Manejo endovascular de la estenosis ilíaca-bilateral mediante la técnica de kissing stent / Endovascular management of bilateral iliac stenosis using the kissing stent technique

La enfermedad aorto-ilíaca es una entidad que, por su localización y distribución, plantea un reto para el radiólogo intervencionista. Existen diferentes técnicas endovasculares que ofrecen una buena permeabilidad a mediano y largo plazos, a partir de una selección apropiada de los pacientes. Este artículo tuvo como objetivo caracterizar la técnica de kissing stent como una alternativa terapéutica más, mínimamente invasiva, en los pacientes con enfermedad aorto-ilíaca. En este sentido, se presenta el caso de una mujer de 60 años con claudicación intermitente de 3 meses de evolución, con cambios tróficos de la piel a predominio derecho, en quien se documentó una estenosis aorto-ilíaca bilateral según el Trans-Atlantic Inter-Society Consensus Working Group II tipo A. Se realizó angioplastia con balón y stent autoexpandibles de ambas ilíacas comunes mediante la técnica de kissing stent. En el seguimiento anual, la paciente toleró el ejercicio, y al examen físico, los pulsos periféricos estuvieron presentes. Además, el manejo endovascular de las lesiones estenótica aorto-ilíacas mediante la técnica de kissing stent resulta segura, menos cruenta y con buenos resultados a mediano plazo, que se debe sustentar en una selección apropiada de los pacientes(AU)

Aortoiliac disease is an entity that, due to its location and distribution, poses a challenge for the interventional radiologist. There are different endovascular techniques offering good permeability in the mid- and long terms, based on appropriate selection of patients. This article aimed at characterizing the kissing stent technique as another minimally-invasive therapeutic alternative in patients with aortoiliac disease. In this respect, the case is presented of a 60-year-old woman with intermittent claudication of three months of evolution, with trophic changes of the skin, predominantly on the right side, and in whom a bilateral aortoiliac disease was documented as type A according to the Trans-Atlantic Inter-Society Consensus Working Group II. Balloon angioplasty and self-expanding stenting of both common iliac arteries were performed using the kissing stent technique. At annual follow-up, the patient tolerated exercise; and, on physical examination, peripheral pulses were present. In addition, endovascular management of aortoiliac disease stenotic lesions using the kissing stent technique is safe, less invasive and present good outcomes in the midterm, which must be based on appropriate selection of patients(AU)

Prophylactic balloon occlusion of the internal iliac arteries in two-cases of placenta accrete syndromes / Philippine Journal of Obstetrics and Gynecology

@#Placenta accreta syndrome results from the abnormal adherence of the placenta to the myometrium due to the absence of the decidua basalis and imperfect development of the Nitabuch layer. It causes serious obstetric morbidity due to the risk of massive hemorrhage. Balloon occlusion of internal iliac arteries has been used prophylactically to decrease hemorrhage in cesarean hysterectomy for placenta accreta. In this paper, two cases of placenta accreta syndromes wherein bilateral internal iliac artery balloon occlusion was done prior to cesarean hysterectomy are presented. Case 1 is a 50-year-old G4P0 (0030) pregnancy uterine who came in at 33 3/7 weeks age of gestation for fetal surveillance. Case 2 is a 38-year-old G4P2 (2012) pregnancy uterine who came in at 33 4/7 weeks age of gestation for decreased fetal movement. Both cases were successfully delivered via cesarean hysterectomy with prophylactic balloon occlusion under a multidisciplinary team in a tertiary care center.

Aneurysm, tortuosity and kinking of abdominal aorta and iliac arteries in Thai cadavers / Aneurisma, tortousidad y torsión de la parte abdominal de la aorta y de las arterias ilíacas en cadáveres tailandeses

The prevalence of the aneurysm, tortuosity, and kinking of abdominal aorta and iliac arteries is important for primary consideration in operative planning. The present study was undertaken to investigate the prevalence of abnormality of abdominal aorta and iliac arteries and demonstrate the patterns of kinking external iliac arteries in Thai cadavers. Eighty-five Thai embalmed cadavers (58 males and 27 females) were observed and measured the diameter of abdominal aorta and iliac arteries using a vernier caliper for assessment of aortic aneurysm (AAA). To investigate the tortuosity and kinking of iliac arteries, a standard goniometer was applied to measure the individual angle of iliac artery. In addition, the kinking patterns of external iliac artery were classified. The prevalence of AAA was 4.71% and the aneurysms of common and internal iliac arteries were 4.12 and 0.59%. The tortuosity of common and external iliac arteries were 1.76 and 20%. No tortuosity of internal iliac artery was observed. In addition, the kinking of common, external, and internal iliac arteries were 4.71, 16.47, and 1.18%, respectively. Moreover, the patterns of external iliac aortic kinking were classified into 4 major types (S-shape; reversed ­C shape; low grade shape; and V-shape). We have observed the prevalence of the aneurysm, tortuosity, and kinking of abdominal aorta and iliac arteries in Thai cadavers. Currently, the 4 kinking variations of external iliac arteries were also first demonstrated.

La prevalencia de aneurisma, tortuosidad y torsión de la parte abdominal de la aorta y arterias ilíacas es relevante para la consideración primaria en la planificación quirúrgica. Se realizó un estudio para investigar la prevalencia de alteraciones en las parte abdominal de la aorta y arterias ilíacas y demostrar los patrones de torsión en las arterias ilíacas externas de cadáveres tailandeses. Se observaron 85 cadáveres tailandeses embalsamados (58 hombres y 27 mujeres); se midió el diámetro de la parte abdominal de la aorta y arterias ilíacas utilizando un pie de metro para la evaluación de aneurisma aórtico. Para investigar la tortuosidad y torsión de las arterias ilíacas, se utilizó un goniómetro estándar para medir el ángulo individual de la arteria ilíaca. Además, se clasificaron los patrones de torsión de las arterias ilíacas externas. La prevalencia de aneurisma aórtico fue 4,71% y los aneurismas de las arterias ilíacas comunes e internas fueron 4,12% y 0,59%. La tortuosidad de las arterias ilíacas comunes y externas fueron 1,76% y 20%. No se observó tortuosidad de la arteria ilíaca interna. Además, la torsión de las arterias ilíacas comunes, externas e internas fueron 4,71%, 16,47% y 1,18%, respectivamente. Por otra parte, los patrones de torsión fueron clasificados en 4 tipos principales (formas de S, de C invertida; de bajo grado y en V). Observamos la presencia de aneurisma, tortuosidad y torsión de la parte abdominal de la aorta y arterias ilíacas en cadáveres tailandeses. Demostramos también por primera vez, las 4 variaciones de torsión de las arterias ilíacas externas.