Ileal artery

Ileal artery – the largest after an aorta a pair blood vessel five-seven centimeters long and with a diameter of 11-13 mm. Arteries begin in the place of bifurcation of an aorta, at the level of the fourth lumbar vertebra. In the field of a joint of ileal bones and a sacrum they break up to outside and internal ileal arteries.

The internal artery breaks up to branches - average pryamokishechny, iliolumbar, sacral, lateral, lower and upper buttock, lower vesical, internal sexual, locking. They deliver blood to bodies and internal walls of a pelvic cavity.

Outside artery, leaving a pelvic cavity, in passing gives to its walls several branches and in the lower extremities proceeds in the form of a femoral artery. Branches of a femoral artery (a deep artery, the lower epigastriß artery) deliver blood to skin and muscles to hips, and then branch on smaller arteries and provide blood supply of foot and a shin.

At men the ileal artery delivers blood to small egg covers, hip muscles, a bladder, penis.

Aneurism of an ileal artery

Aneurism of an ileal artery – sacculate protrusion of a vascular wall. The artery wall gradually loses elasticity and is replaced with connecting fabric. The hypertension, an injury, atherosclerosis can be the reasons of formation of aneurism.

Aneurism of an ileal artery long time can proceed without special symptoms. The pain syndrome in the location of aneurism arises if it, reaching the big sizes, begins to squeeze surrounding fabrics.

The rupture of aneurism can serve as the reason of gastrointestinal bleeding of not clear etiology, falling of arterial pressure, decrease in ChSS, a collapse.

Disturbance of blood supply in the field of an arrangement of aneurism can lead to thrombosis of a femoral artery, shin arteries, and also vessels of bodies of a small pelvis. Disturbances of a blood-groove are followed by dysuric frustration, pains. The thrombogenesis in shin arteries sometimes leads to development of paresis, the alternating lameness and emergence of disturbances of sensitivity.

Aneurism of an ileal artery is diagnosed by means of ultrasonography with duplex scanning, a computer tomography, MRT, an angiography.

Occlusion of ileal arteries

Occlusion and stenosis of an ileal artery most often arise owing to an obliterating thromboangitis, atherosclerosis of arteries, a fibromuscular dysplasia, an aortoarteriit.

At a stenosis of an ileal artery the fabric hypoxia develops, breaks fabric exchange. Reduction of oxygen tension in fabrics leads to a metabolic acidosis and accumulation of nedookislenny products of metabolism. At the same time aggregation and adhesive properties of thrombocytes increase, and dezagregatsionny properties decrease. Viscosity of blood increases, and it inevitably leads to formation of blood clots.

Distinguish the following types of occlusion of ileal arteries (depending on an etiology): a nonspecific aortitis, the mixed form of arteritis, an aortitis and atherosclerosis, iatrogenic, post-embolic, posttraumatic occlusions. Depending on the nature of defeat distinguish chronic occlusion, acute thrombosis, a stenosis.

Occlusion of ileal arteries is followed by emergence of a number of syndromes. The syndrome of ischemia of the lower extremities is shown in the form of the paresthesia slight for fatigue and the alternating lameness, numbness and a chill of the lower extremities. The syndrome of impotence is shown in ischemia of bodies of a small pelvis and a chronic circulatory unefficiency of lower parts of a spinal cord.

Conservative treatment of occlusion of ileal arteries is applied to normalization of processes of a blood coagulation, stopping of a pain syndrome, expansion of collaterals and removal of vasospasms.

In case of conservative therapy of the struck vessels it is possible to apply the following medicines:

• means of ganglioblokiruyushchy action (Mydocalmum, Bupatolum, Vasculatum);
• means of a pancreas (dilminat, angiotrophine, андекалин);
• spasmolytic medicines (Nospanum, papaverine).

Serve as surgical indications:

• the expressed alternating lameness or rest pain;
• necrotic changes of tissues of extremity (urgent operation);
• embolism of large and average arteries (immediate surgery).

Methods of surgical treatment of occlusion of ileal arteries:

• resection of an affected area of an artery and its replacement with a transplant;
• endarterectomy – opening of a gleam of an artery and removal of plaques;
• combination of shunting and resection to endarterectomy;
• lumbar sympathectomy.

Now the method of X-ray endovascular dilatation quite often is applied to recovery of the arteries affected with a stenosis. This method with success is applied as addition to reconstructive operations at multiple defeats of vessels.