Aneurisma idiopático de artéria ilíaca comum direita em criança de três anos - relato de caso / Idiopathic right common iliac artery aneurysm in a three-year-old child - case report

Resumo A incidência de aneurismas ilíacos em crianças não é conhecida, havendo apenas alguns relatos de casos na literatura sobre o tema. Neste estudo, é relatado o caso de um paciente masculino, 3 anos, com aneurisma sacular isolado na bifurcação da artéria ilíaca comum direita de origem idiopática, que foi submetido a ressecção, ligadura da artéria ilíaca interna e anastomose vascular término-terminal. Após 1 mês de seguimento, foi diagnosticada oclusão assintomática da anastomose. Devido à presença de circulação colateral, não houve repercussões clínicas da oclusão, e a criança apresentou evolução clínica favorável a médio prazo.

Abstract The incidence of iliac aneurysms in children is unknown and there are only a small number of case reports in the literature on the subject. This article describes the case of a 3-year-old male patient with an isolated saccular aneurysm at the bifurcation of the right common iliac artery, of idiopathic origin, which was repaired by resection, ligature of the internal iliac artery and end-to-end vascular anastomosis. After 1 month of follow-up, he was diagnosed with asymptomatic occlusion of the anastomosis. The occlusion had no clinical repercussions because of collateral circulation and the child has had a favorable clinical course over the medium term.

Symmetric bilateral aberrant obturator artery: a case report / Arteria obturatriz aberrante simétrica bilateral: reporte de un caso

Aberrant obturator artery (AOA) is an anatomical variation in the origin and course of the obturator artery, which is clinically important because of their vulnerability during surgical procedures performed in the pelvis. This article describes the case of a symmetrical AOA found in both hemipelvises of a male cadaver. Morphological and morphometric characteristics are presented, while their clinical significance is discussed.

La arteria obturatriz aberrante (AOA) es una variación anatómica del origen y trayecto de la arteria obturatriz que tiene importancia clínica debido a su vulnerabilidad durante los procedimientos quirúrgicos realizados en la pelvis. En este artículo se describe el caso de una AOA simétrica encontrada en ambas hemipelvis de un cadáver masculino. Se presentan sus características morfológicas y morfométricas, y se discute su importancia clínica.

Unusual branches of femoral artery in the femoral triangle: a case report / Ramas inusuales de la arteria femoral en el triángulo femoral: reporte de caso

Femoral artery is the major artery of the lower limb. It shows some variations in its branching pattern. One of the rare but clinically important variations is the origin of deep circumflex iliac and inferior epigastric arteries from it instead of from external iliac artery. We report here the origin of inferior epigastric and deep circumflex iliac arteries from the femoral artery bilaterally. Both the arteries passed up deep to the inguinal ligament and had a normal course and distribution after crossing the inguinal ligament. Knowledge of these variations is of importance in plastic surgery, anterior approach to the hip joint, draining psoas abscess or reducing a femoral hernia.

La arteria femoral es la principal arteria del miembro inferior. Se observan algunas variaciones en su patrón de ramificación. Una variante rara, pero clínicamente importante es el origen común de las arterias circunfleja iliaca profunda y epigástrica inferior no desde la arteria ilíaca externa. Presentamos el origen bilateral de las arterias epigástricas inferiores y circunfleja ilíaca profunda desde la arteria femoral. Ambas arterias pasaron profundas al ligamento inguinal y tuvieron un curso y distribución normal después de cruzar el ligamento inguinal. El conocimiento de estas variaciones son de importancia en la cirugía plástica, en el acceso anterior a la articulación de la cadera, el drenaje absceso del músculo psoas mayor o para reducir una hernia femoral.

Unusual branching pattern of external iliac artery: case report / Patrón inusual de ramificación de la arteria ilíaca externa: reporte de caso

During the routine dissection, a rare anomaly was observed in left lower limb of a female cadaver. The external iliac artery continued as femoral artery, branched on lateral side as the lateral circumflex femoral artery and on medial side as profunda femoris artery. On tracing the lateral circumflex femoral artery, the ascending branch towards the spinous anastomosis was very thin and coursed behind the rectus femoris muscle. The transverse and descending branches were not observed, however, the artery coursed along the vastus lateralis towards the knee. The femoral artery had its normal course and continued as popliteal artery. The profunda femoris artery originated from the medial side of the external iliac artery, initially superficial to the femoral vein, coursed downwards and posteriorly, relating posteromedial to femoral artery. The medial circumflex femoral artery originated as thin branch, which further divided into two divisions. The profunda femoris gave origin of 3 perforators and continued as 4th perforator. The unusual branching pattern was observed to be novel and not reported in the literature.

Durante una disección de rutina, se observó una rara anomalía en el miembro inferior izquierdo de un cadáver de sexo femenino. La arteria ilíaca externa dio origen en el lado lateral ala arteria circunfleja femoral lateral y en el lado medial a la arteria femoral profunda. En el recorrido de la arteria circunfleja femoral lateral, la rama ascendente era muy delgada y corría detrás del músculo recto femoral. No se observaron ramas transversales y descendente, sin embargo, la arteria descendió hacia la rodilla a lo largo del músculo vasto lateral. La arteria femoral tuvo su curso normal y continuó como arteria poplítea. La arteria femoral profunda, inicialmente superficial a la vena femoral, se dirigió inferior y posteriormente colocándose posteromedial a la arteria femoral. La arteria circunfleja femoral medial se originó como una rama delgada, que otorgó dos arterias. La arteria femoral profunda dio origen a tres ramas perforantes y continuó como cuarta perforante. Este patrón de ramificación inusual es una descripción nueva no reportada en la literatura.

Looped external iliac artery: a case report / Arteria ilíaca externa en bucle ­ reporte de caso

Variations of the external iliac artery are very rare. We found a rare variation in the left external iliac artery. The artery was long and formed a characteristic loop. The loop was found in the lesser pelvis in close relation to the obturator nerve. This loop may compress obturator nerve and vessels. The knowledge of this loop might be important for gynaecologists, orthopaedic surgeons and urologists since it may be involved in surgeries of hip, ovary and prostate...

Las variaciones de la arteria ilíaca externa son raras. Se encontró una variación poco frecuente en la arteria ilíaca externa izquierda. La arteria era larga y formaba un bucle característico. El bucle se encontró en la pelvis menor en estrecha relación con el nervio obturador. Este circuito puede comprimir el nervio obturador y los vasos circundantes. El conocimiento de este circuito podría ser importante para los ginecólogos, cirujanos ortopédicos y urólogos, ya que pueden estar involucrados en las cirugías de cadera, ovario y próstata...

Aneurisma verdadero en arteria ciática persistente: caso clínico / Persistent sciatic artery aneurysm: a case report

We report the case of a 71 years old female patient, who had a partially thrombosed true aneurysm in a persistent sciatic artery (PSA), treated in the Surgery Department of Hospital Dr. Eduardo Pereira of Valparaiso. The sciatic artery arises from the umbilical artery and during early embryological state is the main blood supply of the lower limbs. Later, the superficial femoral artery appears with the subsequent progressive involution of the sciatic artery. PSA is a rare congenital vascular anomaly that occurs when sciatic artery fails to regress during fetal development. This is associated with superficial femoral artery hipoplasia and the PSA becomes the dominant arterial inflow to the lower limb. This anatomic abnormality may be bilateral and can remain asymptomatic for many years, however, it has been described aneurysmal degeneration, like in this case, symptoms of sciatic nerve compression, aneurysm thrombosis and distal embolization.

Se reporta el caso de una paciente de 71 años, que presenta un aneurisma verdadero, parcialmente trombosado, en una Arteria Ciática Persistente (ACP), tratada en el Servicio de Cirugía del Hospital Dr. Eduardo Pereira de Valparaíso. La arteria ciática se origina en la arteria umbilical y durante las primeras fases embriológicas es el principal aporte sanguíneo de la extremidad inferior. Posteriormente aparece la arteria femoral superficial y se produce la progresiva involución de la arteria ciática. La ACP constituye una rara anomalía y ocurre por la falta de desarrollo de la arteria femoral superficial. La ACP se origina en el adulto en la arteria hipogástrica, transcurre hacia la región glútea a través de la escotadura ciática y sigue hacia distal por la parte posterior del muslo continuándose después con la arteria poplítea. Se acompaña de un variable menor desarrollo del eje arterial anterior de la arteria ilíaca externa y femoral superficial. Esta anomalía anatómica puede ser bilateral y puede permanecer asintomática durante muchos años, sin embargo, se ha descrito la degeneración aneurismática, como en este caso, y síntomas por compresión del nervio ciático, trombosis del aneurisma y embolización distal.

Abnormal branch of external iliac artery in the iliac fossa / Rama anormal de la arteria ilíaca externa en la fosa ilíaca

An abnormal artery arising from external iliac artery was found during routine dissection class for medical undergraduates. The artery took its origin from the external iliac artery midway between its origin from common iliac and termination as femoral artery. The abnormal artery divided into two branches; an ascending and a descending. The ascending branch supplied iliacus and iliac crest. The descending branch entered the femoral triangle by passing behind the femoral sheath. It supplied the muscles of femoral triangle and anastomosed with medial circumflex femoral artery. The knowledge of this variation may be of use for surgeons doing surgery of femoral hernia.

Una variación arterial proveniente de la arteria ilíaca externa fue encontrada durante una disección de rutina en Medicina de pregrado. La arteria se originaba de la arteria ilíaca externa a mitad de camino entre su origen desde la arteria ilíaca común y su terminación, la arteria femoral. La arteria se dividía en dos ramas: ascendente y descendente. La rama ascendente suministraba la irrigación al músculo ilíaco y a la cresta ilíaca. La rama descendente entraba en el trígono femoral pasando por detrás de la vaina femoral y daba la irrigación a los músculos del trígono femoral, anastomosándose con la arteria circunfleja femoral medial. El conocimiento de esta variación puede ser de utilidad para los cirujanos que realizan cirugía de hernia femoral.

Malformação ílio-femoral / Iliofemoral arterial malformation

Durante uma dissecção de rotina realizada em um cadáver do sexo masculino com 65 anos de idade foi constatada malformação arterial iliofemoral. A aorta abdominal estava consideravelmente deslocada lateralmente e também bifurcava em nível mais alto. A artéria ilíaca comum dividia-se uma vértebra acima do nível normal e a artéria femoral dava origem à artéria femoral profunda aproximadamente l,2 cm abaixo do ligamento inguinal, o que é consideravelmente proximal ao seu nível normal. Aqui nós apresentamos uma breve revisão de literatura e base embriológica dessas anomalias.

During routine dissection, an Iliofemoral arterial malformation was noticed in a 65 year old male cadaver. The abdominal aorta was considerably laterally displaced and also bifurcated higher up. The common iliac artery divided one vertebral level higher and the femoral artery gave the profunda femoris artery about 1.2 cm below the inguinal ligament, which is considerably proximal to its usual level of origin. A brief review of literature and embryological basis of the anomalies are discussed.

Endoprótese ramificada de artéria ilíaca interna no tratamento de aneurisma aórtico associado a aneurisma bilateral das artérias ilíacas comuns / Branched stent-graft to the internal iliac artery for treatment of aortic aneurysm associated with bilateral common iliac artery aneurysm

A embolização das artérias ilíacas internas é usualmente realizada durante a correção endovascular dos aneurismas aorto-ilíacos, visando prevenir a ocorrência de endoleak. Entretanto, é freqüente a associação desse procedimento com inúmeras seqüelas pós-operatórias, em decorrência da diminuição do fluxo sangüíneo pélvico. Em virtude disso, torna-se necessário o desenvolvimento de dispositivos e estratégias para a preservação das artérias ilíacas internas durante a correção endovascular dos aneurismas aorto-ilíacos. Descrevemos aqui o emprego pioneiro de uma endoprótese ramificada Helical Sidebranch (Cook) para a artéria ilíaca interna, realizado com sucesso técnico imediato e controle pós-operatório satisfatório.

Embolization of internal iliac arteries is usually performed during endovascular repair of aortoiliac aneurysms, with the aim of preventing occurrence of endoleaks. However, the association of this procedure with several postoperative sequelae is frequent, due to reduced pelvic blood flow. For this reason, there is the need to develop devices and strategies to preserve internal iliac arteries during endovascular repair of aortoiliac aneurysms. In this study, we describe a pioneering use of a Helical Sidebranch (Cook) branched stent-graft to the internal iliac artery, which was performed with immediate technical success and satisfactory postoperative control.