PMC6120599_01
Computed tomography image obtained before the 1st operation demonstrates that the metastatic lymph node (white arrow) measuring 25 x 20 mm in size has invaded the sigmoid colon, the left internal iliac artery (black triangle), the left common iliac vein (white triangle), and the left ureter (white arrowhead).
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Preoperative computed tomography (CT) demonstrated that the metastatic lymph node invaded the sigmoid colon, the left internal iliac artery and vein, and the left ureter (Fig. 1).
Computed tomography image obtained before the 3rd surgery demonstrates a round soft tissue mass at the stump of the left internal iliac artery (white arrow).
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CT before the 3rd surgery suggested the possibility of a pseudoaneurysm at the stump of the left internal iliac artery (Fig. 2).
A: An intraoperative angiogram shows blood flow from the left common iliac artery to the left femoral artery without any extravasation from the stump of the left internal iliac artery (black triangle). B: A proximal plug (white arrow) has been placed in the left common iliac artery. C: A distal plug (black arrow) has been placed in the left external iliac artery. D: Schematic diagram showing catheter embolization using plugs.
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Adequate blood flow from the left common iliac artery to the femoral artery was confirmed angiographically, and no extravasation was observed from the stump of the left internal iliac artery (Fig. 3A). Paul, MN) devices placed proximal and distal to the stump of the left internal iliac artery (Fig. 3B-D).
A: Computed tomography image after the 4th operation demonstrates disappearance of the blood flow between the left common iliac artery and the external iliac artery following the use of plugs (white triangles), and thrombus formation can be visualized in the vessel between these 2 arteries. B: Three-dimensional (3-D) computed tomography image demonstrates good patency of the axillofemoral artery bypass (white arrowhead).
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Postoperative CT demonstrated complete obstruction of the segment between the left common and external iliac artery and good blood flow to the left lower extremity through the bypass (Fig. 4A, B).
Computed tomography image obtained on postoperative day 83 demonstrates the formation of an abscess (white arrow head) in the vicinity of the left iliac artery, which is occluded by plugs (white triangles).
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However, a pelvic abscess was observed to have developed on POD 83 (Fig. 5), which necessitated percutaneous ultrasonographically guided drainage.