury during lumbar disc surgery is a rare but serious complication. This paper reports a patient who sustained an injury to the iliac artery while undergoing intervertebral disc surgery at the lumbar region. He suffered from massive bleeding and shock. An urgent laparatomy was performed under cardiopulmonary bypass, and the vascular injuries were repaired successfully. This case shows that a rapid diagnosis and immediate intervention can result in a favorable outcome.
Cardiopulmonary Bypass ; Diskectomy ; Hemorrhage ; Humans ; Iliac Artery ; Intervertebral Disc ; Lumbosacral Region ; Rupture ; Shock ; Vascular System Injuries

Humans ; Iliac Artery/injuries* ; Hip Joint ; Arthroplasty, Replacement, Hip ; Iatrogenic Disease

In patients presenting with gunshot wounds, a high clinical suspicion of injury to vasculature and viscera remote from the projectile track is paramount. We present a case of a 17 year old male who sustained a gunshot wound to his abdomen and subsequently developed a right external iliac artery contusion requiring surgery as an indirect effect of the pressure wave from the bullet.
Adolescent ; Humans ; Iliac Artery ; injuries ; Male ; Pressure ; Wounds, Gunshot ; complications ; surgery

Vascular complications are uncommon, but it may pose a serious problem in posterior spinal surgery. Vascular injury during lumbar spinal surgery should be suspected if symptoms of circulatory instability are noted. If vascular injury is suspected, a contrast enhanced computed tomography should be checked and proper management, i.e., interventional treatment or surgery should be performed. To date, there have only been a few reports regarding vascular injuries during posterior lumbar spinal surgery. Clinicians should pay attention to signs of vascular injury during posterior spinal surgery, and accordingly, promptly perform treatment. In two patients with retroperitoneal hemorrhage, extravasation of the common iliac arteries was successfully repaired. One patient with pseudoaneurysm was treated by stent placement.
Aneurysm, False ; Diskectomy ; Hemorrhage ; Humans ; Iliac Artery ; Lumbar Vertebrae ; Stents ; Vascular System Injuries*