Standard endovascular repair of iliac/aortoiliac pathologies can lead to complications, such as buttock claudication, colon ischemia and erectile dysfunction. Branch grafts have been developed but require at least 6 weeks for customization and are not currently available in China; they are also quite expensive. To our knowledge, modified fenestrated stent grafts (MFSGs) are a safe and effective alternative for treating patients with juxtarenal aneurysms. Most MFSGs are used for the preservation of renal and left subclavian arteries. Few cases of MFSGs have been reported in the treatment of iliac pathologies. The use of an MFSG is decided on a case-by-case basis. This report presents our first clinical use of an MFSG for preservation of the internal iliac artery.
Aneurysm ; Blood Vessel Prosthesis* ; Buttocks ; China ; Colon ; Erectile Dysfunction ; Humans ; Iliac Artery* ; Ischemia ; Male ; Pathology ; Stents* ; Subclavian Artery ; Transplants

OBJECTIVE: A causal relationship between removal of circumflex iliac nodes distal to the external iliac nodes (CINDEIN) and lower leg edema has been recently suggested. The aim of this study was to elucidate the incidence of CINDEIN metastasis in cervical cancer. METHODS: A retrospective chart review was carried out for 531 patients with cervical cancer who underwent lymph node dissection between 1993 and 2014. CINDEIN metastasis was pathologically identified by microscopic investigation. After 2007, sentinel lymph node biopsy was performed selectively in patients with non-bulky cervical cancer. The sentinel node was identified using 99mTc-phytate and by scanning the pelvic cavity with a γ probe. RESULTS: Two hundred and ninety-seven patients (55.9%) underwent CINDEIN dissection and 234 (44.1%) did not. The percentage of International Federation of Gynecology and Obstetrics stage IIb to IV (42.4% vs. 23.5%, p<0.001) was significantly higher in patients who underwent CINDEIN dissection than those who did not. CINDEIN metastasis was identified in 1.9% overall and in 3.4% of patients who underwent CINDEIN dissection. For patients with stage Ia to IIa disease, CINDEIN metastasis was identified in 0.6% overall and in 1.2% of patients who underwent CINDEIN dissection. Of 115 patients with sentinel node mapping, only one (0.9%) had CINDEIN detected as a sentinel node. In this case, the other three lymph nodes were concurrently detected as sentinel lymph nodes. CONCLUSION: CINDEIN dissection can be eliminated in patients with stage Ia to IIa disease. CINDEIN might not be regional lymph nodes in cervical cancer.
Adult ; Aged ; Female ; Humans ; Iliac Artery/*pathology ; Incidence ; Lymphatic Metastasis ; Middle Aged ; Retrospective Studies ; Uterine Cervical Neoplasms/*pathology

OBJECTIVE: A causal relationship between removal of circumflex iliac nodes distal to the external iliac nodes (CINDEIN) and lower leg edema has been recently suggested. The aim of this study was to elucidate the incidence of CINDEIN metastasis in cervical cancer. METHODS: A retrospective chart review was carried out for 531 patients with cervical cancer who underwent lymph node dissection between 1993 and 2014. CINDEIN metastasis was pathologically identified by microscopic investigation. After 2007, sentinel lymph node biopsy was performed selectively in patients with non-bulky cervical cancer. The sentinel node was identified using 99mTc-phytate and by scanning the pelvic cavity with a γ probe. RESULTS: Two hundred and ninety-seven patients (55.9%) underwent CINDEIN dissection and 234 (44.1%) did not. The percentage of International Federation of Gynecology and Obstetrics stage IIb to IV (42.4% vs. 23.5%, p<0.001) was significantly higher in patients who underwent CINDEIN dissection than those who did not. CINDEIN metastasis was identified in 1.9% overall and in 3.4% of patients who underwent CINDEIN dissection. For patients with stage Ia to IIa disease, CINDEIN metastasis was identified in 0.6% overall and in 1.2% of patients who underwent CINDEIN dissection. Of 115 patients with sentinel node mapping, only one (0.9%) had CINDEIN detected as a sentinel node. In this case, the other three lymph nodes were concurrently detected as sentinel lymph nodes. CONCLUSION: CINDEIN dissection can be eliminated in patients with stage Ia to IIa disease. CINDEIN might not be regional lymph nodes in cervical cancer.
Adult ; Aged ; Female ; Humans ; Iliac Artery/*pathology ; Incidence ; Lymphatic Metastasis ; Middle Aged ; Retrospective Studies ; Uterine Cervical Neoplasms/*pathology

PURPOSE: Colposcopic response of preoperative uterine cervix carcinomas to intra-arterial cisplatin infusion chemotherapy was analyzed to evaluate the efficacy of this therapy after selective pelvic arteriography. MATERIALS AND METHODS: Nine patients of stage 1/11 cervical carcinomas were treated twice with intra-arterial cisplatin chemotherapy of a 3-week interval, with every week follow-up of colposcopy and histology until the radical hysterectomy and pelvic lymphadenectomy on the 6th week. Cisplatin of 50mg/m~ was slowly infused via autoinjector for 10 minutes with the catheter tip placed in both internal iliac arteries around uterine artery branching. RESULTS: Colposcopic regression rate of tumor size was as follows:more than 2/3 decrease of original size in 2 patients, 2/3-1/2 in 2 patients, less than 1/2 in 4 patients, but in one patient minimal increase in tumor size was recognized. Colposcopic and postoperative microscopic pathology revealed degeneration and necrosis of the tumor cells and/or adjacent lymph nodes and fibrosis of surrounding tissues. All patients have been doing well until postoperative 25 months without recurrence or significant complications. CONCLUSION: Preoperative intra-arterial cisplatin chemotherapy after selective internal iliac rteriography is helpful to decrease tumor size and improve histologic response and prognosis in stage I and II cervical carcinomas.
Angiography* ; Catheters ; Cervix Uteri* ; Cisplatin* ; Colposcopy ; Drug Therapy* ; Female ; Fibrosis ; Follow-Up Studies ; Humans ; Hysterectomy ; Iliac Artery ; Lymph Node Excision ; Lymph Nodes ; Necrosis ; Pathology ; Prognosis ; Recurrence ; Uterine Artery

BACKGROUNDThe dysfunction of vascular endothelial cells plays a key role in starting and facilitating restenosis. The acceleration of intima repair and the recovery of endothelial function would reduce the restenosis rate. This study was undertaken to assess the effect of granulocyte-macrophage colony stimulating factor (GM-CSF) on the repair of damaged iliac arteries.

METHODSTwenty-four male New Zealand white rabbits undergoing primary iliac artery deendothelization were randomly divided into two groups (GM-CSF group and control group). The GM-CSF group received a subcutaneous injection of GM-CSF [10 microg x kg(-1) x d(-1)], and the control group was given a subcutaneous injection of equivalent saline. The iliac arteries of all animals were damaged by balloon after 7 days. The levels of nitric oxide (NO) were detected before, 1 week, 2 weeks and 4 weeks after angioplasty. The repair and hyperplasia of the intima were observed microscopically and the indices of stenosis were evaluated by computerized planimetry after 4 weeks of angioplasty.

RESULTSThe NO levels of the GM-CSF group were higher than those of the control group 2 weeks and 4 weeks after angioplasty [(91.92 +/- 11.57) micromol/L vs. (81.67 +/- 12.18) micromol/L; (97.67 +/- 10.13) micromol/L vs. (83.16 +/- 12.64) micromol/L]. Four weeks after balloon damage, histological examination showed that neointima formation, vascular smooth muscle cells and fibrous tissue of the GM-CSF group were less than those of the control group. The endothelium of the GM-CSF group was more integrated, and stenosis of lumen was slighter than that of the control group. Morphometry showed the lumen area of the GM-CSF group was larger than that of the control group [(1.27 +/- 0.31) mm(2) vs. (0.92 +/- 0.24) mm(2)], the neointimal area and percent of intima hyperplasia were significantly smaller than those of the control group [(0.85 +/- 0.34) mm(2) vs. (1.18 +/- 0.38) mm(2); (40 +/- 7)% vs. (55 +/- 6)%].

CONCLUSIONGM-CSF could facilitate the repair of the intima, reduce neointima formation, better the function of the endothelium, and decrease the rate of restenosis.

Angioplasty, Balloon ; adverse effects ; Animals ; Endothelium, Vascular ; pathology ; Granulocyte-Macrophage Colony-Stimulating Factor ; pharmacology ; Hyperplasia ; Iliac Artery ; Male ; Nitric Oxide ; blood ; Rabbits ; Tunica Intima ; drug effects ; pathology

Animals ; Coronary Restenosis ; prevention & control ; Diterpenes ; administration & dosage ; Epoxy Compounds ; Iliac Artery ; pathology ; Male ; Phenanthrenes ; administration & dosage ; Rabbits ; Stents ; Tunica Intima ; pathology

OBJECTIVETo assess the value of subintimal angioplasty in treating patients with iliac artery occlusive disease.

METHODSWe retrospectively analyzed the clinical data of 13 patients with iliac artery occlusion who received subintimal wire placement followed by percutaneous transluminal angioplasty and stent placement in our hospital from May 2004 to August 2006.

RESULTSInitial success was obtained in all the 13 patients with an improvement in both the symptoms and the mean ankle-brachial index of 0.55 (range: 0.39-0.94, P = 0.004) without any complication. During the follow-up (range: 3-21 months; mean: 12 months), the one-year stent patency rate reached 100%.

CONCLUSIONSubintimal angioplasty is a valuable approach to treat iliac artery occlusion with reliable efficacy and safety.

Aged ; Angioplasty, Balloon ; methods ; Arterial Occlusive Diseases ; therapy ; Blood Vessel Prosthesis Implantation ; Female ; Humans ; Iliac Artery ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Adolescent ; Humans ; Iliac Artery ; anatomy & histology ; pathology ; Male ; Pelvis ; injuries ; Peripheral Vascular Diseases ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating ; diagnosis ; diagnostic imaging

OBJECTIVETo investigate the clinical application of pedicled superficial circumflex iliac artery (SCIA) flaps in Burns and Plastic Surgery.

METHODS19 cases with skin and soft tissue defects were repaired with the Superficial circumflex iliac artery flaps. The defects located in the hand and forearm, the lower abdomen and perineal area, the radicle area of thigh, etc. Before the SCIA flaps were transfered to the recipient areas, 15 cases with different kinds of wounds were debrided thoroughly, 3 cases with scar were removed directly. The size of the flaps ranged from 3.0 cm x 4.5 cm to 26.0 cm x 22.0 cm, and the pedical was 5 cm to 7 cm in length.

RESULTSThe flaps in the 18 cases survived completely. Skin necrosis in the distal end of the flap appeared in 1 case, and the wound healed after the second repair. The follow-up period rang from 3 to 18 months. The apperance and function of the hand or foot was satisfactory.

CONCLUSIONSBecause the pedicled SCIA flaps can be obtain conveniently and contain sufficient blood-supply, so the flap is easy to survive and the flap can be designed in a large size. We believe it is an ideal method to use this flap to repair skin and soft tissue defects located in hands, forearms, the lower abdomen and perineal areas, the radicle area of thigh and so on.

Burns ; surgery ; Forearm ; Graft Survival ; Hand ; Humans ; Iliac Artery ; Necrosis ; Reconstructive Surgical Procedures ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; pathology ; transplantation ; Thigh ; Wound Healing

We report a case of erectile dysfunction caused by external iliac artery occlusion, associated with pelvic steal syndrome; bilateral internal iliac arteries were patent. The patient stated that he had experienced erectile dysfunction at similar times along with claudication, but he did not mention it before angiography. He expressed that the erectile dysfunction did not last long and that he felt completely okay after the interventional procedure, in addition to his claudication. Successful treatment of the occlusion, by percutaneous transluminal angioplasty and stent implantation, helped resolve erectile dysfunction completely and treat the steal syndrome.
*Angioplasty ; Arterial Occlusive Diseases/*complications/radiography/*therapy ; Erectile Dysfunction/*etiology/*therapy ; Humans ; Iliac Artery/pathology/*radiography ; Intermittent Claudication/complications ; Male ; Middle Aged ; *Stents ; Subclavian Steal Syndrome/*complications/*therapy