Anatomical study and clinical importance of the inferior epigastric artery / Estudio anatómico e importancia clínica de la arteria epigástrica inferior

SUMMARY: The inferior epigastric artery (IEA) is a major blood vessel that supplies the anterior abdominal wall. The aim of the current study was to provide clinicians, surgeons, and obstetricians with sufficient anatomical data on the inferior epigastric artery, such as its origin and branching pattern. The study included 20 embalmed cadavers, these cadavers were dissected, and the inferior epigastric artery and vena comitans/venae comitantes were identified and traced downwards to the external iliac vessels. The origins, caliber, course and pedicle length of both the artery and the vein(s) were studied. The inferior epigastric artery arose independently from the distal external iliac artery deep to the inguinal ligament in 19 (95 %) cadavers. The artery entered the rectus abdominis muscle at its middle third in 13 (65 %) cases and at its lower third in the remaining specimens. In this study, we found that the artery divided into two branches in 18 (90 %) of the cases; in the remaining two cases, it continued as one trunk. The average pedicle length was 7.2 cm. The mean caliber of the IEA was 3.7 mm. In 18 (90 %) dissections, the venous drainage consisted of a pair of venae comitantes that united to form a common vessel at their draining point on the external iliac vein. The average diameter was 3.9 mm. The current study focuses on the anatomical features of the inferior epigastric artery to increase the success rate of abdominal and pelvic operations in clinical practice.

RESUMEN: La arteria epigástrica inferior (AEI) es un vaso sanguíneo principal que irriga la pared abdominal anterior. El objetivo del presente estudio fue proporcionar a los médicos, cirujanos y obstetras suficientes datos anatómicos sobre la arteria epigástrica inferior, como su origen y patrón de ramificación. El estudio incluyó 20 cadáveres embalsamados, los que se disecaron y se identificó la arteria epigástrica inferior y la vena concomitante y se siguieron hasta los vasos ilíacos externos. Se estudiaron los orígenes, calibre, trayecto y longitud del pedículo tanto de la arteria como de la (s) vena (s). La arteria epigástrica inferior surgió independientemente de la arteria ilíaca externa profunda al ligamento inguinal en 19 (95 %) cadáveres. La arteria ingresó al músculo recto del abdomen en su tercio medio en 13 (65 %) casos y en su tercio inferior en las muestras restantes. En este estudio, encontramos que la arteria se dividió en dos ramas en 18 (90 %) de los casos; en los dos casos restantes, continuó como un tronco. La longitud media del pedículo fue de 7,2 cm. El calibre medio del AEI fue de 3,7 mm. En 18 (90 %) disecciones, el drenaje venoso consistió en un par de venas concomitantes las que formaron un vaso común en su punto de drenaje en la vena ilíaca externa. El diámetro medio fue de 3,9 mm. El estudio actual se centra en las características anatómicas de la arteria epigástrica inferior con el propósito de mejorar la tasa de éxito de las cirugías abdominales y pélvicas en la práctica clínica.

Corona Mortis: anatomical and surgical description on 60 cadaveric hemipelvises / Corona Mortis: descrição anatômica e cirúrgica em 60 hemipelvis cadavéricas

ABSTRACT Objective: to report the prevalence of arterial corona mortis and to describe its surgical and clinical applicabilities. Methods: We dissected 60 hemipelvises (50 men and 10 women) fixed in a 10% formalin solution for the purpose of gathering information on corona mortis. We measured the caliber and length of the obturator artery and its anastomotic branch with the aid of a digital caliper and submitted the data to statistical analyzes and comparisons with the GraphPad Prism 6 software. Results: arterial corona mortis was present in 45% of the studied sample. The most common origin of the obturator artery was the internal iliac artery; however, there was one exceptional case in which it originated from the femoral artery. The caliber of the anastomotic branch was on average 2.7mm, whereas the caliber of the obturator artery was 2.6mm. Conclusion: the vascular connections between the obturator, internal iliac, external iliac and inferior epigastric arterial systems are relatively common over the upper pubic branch. The diameter and a trajectory of the anastomotic artery may vary. Thus, iatrogenic lesions and pelvic and acetabular fractures can result in severe bleeding that puts the patient's life at risk.

RESUMO Objetivo: relatar a prevalência da corona mortis arterial e descrever suas aplicabilidades cirúrgicas e clínicas. Métodos: sessenta hemipelvises (50 homens e 10 mulheres) fixadas em uma solução de formalina a 10% foram dissecadas com o propósito de obter informações sobre a corona mortis. Medidas do calibre e comprimento da artéria obturatória e seu ramo anastomótico foram mensuradas com o auxílio de um paquímetro digital e submetidas a análises e comparações estatísticas no programa GraphPad Prism 6. Resultados: a corona mortis arterial esteve presente em 45% da amostra estudada. A origem mais comum da artéria obturatória foi da artéria ilíaca interna, porém, houve um caso excepcional no qual a artéria obturatória se originou da artéria femoral. O calibre do ramo anastomótico foi em média 2.7mm, enquanto que o calibre da artéria obturatória foi 2.6mm. Conclusão: as conexões vasculares entre os sistemas obturatório, ilíacos interno e externo e epigástrico inferior são relativamente comuns sobre o ramo superior da pube. O diâmetro e a trajetória dessa artéria anastomótica podem variar. Assim, lesões iatrogênicas, fraturas pélvicas e acetabulares podem resultar em hemorragias graves que colocam a vida do paciente em risco.

The inferior epigastric artery: anatomical study and clinical significance / Arteria epigástrica inferior: estudio anatómico y significancia clínica

The inferior epigastric artery usually arises from the external iliac artery. It may arise from different origin. The aim of current study is to provide sufficient date of the inferior epigastric artery for clinician, radiologists, surgeons, orthopaedic surgeon, obstetricians and gynaecologists. The current study includes 171 dissected cadavers (92 male and 79 female) to investigate the origin and branch of the inferior epigastric artery in United Kingdom population (Caucasian) as well as in male and female. The inferior epigastric artery found to be a direct branch arising independently from the external iliac artery in 83.6 %. Inferior epigastric artery arises from common trunk of external iliac artery with the obturator artery or aberrant obturator artery in 15.1 % or 1.3 %. Further, the inferior epigastric artery gives obturator and aberrant obturator branch in 3.3 % and 0.3 %. Therefore, the retropubic connection vascularity is 20 % which is more in female than male. As the retropubic region includes a high vascular variation, a great precaution has to be considered prior to surgery such as hernia repair, internal fixation of pubic fracture and skin flap transplantation. The radiologists have to report treating physicians to decrease intra-pelvic haemorrhage due to iatrogenic lacerating obturator or its accessory artery.

La arteria epigástrica inferior se origina generalmente de la arteria ilíaca externa, pudiendo presentar diferentes orígenes. El objetivo del presente estudio es proporcionar suficiente información de la arteria epigástrica inferior de su importancia para los clínicos, radiólogos, cirujanos, cirujanos ortopédicos, obstetras y ginecólogos. El estudio incluyó 171 cadáveres disecados (92 masculinos y 79 femeninos) pertenecientes a individuos caucásicos de Arabia Saudita con la finalidad de investigar el origen y las ramas de la arteria epigástrica inferior. La arteria epigástrica inferior fue hallada como rama directa independiente de la arteria ilíaca externa en un 83,6 %. La arteria epigástrica inferior se originaba de la arteria iliaca externa en un tronco común con la arteria obturatriz o arteria obturatriz accesoria en el 15,1 % y 1,3 %, respectivamente. La arteria epigástrica inferior daba una rama obturatriz y una obturatriz accesoria en el 3,3 % y 0,3 %, respectivamente. De esta manera, la vascularización retropúbica fue del 20 %, siendo mayor en mujeres que en hombres. Como la región retropúbica incluye una elevada variación vascular, esta arteria tiene que ser considerada antes del acto quirúrgico, como en los casos de la cirugía de hernia, la fijación interna en fracturas del pubis y el trasplante de colgajo de piel. Los radiólogos tienen que informar a los médicos tratantes de estas variaciones para contribuir en la disminución de la hemorragia intra-pélvica debido a la lesión iatrogénica de la arteria obturatriz o su arteria accesoria.

Absence of the celiac trunk and trifurcation of the common hepatic artery: a case report / Ausência de tronco celíaco e trifurcação da artéria hepática comum: relato de caso

Abstract Anatomical variations of the celiac trunk and its branches are particularly important from a surgical perspective due to their relationships with surrounding structures. We report here a particularly rare variant involving absence of the celiac trunk in association with trifurcation of the common hepatic artery. These variations were found in an adult male cadaver. We perform a review of the literature and discuss the clinical and embryological significance of these variations. Recognition of celiac trunk and hepatic artery variations is of utmost importance to surgeons and radiologists because multiple variations can lead to undue complications.

Resumo As variações anatômicas do tronco celíaco e seus ramos são particularmente importantes do ponto de vista cirúrgico devido a sua relação com as estruturas adjacentes. Nós descrevemos aqui uma variante particularmente rara envolvendo ausência do tronco celíaco associada a trifurcação da artéria hepática comum. Essas variações foram observadas no cadáver de um adulto do sexo masculino. Neste artigo revisamos a literatura e discutimos a significância clínica e embriológica dessas variações. O reconhecimento das variações do tronco celíaco e da artéria hepática é extremamente importante para cirurgiões e radiologistas uma vez que variações múltiplas podem levar a complicações inesperadas.

Variability in the origin of the obturator artery

INTRODUCTION: General surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery that crosses the superior pubic ramus and is susceptible to injuries during dissection of the Bogros space and mesh stapling onto Cooper's ligament. The obturator artery is usually described as a branch of the anterior division of the internal iliac artery, although variations have been reported. MATERIALS AND METHODS: The present study was conducted on 98 pelvic halves of embalmed cadavers, and the origin and course of the obturator artery were traced and noted. RESULTS: In 79 percent of the specimens, the obturator artery was a branch of the internal iliac artery. It branched off at different levels either from the anterior division or posterior division, individually or with other named branches. In 19 percent of the cases, the obturator artery branched off from the external iliac artery as a separate branch or with the inferior epigastric artery. However, in the remaining 2 percent of the specimens, both the internal and the external iliac arteries branched to form an anastomotic structure within the pelvic cavity. CONCLUSION: The data obtained in this study show that it is more common to find an abnormal obturator artery than was reported previously, and this observation has implications for pelvic surgeons and is of academic interest to anatomists. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these variations and their close proximity to the femoral ring.

The anatomy of superficial inferior epigastric artery flap / Anatomia do retalho com a artéria epigástrica superficial

PURPOSE: To describe the anatomical variations of superficial inferior epigastric artery (SIEA) flap as a muscle-sparing flap. METHODS: A series of 40 dissections were performed on 20 preserved or fresh male cadavers. The site origin and drainage of vessels, caliber, length, and correlation between diameter and length of pedicle were identified. RESULTS: The SIEA and SIEV were identified at inguinal ligament level in 38 (95 percent) and 40 (100 percent) dissections, respectively. The SIEA originated directly from a common femoral artery 22 (57.9 percent) or a common trunk with other arteries. The SIEA was found within 1 cm of the midpoint of the inguinal ligament in 33 of 38 cases. The meanSD length of SIEA was 3.041.73 (0.5-7) cm. The meanSD caliber of SIEA was 1.450.35 (0.7-2.1) mm. The length of SIEV ranged from 2.2 to 12 cm with a meanSD of 5.452.08 cm. The caliber of SIEV ranged from 1.6 to 4 mm with a meanSD of 2.140.45 mm. The length of SIEA correlated with caliber of arterial pedicle (p<0.001 and correlation coefficient = 0.517). CONCLUSION: The inferior epigastric artery flap can be applied to microsurgical flap transfer, potentially in breast reconstruction, hemifacial atrophy, phalloplasty, or when extremely large amounts of skin coverage are required.

OBJETIVO: Descrever as variações anatômicas do retalho muscular com artéria epigástrica superficial. MÉTODOS: Foram realizadas uma série de 40 dissecções em cadáveres do gênero masculino, preservados ou recentes, Foram identificados o local de origem e drenagem dos vasos: calibre, comprimento e correlação entre diâmetro e comprimento do pedículo. RESULTADOS: As artérias e veias epigástricas superficiais foram identificadas no nível do ligamento inguinal respectivamente em 38 (95 por cento) e 40 (100 por cento) das dissecções. A artéria epigástrica superficial originava diretamente da artéria femoral em 22 (57,9 por cento) ou de um tronco comum com outras artérias. A artéria foi encontrada em um cm do ponto médio do ligamento inguinal em 33 de 38 casos. A média do comprimento da artéria epigástrica superficial foi de 3.04 1.73 (0,5-7) cm. A média do calibre da artéria foi 1.45 0.35 (0.7-2.1). O comprimento da veia epigástrica superficial foi de 2.2 a 12 cm com média de 5.452.08 cm. O calibre da veia era de 1.6 a 4 mm com média de 2.140.45 mm. O comprimento da artéria epigástrica superficial foi correlacionado com o calibre do pedículo arterial. CONCLUSÃO: O retalho com a artéria epigástrica superficial pode ser aplicado em microcirurgia de retalhos, potencialmente em reconstrução mamária, atrofia hemifacial, faloplastia ou quando se faz necessário aplicar em perdas acentuadas de pele.

Anatomía y variaciones del tronco celíaco / Anatomy and variations of the celiac trunk

El objetivo de este estudio fue analizar la anatomía del tronco celíaco a través de sus diámetro, longitud, origen y variación de sus ramos. Fueron disecados 69 cadáveres fijados en formalina al 10 por ciento en los Laboratorios Anatomía de la Universidad Federal de Sao Paulo (UNIFESP/EPM), Universidad Lusíadas de Santos y Universidad Santo Amaro (UNISA), Brasil y 20 cadáveres del Servicio de Verificación de Óbitos de la Universidad Sao Paulo (USP) y de la Universidad Federal de Sao Paulo (UNIFESP/EPM), Brasil. Las disecciones de la región del tronco celíaco fueron realizadas después de hacerlo con la cavidad peritoneal. Los resultados obtenidos permitieron llegar a las siguientes conclusiones: 1) La longitud media del tronco celíaco hasta su primera rama, la arteria gástrica izquierda y/o esplénica en 81 cadáveres fue de 1,23 cm en el sexo masculino y 1,18 cm en el femenino. Verificamos como primer ramo del tronco celíaco, la arteria gástrica izquierda en 55 (67,90 por ciento), arteria esplénica en dos (2.47 por ciento), ambas en seis (7,41 por ciento), y en 18 (22,22 por ciento), las tres arterias trifurcándose en la misma altura formando el triple de Haller. 2) La medida de la longitud del tronco celíaco hasta su último ramo, la arteria hepática común y/o esplénica en 68 cadáveres, tuvo una longitud media de 1,74 cm en el sexo masculino y 1,74 cm en el femenino. Verificamos como último ramo del tronco celíaco, la arteria hepática común en 13 (19,12 por ciento), la arteria esplénica en cuatro (5.88 por ciento), ambas en 33 (48,53 por ciento) y en 18 (22,22 por ciento), las tres arterias trifurcándose en la misma altura. 3) La medida del diámetro del tronco celíaco en 77 cadáveres tuvo una mediana de 0.65 cm en el sexo masculino y 0,67 cm en el femenino. 4) La medida de la distancia entre el tronco celíaco y la arteria mesentérica superior en 76 cadáveres, tuvo una mediana de 0,72 cm en el sexo masculino y 0,74 cm en el femenino. 5) El tronco celíac...

The aim of this study was to analyze anatomy of the celiac trunk through its diameter, length, emission and variation of its branches. Sixty-nine cadavers fixed in 10 percent formalin solution were dissected in the anatomy laboratories of the Federal University of Sao Paulo (UNIFESP/EPM), Lusiadas of Santos University (UNILUS) and Santo Amaro University (UNISA) and 20 non-fixed cadavers from Death Verification Services, of the Sao Paulo University (USP) and Federal University of Sao Paulo (UNIFESP/EPM). Dissection of the trunk celiac of these cadavers was performed after opening of the peritoneal cavity. The obtained results allowed us to conclude the following: 1) Mensuration of the length from the celiac trunk up to its first branch, the left gastric and/or splenic artery in 81 cadavers with a mean length of 1.23 cm in males, and 1.18 cm in females. We verified as the first branch of the celiac trunk, the left gastric artery in 55 ( 67.90 percent), splenic artery in two (2.47 percent), both in six (7.41 percent), and in 18 (22.22 percent) the three arteries trifiircating at the same level, forming the Haller's tripod. 2) Mensuration of the length from the celiac trunk up to its last artery, the common hepatic and/or splenic artery in 68 cadavers, with a mean length of 1.74 cm in males, 1.74 cm in females. We verified as the last branch of the celiac trunk, the common hepatic artery in 13 (19.12 percent), the splenic in four (5.88 percent), both in 33 (48.53 percent) and 18 (22.22 percent) the three arteries trifiircating at the same level. 3) Mensuration of the celiac trunk diameter in 77 cadavers had a mean of 0.65 cm in males and 0.67 cm females. 4) Mensuration of the distance between the celiac trunk and superior mesenteric artery in 76 cadavers had a mean of 0.72 cm in males and 0.74 cm in females. 5) The celiac trunk emitted in 73 (82.02 percent) out of the 89 cadavers the left gastric, splenic and hepatic arteries. In the remaining 16(17.98 percent)...

Incidence of corona mortis; preperitoneal anatomy for laparoscopic hernia repair.

The present study 66 half pelvis of cadaver for vascular structure called corona mortis, vessel that connect between external iliac and internal iliac system. The vessel was found 77.27% and the incidence of aberrant is 13.6%. The average distance from symphysis pubis to the vessel is 5.28 cm and distance above superior pubic rami is 1.37 cm.

Aterogénesis de la arteria grastroepiplóica derecha en la población mexicana / Right gastro epiploic artery atherogenesis in mexican population

La aterosclerosis se ha convertido en un problema de salud pública en el mundo occidental y es la causa de 20 por ciento de la mortalidad en Estados Unidos por enfermedades cardiovasculares. Vineber y Miller iniciaron la cirugía para el tratamiento de la enfermedad coronaria en 1951, Kolesov realizó la primera anastomosis terminolateral a la arterial coronaria descendente anterior en 1964. Con los procedimientos de revascularización subsecuentes, se ha incrementado la supervivencia de la población y mejoró su calidad de vida. Los injertos arteriales tienen los mejores resultados en la cirugía de revascularización miocárdica. La arteria torácica interna izquierda (ATII) es hasta el momento actual la mejor elección; sin embargo, es necesario encontrar alternativas en los injertos para la revascularización miocárdica. Otras arterias utilizadas han sido: la arteria gastroepiplóica derecha, arteria epigástrica inferior y arteria radial. La arteria gastroepiplóica derecha (AGED), por sus características morfológicas y fisiológicas, se considera un injerto prometedor en estas cirugías a largo plazo.En la actualidad no existe información acerca de la aterosclerosis en la AGED en la población mexicana, situación que originó este trabajo. La muestra se obtuvo de cadáveres sin patología cardiovascular, se encontró un promedio de diámetro luminal de 1.4 mm con sólo 20 por ciento de aterosclerosis, siendo sólo 4 por ciento significativa, por lo que esta arteria se considera buen hemoducto alternativo.

Origen de la arteria circunfleja ilíaca superficial / Origin of the superficial circumplex iliac artery

La arteria circunfleja ilíaca superficial es un pequeño vaso que se origina, generalmente, en la arteria femoral a nivel del trígono femoral, dirigiéndose paralela al ligamento inguinal hacia la espina ilíaca anterosuperior. Aunque de pequeño calibre adquiere importancia en algunas intervenciones quirúrgicas de la región. Disecamos 50 regiones inguinales de cadáveres formolizados en la disciplinas de anatomía topográfica de las Universidades de La Frontera, Chile y Federal de Sao Paulo, Brasil. La arteria cincunfleja ilíaca superficial tuvo un diámetro externo de 1,4 mm en promedio y la distancia desde su origen al ligamento inguinal fue de 14,9 mm. La arteria se originó directamente de la arteria femoral en 33 casos (66 por ciento); de un tronco común con la arteria epigástrica superficial en 11 (22 por ciento) y de la arteria circunfleja femoral lateral en dos casos (4 por ciento). Aunque tiene un pequeño diámetro, la arteria circunfleja ilíaca superficial es importante tanto para el anatomista como para los cirujanos vasculares y plásticos, ya que irriga las regiones inguinal y abdominal y el conocimiento de sus características reforzaría a estos profesionales durante los procedimientos quirúrgicos realizados en dichas regiones