Microsurgical Bypass Training Rat Model: Part 2-Anastomosis Configurations.

Fetal abdominal blood vessels and organ microvasculature detected by Slowflow HD.

Introduction/BackgroundParaaortic lymphadenectomy is a part of surgical staging in gynecologic oncology practice.MethodologyThis cadaveric educational video shows the technique of paraaortic lymph node dissection in a step by step manner.ResultsBoundaries of...

Background/Objectives: The abdominal aorta (AA) bifurcates at the level of the L4 vertebra, giving origin to the right and left common iliac arteries (CIA). The CIA then bifurcates into external iliac arteries (EIA) and internal iliac arteries (IIA). The present radiological study aimed to (i) measure the diameter of the right and left CIA, (ii) measure the distance between the AA bifurcation and the point where the ureter crossed the ipsilateral iliac vessels, (iii) examine the angle of AA bifurcation, and (iv) observe the vertebral level at which the AA bifurcated. Methods: The retrospective cross-sectional study included contrast-enhanced CT angiograms of 200 patients (n = 144 males and 56 females) who attended the radiology department from 1 January 2022 to 31 December 2023. Two independent radiologists interpreted the angiograms. The results were interpreted using parametric and non-parametric statistical tests. Results: The mean angle of the AA bifurcation was 40.46° and 44.68° in males and females, respectively (p = 0.013). The mean diameter of the right and left CIA was wider in males than in females, but no statistical significance was found. The average distance between the AA bifurcation and the point where the right and left ureter crossed the ipsilateral iliac arteries was longer in females (60.99 and 60.29 mm, respectively) than in males (59.05 and 59.95 mm, respectively), but no statistical difference was found (p > 0.05). The most common vertebral level for AA bifurcation was the L4 vertebra, which was found in 137 (68.50%) patients. The AA bifurcated at the level of L3 and L5 in 52 (26.00%) and 11 (5.50%) patients, respectively. Conclusions: Understanding the radiological anatomy of the CIA and AA bifurcation and its relation to the ureter is crucial for surgeons performing aortic and pelvic surgeries.

A 46-year-old man presented with a huge splenic artery dissecting aneurysm that had been incidentally found and was successfully resected before rupture. The histopathologic findings were compatible with segmental mediolytic arteriopathy (SMA). Simultaneous involvement of the left renal and right common iliac artery was observed. The patient was also found to have an adrenocortical adenoma, gastrointestinal stromal tumor, hepatocellular carcinoma and schizophrenia. The relationship between SMA and other accompanying diseases was discussed.

Aortic dissection (AD) is a tear in the intima of the aorta, leading to blood flow into the medial layer and creating a false lumen. It is a true medical emergency with high mortality, particularly for Type A dissections involving the ascending aorta0 Aortic dissection is a rare but catastrophic cardiovascular emergency. This report details the case of a 62-year-old male presenting with an extensive aortic dissection, which spanned the entire length of the aorta—from the aortic root to the common iliac arteries. Remarkably, the dissection flap involved the ostia of several critical branch vessels, namely the left carotid artery, the left renal artery, and the left common iliac artery. The patient, presenting with non-specific chest pain initially treated as gastric distress, was diagnosed rapidly using Point-of-Care Ultrasound (POCUS) and confirmed with computer tomography (CT). This case underscores the challenges in diagnosing extensive aortic dissection and highlights the importance of timely and comprehensive imaging for planning management, which, unfortunately, was refused by the patient against medical advice (AMA).

Normal Diameter and Growth Rate of Infrarenal Aorta and Common Iliac Artery in Chinese Population Measured by Contrast-Enhanced Computed Tomography

Rapidly Progressive Aneurysmal Disease Associated with Epstein Barr Virus-Positive Lymphoproliferative Disease in a CVID patient with NFKB-1 Mutation

To examine whether there were differences between races in regard to the relationships among element contents in the arteries, the authors investigated the relationships among the average contents of calcium, phosphorus, sulfur, and magnesium in the 18 kinds of the Thai artery. After ordinary dissection by medical students at Chiang Mai University was finished, the thoracic and abdominal aortas, ramifying site of the abdominal aorta into the common iliac arteries, coronary, common carotid, internal thoracic, subclavian, axillary, brachial, radial, superior and inferior mesenteric, renal, common iliac, internal iliac, and external iliac arteries were resected from the subjects who consisted of 12 men and 3 women, ranging in age from 39 to 84 yr. The femoral and posterior tibial arteries were resected from the subjects, consisting of 15 men and 5 women, ranging in age from 25 to 88 yr. The element content of the arteries was analyzed by inductively coupled plasma-atomic emission spectrometry. It was found that there were extremely significant direct correlations among the average contents of calcium, phosphorus, and magnesium in the 18 kinds of the Thai artery, but no significant correlations were found between the average contents of sulfur and elements, such as calcium, phosphorus, and magnesium. These results were in agreement with those of the Japanese arteries. Therefore, it was suggested that there was no significant difference between the arteries of the Thai and the Japanese in the relationships among calcium, phosphorus, sulfur, and magnesium.

When performing high-risk abdominal aortic aneurysm (AAA), aortic cross-clamp time was reduced to a mean of 9 minutes by performing retrograde anastomosis using a ringed Y-graft (RYG). Retrograde anastomosis with RYG was performed in nine patients, (eight men and one woman) with a mean age of 74 years (range: 65–82 years). Three patients had angina pectoris and chronic renal failure, two had angina pectoris, one had thoracoabdominal aortic aneurysm and chronic renal failure, one had renal failure, one had aortic regurgitation, and one had aortic stenosis. First, the right common, external, and internal iliac arteries were clamped, then, the right limb of the graft was anastomosed to the common iliac artery or external iliac artery. Next, the aorta and left common iliac artery were clamped, and a longitudinal incision was made in the aneurysm. The proximal end of the RYG was inserted into the aorta and blood flow was resumed. Finally, the left limb of the graft was anastomosed to the left common iliac artery or external iliac artery. The mean aortic cross-clamp time was 9 minutes (range: 8–18 minutes). There were no cardiac complications during surgery. The mean operating time was 3:34 hours (range: 3:05–4:35 hours), and the blood loss averaged 1156 ml (range: 200–2000 ml). None of the patients developed postoperative complications and all of them have remained well after discharge. Retrograde anastomosis using RYG is one type of surgery that could be used in cases of high-risk patients with AAA.

Erectile Dysfunction Due to Atherosclerotic Vascular Disease: The Development of an Animal Model

Isolated abdominal aortic dissection constitutes a relatively small percentage of all aortic dissections. In this paper we present a case of a 59-year-old man who reported to the hospital because of the sudden appearance of intermittent claudication of his left lower limb. After establishing the diagnosis the patient was qualified for endovascular treatment due to dissection involving the final 1 cm of his abdominal aorta and extending to his left common iliac artery with significant true lumen compression. Stent was implanted into the left common iliac artery with almost complete occlusion of the false lumen and expansion of the true lumen of his iliac artery. During the 70-month follow-up we achieved a good result with evidence of stent patency and no signs of expansion of the false lumen. The paper discusses the epidemiology, aetiology, diagnosis and treatment of isolated abdominal dissections.

In the development of small-caliber vascular grafts (diameter; less than 3 mm), animal implantation studies have been mostly performed by using rat abdominal aortas, and their certain patency must evaluate with sacrificing every observation periods, which is both labor-intensive and time-consuming when performing a large number of experiments. This study is the first to demonstrate the application of 3-Tesla contrast-free time-of-flight magnetic resonance angiography (TOF-MRA) in the continuous assessment of the status of a tissue-engineered vascular graft in rat. As a model graft, a single connective tubular tissue (diameter; 1.5 mm), prepared by embedding the silicone rod (diameter; 1.5 mm) into a subcutaneous pouch of a rat for 2 weeks an in vivo tissue-engineering, was used. The graft was implanted in the abdominal aorta (diameter; 1.3 mm) of the rat by end-to-end anastomosis. Repeated TOF-MRA imaging of the graft obtained over a 3-month follow-up period after implantation made it possible to evaluate the patency of the graft, both simply and noninvasively. It also permitted visualization of the connected abdominal aorta and renal and common iliac arteries having smaller caliber (diameter; less than 1 mm). In addition, the degree of the stenosis or aneurysm could also be detected. 3-Tesla MRA allowed the simplified and noninvasive assessment of the status on the vascular graft, including the formation of a stenosis or aneurysm, in the same rat at different times, which will be contributing to enhance the development of tissue-engineered vascular grafts even with small caliber.

To establish a method by which angiography of the inferior mesenteric artery (IMA) can be performed smoothly, we investigated the relative locations of the coeliac trunk (CT), superior mesenteric artery (SMA), IMA, and left renal artery (LtRA). From a total of 60 cadavers, 32 cadavers with few arteriosclerotic lesions and little vascular tortuosity were selected for the study. The abdominal aorta (Ao) were removed and incised on both lateral side, along the vertical axis and transected into the ventral and dorsal sides. The intravascular lumen on the ventral side of the Ao was photographed using a digital camera, and the horizontal and vertical diameters of the sites of confluence of the CT, SMA, and IMA, were measured on the computer screen. We also calculated the distances between the branches, including the CT, SMA, IMA, LtRA, and the common iliac artery (CoI). Although the SMA-IMA distance did not correlate with the CT-SMA distance, the ratio of the SMA-IMA to CT-CoI distance was four times greater than the ratio of the CT-SMA to CT-CoI distance. The site of branching of the IMA can be inferred to some extent from the CT and SMA distance.

A Unique Technique for Intentional Occlusion of an Abdominal Aortic Aneurysm

To describe a case of an anomalous common iliac artery (CIA) arising from the aorta as the fourth lumbar artery (4th LA) and following a retro-psoas course as the continuation of the 4th LA. Contrast-enhanced abdominopelvic computed tomography (CT) findings of an incidentally detected anomalous CIA are described in an 8-year-old girl. CT showed that the right CIA originated from the distal aorta at the L3-L4 level with an acute angle and continued posteriorly in the course of the 4th LA. The right CIA descended into the iliac fossa as a single artery, lying posterior to the psoas muscle. It gave off the internal iliac artery (IIA) low in the iliac fossa and continued as the external iliac artery (EIA). The median sacral artery (MSA) originated from the left proximal CIA and joined the posterior division of the right IIA. Fourth LA continuation of the CIA is a rare vascular anomaly with a few published reports to date. The anomaly occurs far more on the right side than the left and is mostly asymptomatic. An abnormal connection between the umbilical artery and the distal aorta probably results in this anomaly, as well as in another group of CIA anomalies that are characterized by the absence of one or two CIAs with trifurcation or quadrifurcation of the distal aorta. Although the vascular anomaly is mostly asymptomatic, knowledge of it is important in the interventions of the area to prevent complications.