ABSTRACT
A 53-year-old lady was admitted with decompensated dengue shock syndrome during the febrile phase, complicated by massive retroperitoneal bleeding requiring angioembolization. She was initially stabilized by fluid resuscitation at emergency department prior to ICU admission. While in ICU, her haemoglobin level plummeted from 17.5 g/dL to 5.8 g/dL without any obvious source of bleeding. She had hemodynamic instability and worsening acidosis. The abdominal ultrasound performed showed complex ascites and CT abdomen revealed a large right retroperitoneal hematoma with ongoing bleeding. The patient’s hemodynamic was restored and bleeding resolved after angioembolization of the right L2 lumbar artery and right phrenic artery.
ABSTRACT
Objective To evaluate the curative effect and safety of lumbar artery embolization in treating massive hemorrhage caused by percutaneous transforaminal endoscopic discectomy (PTED).Methods From January 2013 to December 2016,lumbar artery angiography was performed in 4 patients with massive hemorrhage caused by PTED.Based on the angiographic findings,lumbar artery embolization therapy with embolic microspheres and spring coils was carried out.Results Lumbar artery angiography revealed that extravasation of contrast agent was detected in 3 patients and pseudoaneurysm in one patient.The bleeding completely stopped immediately after lumbar artery embolization in all 4 patients.The patients were followed up for 1-3 months,and no re-bleeding or serious complications occurred.Conclusion It is very difficult to make medical and surgical management for massive hemorrhage caused by PTED.Lumbar artery embolization is safe,effective and minimally-invasive for the treatment of massive hemorrhage caused by PTED.This therapy is worthy of clinical use.
ABSTRACT
Objective To evaluate the clinical efficacy of ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery,the anterior fourth lumbar artery or the posterior intercostal artery.Methods Between April,2005 to August,2015,6 patients diagnosed as large skin defects in the upper extremity were treated with ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery,the anterior fourth lumbar artery or the posterior intercostal artery.The proximal flap blood supply was offered by the superficial circumflex iliac artery,and the distal flap blood supply was provided by the anterior fourth lumbar artery or the posterior intercostal artery.The maximal size of the flap was measured as 35.0 cm×15.0 cm,and the minimal size was 25.0 cm×9.0 cm.The donor sites of the flap were directly sutured.All cases were implemented by postoperative followup visit in hospital for observation of appearance,texture,functions and donor site of flaps.Results Postoperatively,all flaps survived.The follow-up time endured for 6 to 24 months.The flap thickness was appropriate with normal shape and soft texture.Protective sensation and perspiration function of the flap were restored.Linear scars alone were observed in the donor sites of the flap.Conclusion Ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery,the anterior fourth lumbar artery or the posterior intercostal artery can extend the excision scope of the flap and provides sufficient blood supply for the flap.The flap texture is soft and can be directly sutured.This technique is an ideal option for repairing of large soft tissue defects of the upper extremity.
ABSTRACT
Esophageal and gastric varix, portal hypertensive gastropathy, Mallory-Weiss tear and gastric ulcer are common causes of bleeding in patients with liver cirrhosis. However, spontaneous arterial bleeding without a history of trauma is a rare cause of bleeding which can be fatal. We report a case of a 55-year-old woman with alcoholic liver cirrhosis who developed spontaneous bleeding of multiple right lumbar arteries and died in spite of repetitive transfusion and embolization.
Subject(s)
Female , Humans , Middle Aged , Arteries , Gastrointestinal Hemorrhage/etiology , Hematoma/diagnosis , Liver Cirrhosis/complications , Lung Injury/pathology , Tomography, X-Ray ComputedABSTRACT
Background: The internal iliac artery originates from the common iliac artery at the level of sacroiliac joint. The internal iliac artery descends posterior to the greater sciatic foramen thereby dividing into anterior and posterior divisions. The posterior division of the internal iliac artery is known to give rise to three main branches i.e. iliolumbar artery, lateral sacral artery. Accidental haemorrhage is common during erroneous interpretation of anomalous blood vessels. The knowledge of the normal and the abnormal anatomy of the branches of the internal iliac artery is essential for obstetric surgeons. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: Out of 50 specimens, ilio-lumbar artery took origin from posterior division, directly in 22 specimens (44%), with obturator artery in 5 specimens (10%) and with superior gluteal artery in 2 specimens (4%). From anterior division, with obturator artery in 6 specimens (12%) and with inferior gluteal artery in 1 specimen (2%). From common trunk, as direct branch in 10 specimens (20%), with lateral sacral artery in 1 specimen (2%), with vertebral branch in 1 specimen (2%), with superior gluteal artery in 1 specimen (2%) and was found to be absent in 1 specimen (2%). Posterior division of internal iliac artery given origin directly to superior gluteal artery in 44 specimens (88%), with ilio-lumbar artery in 1 specimen (2%), with obturator artery in 2 specimens (4%). Lateral sacral artery from posterior division was observed in 38 specimens (76%) and unpaired origin was observed in 7 specimens (14%). Conclusion: Internal iliac artery supplies the pelvic viscera and musculature the knowledge of its branches helpful in pelvis surgeries.
ABSTRACT
Objective To study the feeding arteries of sacral tumors with digital substraction angiography (DSA). Methods A total of 27 patients with sacral tumors, who were encountered at authors’ hospital during the period from January 2006 to December 2012 , were enrolled in this study. DSA of abdominal aorta, bilateral internal iliac arteries, median sacral artery and lumbar arteries was performed in all patients. The origins, branches of the feeding arteries were determined, and the results were analyzed. Results Of the 27 cases with sacral tumors, DSA demonstrated median sacral artery in 20 (20 arteries in total), lateral sacral artery in 22 (36 arteries in total), ilio-lumbar artery in 18 (27 arteries in total), lumbar artery in 10 (15 arteries in total), inferior gluteal artery in 3 (3 arteries in total) and superior gluteal artery in 2 (2 arteries in total). Conclusion In our series, the blood supply of the sacral tumors is mainly from the median sacral artery, lateral sacral artery, ilio-lumbar artery and lumbar artery. Occasionally, superior and inferior gluteal arteries also participate in the blood supply of the sacral tumors. For the evaluation of sacral tumors, attention should be paid to the presence of rare feeding arteries.
ABSTRACT
A 55-year-old female patient presented with lower back pain and neurogenic intermittent claudication and underwent L3-L4 posterolateral fusion. To prepare the bone fusion bed, the transverse process of L3 and L4 was decorticated with a drill. On the 9th post-operative day, the patient complained of a sudden onset of severe abdominal pain and distension. Abdominal computed tomography revealed retroperitoneal hematoma in the right psoas muscle and iatrogenic right L3 transverse process fracture. Lumbar spinal angiography showed the delayed hematoma due to rupture of the 2nd lumbar artery pseudoaneurysm and coil embolization was done at the ruptured lumbar artery pseudoaneusyrm. Since then, the patient's postoperative progress proceeded normally with recovery of the hemodynamic parameters.
Subject(s)
Female , Humans , Middle Aged , Abdominal Pain , Aneurysm, False , Angiography , Arteries , Hematoma , Hemodynamics , Hemorrhage , Intermittent Claudication , Low Back Pain , Psoas Muscles , Rupture , Spinal FusionABSTRACT
Objective: To analyze the correlation of intervetebral disc degeneration with the diffusion values of lumbar vertebral discs and lumbar blood supply in patients with suspected lumbar intervertebral problems, so as to assess ADC value in diagnosis of intervertebral degeneration and the related blood supply. Methods: Sixty-five patients with suspected lumbar intervertebral problems were included in the present study; they had a mean age of (52.3±28.5) years and an age range of 16-76 years. Eleven of them had low back pain complicated with sciatica, 16 had low back pain without sciatica, 33 had sciatica without low back pain, and 5 had intermittent claudication. The disease course was 1-57 weeks, with a mean of (13.4±6.3) weeks. MR angiography and diffusion imaging were performed to evaluate the status of lumbar arteries and to obtain the ADC values of L1-4, so as to analyze the correlation of ADC values, lumbar blood supply, and intervetebral disc degeneration. Results: The ADC values of L1-4 were negatively correlated with the degeneration of lumbar discs (P<0.05). There was a relation between the artery status of L1, L2 and L3 with the degeneration of corresponding lumbar discs of L1-2, L2-3, and L 3-4, (r3 = 0.823, P = 0.016 3 ; r5 = 0.791, P = 0.019 2; r, = 0.835, P = 0.010 3). The artery status of L4 and the L4-5 discs was not significantly correlated with degeneration of corresponding lumbar discs(r3 =0.306, P = 0.209 2). Conclusion: The ADC values of lumbar intervertebral disc can reflect the degeneration of L 1-4 , and degeneration of L1-2, L2-3 is and L3-4 is correlated with the artery status of corresponding discs.
ABSTRACT
There are many reports on lumbar artery injuries. However, there are only a few case reports of a lumbar artery injury presenting with hypovolemic shock from either a blunt or penetrating trauma. We described a 47-year-old man with a retroperitoneal hemorrhage secondary to a lumbar artery injury presenting as hypovolemic shock after a 3 m fall.
Subject(s)
Humans , Middle Aged , Arteries , Hemorrhage , Hypovolemia , Shock , SpineABSTRACT
There could be several methods for trochanteric reconstruction including local flap, pedicled perforator flaps, free flap, etc. We performed greater trochanteric reconstruction with lumbar artery perforator free flap in some aberrant method. So we report this experience with review of literatures. A 42-year-old man visited our hospital with a large soft tissue defect in his left greater trochanteric area by traffic accident. The patient had wide skin and soft tissue defect combined with open femur fracture. During one month period of admission, he underwent femur open reduction and wound debridement four times. After that we planned thoracodorsal perforator free flap reconstruction. The flap was outlined as large as 20x15 cm and elevated in a suprafascial plane from the lateral border. During intramuscular perforator dissection, we found that two 1.5 mm diametered perforator vessels coursed inferomedially toward second lumbar region. Finally the flap became lumbar artery perforator flap based on second lumbar artery perforator as a main pedicle. After flap transfer, the perforator vessels were connected with inferior gluteal artery and vein microsurgically. The operation was successful without uneventful course. We found no significant postoperative complication and donor site morbidity during six months follow up periods. Lumbar artery perforator flap could be an alternative procedure for thoracodorsal perforator flap in some patients with anatomic variant features.
Subject(s)
Adult , Humans , Accidents, Traffic , Arteries , Debridement , Femur , Follow-Up Studies , Free Tissue Flaps , Lumbosacral Region , Perforator Flap , Postoperative Complications , Skin , Surgical Flaps , Tissue Donors , Veins , Wounds and InjuriesABSTRACT
We report a case of retroperitoneal hemorrhage and abdominal wall hemorrhage due to spontaneous lumbar artery and inferior epigastric artery rupture, in a patient with chronic renal failure treated with hemodialysis. There was no history of specific trauma. The bleeding was confirmed by CT and angiography, and controlled successfully by selective angiographic embolization. We suggest that a possibility of spontaneous retroperitoneal bleeding should be considered in a case of abdominal pain or mass in a hemodialysis patient.