A man in his mid-70s with a complex medical history, including splenectomy, presented with fever and rigours. Workup revealed Salmonella enterica serotype typhimurium bacteraemia and right internal iliac artery endarteritis. Two weeks following a 6-week course of antibiotics, he had a recurrence of Salmonella bacteraemia requiring an extended course of treatment.

Blood flow through the abdominal aorta and iliac arteries is a crucial area of research in hemodynamics and cardiovascular diseases. To get in to the problem, this study presents detailed analyses of blood flow through the abdominal aorta, together with left and right iliac arteries, under Earth gravity and weightless conditions, both at the rest stage, and during physical activity. The analysis were conducted using ANSYS Fluent software. The results indicate, that there is significantly less variation in blood flow velocity under weightless conditions, compared to measurement taken under Earth Gravity conditions. Study presents, that the maximum and minimum blood flow velocities decrease and increase, respectively, under weightless conditions. Our model for the left iliac artery revealed higher blood flow velocities during the peak of the systolic phase (systole) and lower velocities during the early diastolic phase (diastole). Furthermore, we analyzed the shear stress of the vessel wall and the mean shear stress over time. Additionally, the distribution of oscillatory shear rate, commonly used in hemodynamic analyses, was examined to assess the effects of blood flow on the blood vessels. Countermeasures to mitigate the negative effects of weightlessness on astronauts health are discussed, including exercises performed on the equipment aboard the space station. These exercises aim to maintain optimal blood flow, prevent the formation of atherosclerotic plaques, and reduce the risk of cardiovascular complications.

Arterio-ureteral fistulas (AUFs), which are relatively rare but potentially life-threatening, require prompt diagnosis and treatment. We reported a case of AUFs following robot-assisted laparoscopic radical cystectomy (RARC) with extended pelvic lymph node dissection and ileal conduit urinary diversion for muscle-invasive bladder cancer, which resulted in massive hemorrhage. Urine leaked from the anastomosis between the ureter, and the end of the ileal conduit was infected, which resulted in an AUF between the pseudoaneurysm of the right common iliac artery and the ureter. The AUF was managed successfully by vascular intervention with an arterial stent graft.

Left renal vein variants are not commonly observed in the general population. Usually, the renal vein runs in front of the aorta before entering the inferior vena cava, while the most common variants include the presence of a circumaortic or retroaortic renal vein. However, when present, left venal rein variants are important to recognize due to their potential clinical and surgical relevance. In this regard, CE-CT is an instrument with high sensitivity and specificity in detecting vascular anomalies and can certainly help diagnose. In this article, we present a unique case of a left venal rein compressed between the left iliac artery and vertebral bodies associated with the presence of a superior mesenteric artery Syndrome, another rare entity that occurs when the duodenum is compressed between the aorta and the superior mesenteric artery.

Iliac artery angioplasty with stenting is an effective alternative treatment modality for aortoiliac occlusive diseases. Few randomized controlled trials have compared the efficacy and safety between self-expandable stent (SES) and balloon-expandable stent (BES) in atherosclerotic iliac artery disease. In this randomized, multicenter study, patients with common or external iliac artery occlusive disease were randomly assigned in a 1:1 ratio to either BES or SES. The primary end point was the 1-year clinical patency, defined as freedom from any surgical or percutaneous intervention due to restenosis of the target lesion after the index procedure. The secondary end point was a composite event from major adverse clinical events at 1 year. A total of 201 patients were enrolled from 17 major cardiovascular intervention centers in South Korea. The mean age of the enrolled patients was 66.8 ± 8.5 years and 86.2% of the participants were male. The frequency of critical limb ischemia was 15.4%, and the most common target lesion was in the common iliac artery (75.1%). As the primary end point, the 1-year clinical patency as primary end point was 99% in the BES group and 99% in the SES group (p > 0.99). The rate of repeat revascularization at 1 year was 7.8% in the BES group and 7.0% in the SES group (p = 0.985; confidence interval, 1.011 [0.341-2.995]). In our randomized study, the treatment of iliac artery occlusive disease with self-expandable versus balloon-expandable stent was comparable in 12-month clinical outcomes without differences in the procedural success or geographic miss rate regardless of the deployment method in the distal aortoiliac occlusive lesion (ClinicalTrials.gov, NCT01834495).

BACKGROUND: Iliac artery aneurysms are rare, with isolated iliac artery aneurysms responsible for only 2 % of all aneurysmal diseases. External iliac artery (EIA) aneurysms are extremely rare, and the exact cause is unknown. In this case, we report a giant aneurysm without any risk factor presented with rupture and managed by open repair.
METHODS: An 85-year-old man presented to the emergency department with sudden onset right lower quadrant abdominal pain and vague right lower limb pain. After a complete physical examination, an abdominopelvic CT scan revealed an 80 mm EIA aneurysm containing thrombosis and active leakage. The patient underwent open repair of an aneurysm using a graft between the Aorta and EIA. The surgery was uneventful. Later in the ICU, the patient experienced a cardiac arrest and unfortunately could not recover from it.
CONCLUSIONS: In this case, a patient with a relatively large aneurysm presented with abdominal pain and lower limb discomfort. Although endovascular surgery is recommended for the repair of iliac aneurysms, open repair is common for ruptured aneurysms. Endovascular repair is less invasive but may lead to contrast-induced renal dysfunction. Open repair may induce complications such as sexual dysfunctions, graft infection, and pelvic ischemic conditions.
CONCLUSIONS: EIA aneurysms are exceedingly rare. They may present with a Rupture that puts the patient in critical condition, such as in this case. Due to the hemodynamic instability, open repair is considered one of the main approaches for repairing the aneurysm.

Anatomic variations of the iliofemoral arterial system are rare. We describe the pattern of a complete arterial loop (360 degree) of the external iliac artery detected incidentally in a lady who presented with abdominal pain.

An 85-year-old man underwent hemiarthroplasty for a left intertrochanteric femoral fracture at another hospital two years prior. While under outpatient monitoring, the left femur displacement occurred. Therefore, total hip arthroplasty of the left hip was scheduled. However, during acetabular cup insertion damage to the inner plate led to a sudden decrease in blood pressure from 120 to 60 mmHg. The physicians suspected a pelvic vascular injury and promptly stopped the procedure. In case of adhesion between the acetabular cup and the left iliac vein, intraoperative vascular damage would be repaired via endovascular intervention. Subsequently, orthopedic surgery was cautiously performed, taking into account the potential of a vascular injury. The surgery proceeded as planned without vascular intervention. This case involved a patient with suspected injury to the iliac vein and artery during acetabular cup placement. Following comprehensive enhanced CT and angiography tests, orthopedic surgery was performed in preparation for potential vascular damage, demonstrating the multidisciplinary approach to managing such cases.

OBJECTIVE: To assess the comparative safety and efficacy of covered stents (CS) and bare metal stents (BMS) in endovascular treatment of aorto-iliac disease in patients with peripheral arterial disease.
METHODS: A systematic review was conducted adhering to the PRISMA 2020 and PRISMA for Individual Participant Data 2015 guidelines.
METHODS: A search of PubMed, Scopus, and Web of Science for articles published by December 2023 was performed. The primary endpoint was primary patency. Certainty of evidence was assessed via the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.
RESULTS: Eleven studies, comprising 1 896 patients and 2 092 lesions, were included. Of these, nine studies reported on patients\' clinical status, with 35.5% classified as Rutherford 4 - 6. Overall primary patency for CS and BMS at 48 months was 91.2% (95% confidence interval [CI] 84.1 - 99.0%) (GRADE, moderate) and 83.5% (95% CI 70.9 - 98.3%) (GRADE, low). The one-stage individual participant data meta-analyses indicated a significant risk reduction for primary patency loss favouring CS (hazard ratio [HR] 0.58, 95% CI 0.35 - 0.95) (GRADE, very low). The 48 month primary patency for CS and BMS when treating TransAtlantic InterSociety Consensus (TASC) C and D lesions was 92.4% (95% CI 84.7 - 100%) (GRADE, moderate) and 80.8% (95% CI 64.5 - 100%) (GRADE, low), with CS displaying a decreased risk for patency loss (HR 0.39, 95% 0.27 - 0.57) (GRADE, moderate). While statistically non-significant differences were identified between CS and BMS regarding technical success, 30 day mortality, intra-operative and immediate post-operative procedure related complications, and major amputation, CS displayed a decreased re-intervention risk (risk ratio 0.59, 95% CI 0.40 - 0.87) (GRADE, low).
CONCLUSIONS: This review has illustrated the improved patency of CS compared with BMS in the treatment of TASC C and D lesions. Caution is advised in interpreting overall primary patency outcomes given the substantial inclusion of TASC C and D lesions into the analysis. Ultimately, both stent types have demonstrated comparable safety profiles.

OBJECTIVE: To explore the relationship between the retroperitoneal vasculature and anterior surface of the lower spine, and to establish values for aiding in prediction of the pertinence of anterior approach at the L4-L5 and L5-S1 intervertebral discs.
METHODS: The study included 13 fresh human cadavers. After exploration of the abdominal cavity and removal of the visceral organs, the vasculature, and anterior spinal surface were revealed beneath the lower extension of the perirenal fascia. Morphometric measurements of the great vessels and the intervertebral discs were obtained. All measurements were analyzed and presented as mean and standard deviation. Differences in the values between sexes were assessed.
RESULTS: The anterior height of the L4-L5 and L5-S1 intervertebral disc was 6.8 ± 0.81 mm and 6.7 ± 0.99 mm, respectively. The widths of the aorta, inferior vena cava, right and left common iliac arteries, and right, and left common iliac veins were 16.4 ± 3.58, 20.6 ± 3.36, 11.5 ± 2.32, 11.5 ± 2.43, 14.7 ± 3.13, and 15.5 ± 3.27 mm, respectively. The mean aortic bifurcation angle was 45.5°. The aortic bifurcation was located above the lower endplate of the L4 vertebrae in 53.8% of the cadavers. The area of the interarterial and interiliac trigones was 14.6 ± 5.33 cm < sup > 2 < /sup > and 7.1 ± 4.35 cm2, respectively. No statistically significant differences were noted between the sexes.
CONCLUSIONS: An elaborate radiological examination of the vasculature should be performed prior to surgery to avoid unwanted vascular complications during the anterior approach. Knowing the area of the interarterial and interiliac triangles and the aortic bifurcation location could be aid in assessing the safe working zone.