Fiber Optic RealShape (FORS) Technology for Endovascular Navigation in Severe Tortuous Vessels

Purpose: The purpose of this study was to describe the use of a wire and catheters embedded with optical fiber (Fiber Optic RealShape [FORS]) to catheterize tortuous target vessels avoiding radiation. Technique: A virtual biplane vies was simulated coupling traditional x-ray system, preoperative CT scan, and FORS system to treat an isolated hypogastric aneurysm. Despite the complex anatomy, catheterization of all target vessels was possible in 12 minutes with 19 seconds of fluoroscopy time (Radiation Exposure 3.8 mGy×cm2). A minimal invasive endovascular exclusion of the aneurysm was achieved through selective coil-embolization of the iliolumbar artery and implantation of balloon expandable covered stents, thus preserving the perfusion of the superior gluteal artery. Conclusion: FORS guidance allowed catheterization of a target vessel with challenging anatomy with a low radiation exposure.

Assessment of the iliolumbar artery: its structural variations and applied aspect

Background: The Iliolumbar artery normally arises from the posterior division of Internal iliac artery. The main artery and its two branches supply the iliacus and lumbar region and other vital structures in that area. However, various studies conducted depict the differences in the pattern of its origin and course. Thus, the goal of this study was to discover the various origins of the iliolumbar artery, as well as its relationships with other surgically significant anatomical structures; the importance of which can prevent any intraoperative hemorrhages during surgery.Methods: The study was conducted in Department of Anatomy Lady Hardinge Medical College between 2019-2021. Pelvis of 12 formalin fixed adult cadavers (8 females, 4 males) were dissected to observe the iliolumbar artery. Its origin, caliber and course were measured using a digital vernier caliper. The relationship of iliolumbar artery was established with obturator nerve, lumbosacral trunk and sympathetic chain.Results: Iliolumbar artery was originating from trunk of internal iliac artery in 70.83% cases in which the mean distance of origin and mean caliber was more on right side. In the remaining 29.17% cases where the Iliolumbar artery was arising from posterior division of internal iliac artery, the mean distance of origin and mean caliber was higher on left side. The truncal origin of iliolumbar artery was predominant in females.Conclusions: The variant origin of the iliolumbar artery and its clinic-anatomical relationships have been highlighted to reduce iatrogenic artery trauma during surgery.

Surgical anatomy of the anastomoses of the iliolumbar artery

Objective: to determine the variants of topography and quantity of the anastomoses of the iliolumbar artery.Materials and methods. The material of the research was 206 dead bodies of men (aged 22–82 at the time of death) and 113 dead bodies of women (aged 32–93 at the time of death) who had died of accidental causes not related to pelvic pathology. The vascular injection method, preparation method were used to achieve the objective of the study. The statistical processing of the obtained data was performed.Results. It has been found that the formation of the anastomoses of the iliolumbar artery is most often found in its proximal and middle thirds, significantly rarely — in its distal third. We have revealed no statistically significant differences between the average diameters of the iliolumbar artery and the average diameters of its anastomoses in men.Conclusion. The performed research has demonstrated that the anastomoses of the iliolumbar artery in men and women have a definite pattern of origination.

Hemorrhage of the Ramus Lumbalis of the Iliolumbar Artery as a Cause for Shock in Blunt Trauma Victims on Therapeutic Anticoagulation

Noncavitary torso hemorrhage is a rare and poorly characterized injury that can lead to exsanguination if not promptly addressed. When present in a high-risk patient on therapeutic anticoagulation, it can lead to a swift fatal outcome. Two cases (an 80-year-old female on warfarin and a 67-year-old male on apixaban for atrial fibrillation) presented with shock after direct blunt trauma in their torsos. Embolotherapy techniques were utilized to obtain angiostasis while the patients were resuscitated with massive transfusion protocols and reversal of the agents received. In the setting of severe localized blunt trauma on an aging victim while on antithrombotic medications, noncavitary torso hemorrhage must be included in the differential diagnosis. Local expertise and a high level of suspicion were critical in the early intervention, and postprocedural management of the injuries sustained and secured a good result.