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.

Morphohistological analysis of the prevalence and distribution of atheroma in the abdominal aorta and its branches: a cadaveric study / Análise morfo-histológico sobre prevalência e distribuição de ateroma na aorta abdominal e em seus ramos: estudo em cadáveres

Abstract Background Aneurysms and atheromatous processes are prominent pathological features that are commonly associated with significant morbidity and mortality. Objectives This cadaveric study was conducted to evaluate the morphometric and histological aspects of atheromatous plaque formation in abdominal aortas and their branches and their associated morphological variations, if present, characterized by loops, kinking, or tortuosity. Methods The study was performed using 30 human cadavers (approx. 65-75 years). Frequency of occurrence of calcified plaques in the abdominal aorta and its branches and their morphometric measurements were noted and histological features were observed with the aid of Hematoxylin & Eosin staining. Results Variations in the abdominal aorta and the common iliac artery were observed in 16.6% of specimens. Atheromatous plaque formation was seen in 2 specimens (1 specimen was associated with kinking) while in 3 other specimens only variation in normal structure (kinking/ tortuous artery) was observed. Histological analysis showed foamy macrophages and dense calcification, giving an atheromatous appearance. Conclusions Cadaveric reports of the location, nature, and degree of plaque formation in the abdominal aorta and its branches are extremely important in clinical settings and for choosing treatment options.

Resumo Contexto Aneurismas e processos ateromatosos são características patológicas perceptíveis que costumam estar associadas a morbidade e mortalidade significativas. Objetivos Este estudo em cadáveres teve como objetivo avaliar os aspectos morfométricos e histológicos da formação de placa ateromatosa na aorta abdominal e em seus ramos com suas subsequentes variações morfológicas caracterizadas por enrolamentos, acotovelamentos ou tortuosidades, se presentes. Métodos O estudo foi realizado com 30 cadáveres humanos (aproximadamente 65-75 anos). Foi descrita a frequência de ocorrência de placas calcificadas na aorta abdominal e em seus ramos com as respectivas medidas morfométricas e características histológicas com auxílio da coloração por hematoxilina e eosina. Resultados Variações na aorta abdominal e na artéria ilíaca comum foram observadas em 16,6% dos espécimes. A formação de placa ateromatosa foi observada em dois espécimes (um espécime foi associado a acotovelamento), enquanto em outros três espécimes houve apenas variação na estrutura normal (acotovelamento/artéria tortuosa). A análise histológica mostrou macrófagos espumosos e calcificação densa, o que gerou uma impressão ateromatosa. Conclusões Os estudos em cadáveres sobre localização, natureza e grau de formação de placa na aorta abdominal e em seus ramos são extremamente importantes para os cenários clínicos e as opções de tratamento.

Identificação pela ultrassonografia vascular da compressão da veia ilíaca comum esquerda em mulheres assintomáticas: ortostatismo pode influenciar o diagnóstico? / Left common iliac vein compression identified by vascular ultrasonography in asymptomatic women: does standing position influence diagnosis?

Resumo Contexto A ultrassonografia vascular é o exame de imagem de escolha para rastreamento inicial da compressão na veia ilíaca comum esquerda, cujo achado assintomático pode ser encontrado em até 25% em algumas casuísticas. Objetivo Identificar, pela ultrassonografia vascular, se há diferença na avaliação da compressão na veia ilíaca comum esquerda em mulheres assintomáticas em decúbito dorsal e ao ortostatismo. Métodos Trata-se de um estudo observacional transversal em 50 mulheres voluntárias, sem sintomas de compressão venosa pélvica. Os parâmetros avaliados pela ultrassonografia vascular em decúbito dorsal e ao ortostatismo foram os diâmetros e as velocidades máximas na veia ilíaca comum esquerda no local do cruzamento com a artéria ilíaca comum direita e antes desse cruzamento, além dos índices de velocidade na veia ilíaca comum esquerda no local do cruzamento. Resultados Foram identificados oito casos de compressão significativa na veia ilíaca comum esquerda na avaliação em decúbito dorsal (16%) e somente dois casos (4%) ao ortostatismo. Os diâmetros na veia ilíaca comum esquerda foram estatisticamente maiores (p = 0,002) no local de cruzamento com a artéria ilíaca comum direita ao ortostatismo, e as velocidades e índices de velocidades foram estatisticamente maiores (p < 0,001) em decúbito dorsal. Não houve identificação de compressão significativa na veia ilíaca comum esquerda em ortostatismo quando os índices de velocidades estavam normais em decúbito dorsal. Conclusão Não houve diferença na detecção de compressão significativa da veia ilíaca comum esquerda ao ortostatismo em relação ao decúbito dorsal; no entanto, o estudo mostrou que pode haver menor compressão anatômica da veia ilíaca comum esquerda em posição ortostática.

Abstract Background Vascular ultrasonography is the imaging exam of choice for initial screening for left common iliac vein compression, which is an asymptomatic finding that can be detected in up to 25% of some patient samples. Objective To determine, using vascular ultrasonography, whether findings of left common iliac vein compression in asymptomatic women are different when assessed in the prone and standing positions. Methods This is a cross-sectional observational study of 50 adult female volunteers with no symptoms of pelvic venous compression. The parameters assessed with vascular ultrasonography in the prone and standing positions were diameters and maximum velocities of the left common iliac vein at the point at which it crosses behind the right common iliac artery and before this point, in addition to left common iliac vein velocity indices at the crossing. Results Eight cases of significant compression of the left common iliac vein were identified when assessed in prone position (16%) and just two cases (4%) were identified in the standing position. Left common iliac vein diameters were statistically larger (p = 0.002) at the point where it crosses behind the right common iliac artery in the standing position and velocities and velocity indices were statistically higher (p < 0.001) in the prone position. No significant compression of the left common iliac vein was identified in the standing position when velocity indices were normal in the prone position. Conclusions There was no difference in detection of significant compression of the left common iliac vein when assessed in the standing position in comparison with assessment in the prone position. However, the study showed that anatomic compression of the left common iliac vein may be reduced in the standing position.

Anastomosis entre vasos ilíacos y obturadores en la región retropúbica: estudio en cadáveres / Anastomosis among iliac vessels and obturators in the retropubic region: study in cadavers

Introducción: En las cirugías de la región retropúbica, la sección o ruptura de la anastomosis puede causar graves hemorragias de difícil control. Nuestro objetivo fue verificar la presencia o no de anastomosis arterial o venosa entre los vasos ilíacos y obturadores en la región retropúbica. Materiales y Métodos: Treinta cadáveres (14 hombres/16 mujeres; 60% de raza blanca y 40%, no blanca). Después de la disección, se verificó si había anastomosis y su distancia de la sínfisis púbica. Resultados: El 13,3% no tenía comunicación y el 86,6% tenía algún tipo de anastomosis (p <0,01), la anastomosis venosa fue la más frecuente (p <0,05). La distancia promedio entre la anastomosis y la sínfisis púbica fue de 5,7 cm. Al comparar el sexo, la anastomosis y el lado, el 57% de los hombres presentaba anastomosis en ambos lados, y el 81% y 88% de las mujeres la tenían en el lado derecho e izquierdo, respectivamente (p <0,05). Cuando se comparó la presencia de anastomosis con el lado, el 70% estaba en el derecho y el 73%, en el izquierdo (p >0,05). El 72% de los blancos y el 67% de raza no blanca tenían anastomosis (p >0,05). Conclusiones: La presencia de anastomosis es más frecuente que la ausencia y no existe diferencia significativa en cuanto al lado. Está localizada, en promedio, a 5,7 cm de la sínfisis púbica y la venosa es significativamente más frecuente. Es significativamente más frecuente en las mujeres. No hay diferencia estadística en cuanto a la presencia de anastomosis entre la raza blanca y no blanca. Nivel de Evidencia: IV

Introduction: During surgical interventions, section or rupture of the anastomosis may cause severe difficult-to-control bleeding. The aim of this study was to verify the presence or absence of arterial or venous anastomosis among iliac and obturator vessels in the retropubic region. Methods: Thirty cadavers (14 men/16 women; 60% white and 40% non-white). After dissection, the presence of anastomosis and its distance from the pubic symphysis were verified. Results: The 13.3% presented no communication and 86.6% presented some type of anastomosis (p<0.01). Venous anastomosis was more frequent (p<0.05). The mean distance from anastomosis to pubic symphysis was 5.7 cm. Regarding sex and side, 57% of male specimens presented anastomosis on both sides, while 81% and 88% of women had on the right and left side, respectively (p<0.05). Seventy percent of specimens had anastomosis on the right side and 73% on the left (p>0.05). Anastomosis was observed in 72% of whites and 67% of non-whites. Conclusions: Presence of anastomosis is more frequent than its absence, and there is no significant difference regarding side. It is located at 5.7 cm from the pubic symphysis and venous anastomosis is significantly more frequent. Anastomosis is significantly more frequent in females. There is no statistically significant difference between white and non-white races. Level of Evidence: IV

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.

Rare origin of the obturator artery from the external iliac artery with two obturator veins / Origem rara de artéria obturatória a partir da artéria ilíaca externa acompanhada por duas veias obturatórias

Abstract The obturator artery is a branch of the internal iliac artery, although there are reports documenting variations, with origin from neighboring vessels such as the common iliac and external iliac arteries or from any branch of the internal iliac artery. It normally runs anteroinferiorly along the lateral wall of the pelvis to the upper part of the obturator foramen where it exits the pelvis by passing through said foramen. Along its course, the artery is accompanied by the obturator nerve and one obturator vein. It supplies the muscles of the medial compartment of the thigh and anastomoses with branches of the femoral artery on the hip joint. We report a rare arterial variation in a Brazilian cadaver in which the obturator artery arose from the external iliac artery, passing beyond the external iliac vein toward the obturator foramen, and was accompanied by two obturator veins with distinct paths. We also discuss its clinical significance.

Resumo A artéria obturatória é um ramo da artéria ilíaca interna, embora haja grande variabilidade a respeito de sua origem, pois tal vaso pode surgir de diversas artérias vizinhas, como a artéria ilíaca comum e a artéria ilíaca externa, assim de como qualquer ramo da artéria ilíaca interna. Normalmente, a artéria obturatória corre anteroinferiormente pela parede lateral da pelve até a porção superior do forame obturatório, ponto em que sai da pelve. No seu trajeto, a artéria é acompanhada pelo nervo e veia obturatórios. Ela supre os músculos do compartimento medial da coxa e possui anastomoses com ramos da artéria femoral na articulação do quadril e coxa. Este trabalho visa relatar e discutir os aspectos clínicos de uma variação incomum na artéria obturatória, na qual ela se origina da artéria ilíaca externa acompanhada de duas veias obturatórias com trajetos distintos.

Clinical importance of a star shaped branch of internal iliac artery and unusual branches of an abnormal obturator artery: rare vascular variations / Importância clínica de um ramo estrelado de artéria ilíaca interna e de ramos incomuns de artéria obturatória anormal: variações vasculares raras

The internal iliac artery (IIA) is one of the branches of the common iliac artery and supplies the pelvic viscera, the musculoskeletal part of the pelvis, the gluteal region, the medial thigh region and the perineum. During routine cadaveric dissection of a male cadaver for undergraduate Medical students, we observed variation in the course and branching pattern of the left IIA. The artery gave rise to two common trunks and then to the middle rectal artery, inferior vesicle artery and superior vesicle artery. The first, slightly larger, common trunk gave rise to an unnamed artery, the lateral sacral artery and the superior gluteal artery. The second, smaller, common trunk entered the gluteal region through the greater sciatic foramen, below the piriformis muscle and presented a stellate branching pattern deep to the gluteus maximus muscle. Two of the arteries forming the stellate pattern were the internal pudendal artery and the inferior gluteal artery. The other two were muscular branches.

A artéria ilíaca interna (AII) é um dos ramos da artéria ilíaca comum e supre as vísceras da pelve, a parte musculoesquelética da pelve, a região glútea, a região medial da coxa e o períneo. Durante a dissecção de rotina realizada em um cadáver do sexo masculino para estudantes de Medicina, observamos uma variação no curso e padrão de ramificação da AII esquerda. A artéria deu origem a dois troncos comuns e então à artéria retal média, artéria vesical inferior e artéria vesical superior. O primeiro tronco comum, ligeiramente maior, deu origem a uma artéria sem nome, à artéria sacral lateral e à artéria glútea superior. O segundo tronco comum, menor, adentrou a região glútea através do forame ciático maior, abaixo do músculo piriforme, e apresentou um padrão estrelado de ramificação na parte profunda do músculo glúteo máximo. Duas das artérias que formaram o padrão estrelado foram a artéria pudenda interna e a artéria glútea inferior. Os outros dois ramos eram musculares.

Importância da preservação da artéria ilíaca circunflexa superficial do abdome na prevenção das necroses da parede abdominal em pacientes submetidas a miniabdominoplastias: estudo anatômico cirúrgico descritivo prospectivo / Importance of superficial circumflex iliac artery preservation to prevent abdominal wall necrosis in patients who underwent mini-abdominoplasty: an surgical-anatomic descriptive and prospective study

INTRODUÇÃO: A abdominoplastia é o terceiro procedimento mais realizado em cirurgia plástica. Na intenção de evitar complicações cirúrgicas, foi feito o estudo da artéria ilíaca circunflexa superficial do abdome (AICS), investigando a importância da sua preservação nestas cirurgias, como um dos fatores de alta importância na prevenção das necroses. MÉTODOS: O presente estudo anatômico prospectivo foi realizado no Serviço de Cirurgia Plástica do Hospital Agamenon Magalhães. Trinta e três pacientes foram submetidos à dermolipectomia abdominal à Pitanguy, com os retalhos cirúrgicos ressecados sendo submetidos a estudos hemodinâmicos para análise do território anatômico irrigado pela AICS. RESULTADOS: Foram operados 82 pacientes, sendo selecionados 33 que preencheram os critérios de inclusão para este estudo, seis (18,9%) foram excluídos por motivos técnicos. O grupo de pacientes em estudo apresentou faixa etária entre 23 e 49 anos (36,6 ± 7,5). O Índice de Massa Corporal variou de 22,0 a 30,5 (24,9 ± 2,1). O peso das peças cirúrgicas ressecadas variou de 450 a 1010 gramas (623,1 ± 141,5), o teste de Pearson entre IMC e peso das peças demonstrou importante correlação r = 0,91 e r2 = 0,83. Trinta e dois eram femininos (97%) e um masculino (3%). Uma paciente era portadora de hipertensão arterial sistêmica (3%). Vinte e sete eram pardos (81,8%), dois brancos (6,1%), três negros (9,1%) e um da raça indígena (3,0%). Nos estudos hemodinâmicos, as imagens e filmes obtidos demonstraram que a injeção do contraste iodado na AICS foi considerada adequada, compatível com o objetivo do trabalho em 25 (92%) pacientes e inadequada em dois (8%) pacientes. CONCLUSÃO: Os resultados hemodinâmicos deste estudo levam à conclusão que a preservação da AICS do abdome nas miniabdominoplastias tem relevante importância na prevenção das necroses da parede abdominal.

complications, a study of the superficial circumflex iliac artery of the abdomen (SCIA) was carried out to investigate the importance of this artery preservation in abdominoplasties as one of the high importance factors to prevent necrosis. METHODS: This prospective study was carried out at the Plastic Surgery Service of the Agamenon Magalhaes Hospital. We included 33 patients who underwent abdominoplasty using Pitanguy's technique where the resected surgical flaps underwent hemodynamic studies to analyze the anatomical area irrigated by SCIA. RESULTS: A total of 82 patients underwent surgery, of them 33 met the study inclusion criteria, and 6 (18.9%) were excluded for technical reasons. Patients' age ranged from 23 and 49 years (36.6±7.5), their body mass index (BMI) ranged from 22.0 to 30.5 (24.9 ± 2.1), and weight of resected surgical specimens ranged from 450 to 1010 grams (623.1 ± 141.5). Pearson's test between BMI and weight of surgical specimens showed significant correlation r = 0.91 and r2 = 0,83. We included in the study 32 women (97%) and 1 man (3%). One patient had hypertension (3%). Of the sample, 27 patients were pardo (81.8%), 2 white (6.1%), 3 black (9.1%) and 1 native south American (3.0%). In hemodynamic studies, images and videos obtained showed that injection of iodinated contrast in SCIA were considered adequate, and consistent with the objective of this study in 25 (92%) patients and inadequate for 2 (8%) patients. CONCLUSION: Hemodynamic results of our study indicated that preservation of SCIA of the abdomen in mini-abdominoplasties is important to prevent necrosis of abdominal wall.

Corona mortis: importancia anatomo ­ clínica y ocurrencia en una muestra de la población colombiana / Corona mortis: anatomical and clinical relevance and occurrence in a sample of the Colombian population

Corona mortis es una variación anatómica referida a la anastomosis de los vasos iliacos externos e internos, mediante vasos que se arquean por encima y por detrás del ramo superior del pubis. En caso de resultar lesionados iatrogénicamente, se pueden presentar hemorragias de difícil manejo. El objetivo del estudio fue caracterizar los vasos obturatrices en una muestra cadavérica de la población colombiana, para determinar su morfometría y la frecuencia con que se presentan los diferentes patrones venosos y arteriales. Se estudiaron hemipelvis de 14 cadáveres, pertenecientes al anfiteatro del Departamento de Morfología de la Universidad del Valle en Cali, Colombia. Tras acceder a la cavidad pélvica y completar la disección de todos los vasos que se relacionaban con el canal obturador y la cara pélvica del ramo superior del pubis, se determinaron sus características morfológicas y sus dimensiones. Las variaciones arteriales, corona mortis y arteria obturatriz aberrante, se presentaron en el 35,7% de las hemipelvis y las variaciones venosas en el 82,1%. La arteria corona mortis sólo se presentó en el 3,6% de las hemipelvis y el 32,1% presentaron arteria obturatriz aberrante. La moda de las frecuencias absolutas de los patrones venosos fue la vena corona mortis que se presentó en el 75,0% de las hemipelvis. El conocimiento de los patrones arteriales y venosos de los vasos obturatrices y de sus variaciones anatómicas para la población colombiana es indispensable para evitar lesionarlos durante procedimientos clínico - quirúrgicos que comprometan el anillo pélvico anterior y la región inguinal.

The corona mortis is an anatomical variation related to the anastomosis between the internal and external iliac blood vessels, through certain arteries and veins that form arches above and behind the superior pubic ramous. Serious hemorrhages can result from iatrogenic injury of these vessels. The study objective was to characterize the obturator vessels in a sample of Colombian cadavers, to determine their morphometric features and the frequencies in which the arterial and venous patterns are present. Hemipelvises of 14 cadavers from the dissection room of the Department of Morphology at the Universidad del Valle, in Cali, Colombia, were taken as sample. Once the dissection of the vessels related with the obturator canal and the pelvic surface of the superior pubic ramous was completed, their morphological features were determined and measurements were taken of their diameters and lengths. The arterial variations, corona mortis and aberrant obturator artery, were present in 35.7% of the hemipelvises and the venous variations in 82.1%. The corona mortis artery was only present in 3.6% of the hemipelvises and 32.1% presented an aberrant obturator artery. The mode of the absolute frequencies of the venous patterns was the corona mortis vein, present in 75.0% of the hemipelvises. The knowledge of the arterial and venous patterns of the obturator vessels and their anatomical variations for the Colombian population is very important in order to avoid causing any injury to them in the course of clinical and surgical procedures that have to do with the anterior pelvic ring and the inguinal region.

Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique / Tratamento endovascular do aneurisma de aorta abdominal associado à dificuldade no acesso aórtico devido a artérias ilíacas de pequeno calibre: aplicação técnica do Endoconduíte

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

O tratamento endovascular para aneurisma de aorta abdominal (AAA) já está bastante difundido, sendo considerado como primeira escolha na maioria dos casos. Limitações no acesso pelas artérias ilíacas tortuosas, com estenoses, calibre pequeno ou doença oclusiva já foram contornadas com o uso de condutos, dissecção direta aortoilíaca, angioplastias, entre outros procedimentos. O objetivo deste desafio é mostrar as vantagens e limitações de cada alternativa, além de apresentar o resultado e as dificuldades com o endoconduíte.

Unusual branching pattern of external iliac artery: case report / Patrón inusual de ramificación de la arteria ilíaca externa: reporte de caso

During the routine dissection, a rare anomaly was observed in left lower limb of a female cadaver. The external iliac artery continued as femoral artery, branched on lateral side as the lateral circumflex femoral artery and on medial side as profunda femoris artery. On tracing the lateral circumflex femoral artery, the ascending branch towards the spinous anastomosis was very thin and coursed behind the rectus femoris muscle. The transverse and descending branches were not observed, however, the artery coursed along the vastus lateralis towards the knee. The femoral artery had its normal course and continued as popliteal artery. The profunda femoris artery originated from the medial side of the external iliac artery, initially superficial to the femoral vein, coursed downwards and posteriorly, relating posteromedial to femoral artery. The medial circumflex femoral artery originated as thin branch, which further divided into two divisions. The profunda femoris gave origin of 3 perforators and continued as 4th perforator. The unusual branching pattern was observed to be novel and not reported in the literature.

Durante una disección de rutina, se observó una rara anomalía en el miembro inferior izquierdo de un cadáver de sexo femenino. La arteria ilíaca externa dio origen en el lado lateral ala arteria circunfleja femoral lateral y en el lado medial a la arteria femoral profunda. En el recorrido de la arteria circunfleja femoral lateral, la rama ascendente era muy delgada y corría detrás del músculo recto femoral. No se observaron ramas transversales y descendente, sin embargo, la arteria descendió hacia la rodilla a lo largo del músculo vasto lateral. La arteria femoral tuvo su curso normal y continuó como arteria poplítea. La arteria femoral profunda, inicialmente superficial a la vena femoral, se dirigió inferior y posteriormente colocándose posteromedial a la arteria femoral. La arteria circunfleja femoral medial se originó como una rama delgada, que otorgó dos arterias. La arteria femoral profunda dio origen a tres ramas perforantes y continuó como cuarta perforante. Este patrón de ramificación inusual es una descripción nueva no reportada en la literatura.

Arteria circunfleja iliaca superficial: importancia anátomo quirúrgica / Superficial circumflex iliac artery. anatomical surgical importance

La arteria circunfleja ilíaca superficial es un pequeño vaso que se origina, generalmente, en la arteria femoral a nivel del triángulo femoral, dirigiéndose paralela al ligamento inguinal hacia la espina ilíaca anterosuperior. Actualmente es utilizada frecuentemente en colgajos libres llevados a cabeza, cuello, miembros e incluso en reconstrucciones peneanas. Disecamos 68 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 1,42 mm en promedio y la distancia desde su origen al ligamento inguinal fue de 15,1 mm. La arteria se originó directamente de la arteria femoral en 47 casos (69,1 por ciento); de un tronco común con la arteria epigástrica superficial en 14 (20,5 por ciento) y de la arteria circunfleja femoral lateral en tres casos (4,41 por ciento) y en otros cuatro orígenes (5,9 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, siendo fundamental para el éxito en la obtención de un buen colgajo.

The superficial circumflex iliac artery is a small vessel that originates, usually in the femoral artery at the femoral triangle, heading parallel to the inguinal ligament to the anterior superior iliac spine. Currently it is frequently used in free flaps for head, neck, limbs and even in penile reconstruction. We dissected 68 inguinal regions in corpses in formolized topographic anatomy courses of the Universidad de La Frontera, Chile and Federal University of São Paulo, Brazil. The superficial circumflex iliac artery had a diameter of 1.42 mm on average, and the distance from its origin to the inguinal ligament was 15.1 mm. The artery originated directly from the femoral artery in 47 cases (69.1 percent), from a common trunk with the superficial epigastric artery in 14 (20.5 percent) and the lateral femoral circumflex artery in three cases (4.41 percent) and four other sources (5.9 percent). Although it has a small diameter, superficial circumflex iliac artery is important for the anatomist as well as vascular and plastic surgeons, and essential for success in obtaining a good flap.

Reference Diameters of the Abdominal Aorta and Iliac Arteries in the Korean Population

PURPOSE: It is important to know the normal diameter of artery throughout the body so that clinicians are able to determine when an artery becomes aneurysmal. However, there are no previous studies on the normal diameter of arteries in the general Korean population. The purpose of this article is to determine the normal reference diameters of the abdominal aorta and iliac arteries in the Korean population. MATERIALS AND METHODS: We recruited the study population from three cities in Korea for the abdominal aortic aneurysm (AAA) screening. We measured the diameter of the aorta and iliac arteries. We analyzed the reference diameter of the population without AAA. The results were analyzed by Student's t-test and ANOVA on SPSS version 19. A p value <0.05 was considered to be statistically significant. RESULTS: One thousand two hundred and twenty-nine people were enrolled. 478 men and 751 women, with a mean age of 63.9+/-10.1 years (range 50 to 91) were examined. Eleven out of 1229 (0.89%) were diagnosed with AAA. In the population of 1218 people without AAA, the mean diameters (cm) of male/female were 2.20/2.11 (p<0.001) at suprarenal, 2.04/1.90 (p<0.001) at renal, 1.90/1.79 (p<0.001) at infrarenal, 1.22/1.17 (p<0.001) at right iliac and 1.47/1.15 (p=0.097) at the left iliac, respectively. There was a significantly larger diameter in the male population. The diameter of each level increased with age. CONCLUSION: The normal reference diameter of the infrarenal abdominal aorta in the Korean population is 1.9 cm in males and 1.79 cm in females. The diameter of the abdominal aorta increases with age.

Looped external iliac artery: a case report / Arteria ilíaca externa en bucle ­ reporte de caso

Variations of the external iliac artery are very rare. We found a rare variation in the left external iliac artery. The artery was long and formed a characteristic loop. The loop was found in the lesser pelvis in close relation to the obturator nerve. This loop may compress obturator nerve and vessels. The knowledge of this loop might be important for gynaecologists, orthopaedic surgeons and urologists since it may be involved in surgeries of hip, ovary and prostate...

Las variaciones de la arteria ilíaca externa son raras. Se encontró una variación poco frecuente en la arteria ilíaca externa izquierda. La arteria era larga y formaba un bucle característico. El bucle se encontró en la pelvis menor en estrecha relación con el nervio obturador. Este circuito puede comprimir el nervio obturador y los vasos circundantes. El conocimiento de este circuito podría ser importante para los ginecólogos, cirujanos ortopédicos y urólogos, ya que pueden estar involucrados en las cirugías de cadera, ovario y próstata...

Multidetector computed tomographic angiography evaluation of micropig major systemic vessels for xenotransplantation

Due primarily to the increasing shortage of allogeneic donor organs, xenotransplantation has become the focus of a growing field of research. Currently, micropigs are the most suitable donor animal for humans. However, no standard method has been developed to evaluate the systemic vascular anatomy of micropigs and standard reference values to aid in the selection of normal healthy animals as potential organ donors are lacking. Using 64-channel multidetector row computed tomographic angiography (MDCTA), we evaluated morphological features of the major systemic vessels in micropigs and compared our results to published human data. The main vasculature of the animals was similar to that of humans, except for the iliac arterial system. However, diameters of the major systemic vessels were significantly different between micropigs and humans. Specifically, the diameter of the aortic arch, abdominal aorta, external iliac artery, and femoral artery, were measured as 1.50 +/- 0.07 cm, 0.85 +/- 0.06 cm, 0.52 +/- 0.05 cm, and 0.48 +/- 0.05 cm, respectively, in the micropigs. This MDCTA data for micropig major systemic vessels can be used as standard reference values for xenotransplantation studies. The use of 64-channel MDCTA enables accurate evaluation of the major systemic vasculature in micropigs.

Aortic bifurcation: a cadaveric study of its relationship to the spine.

BACKGROUND: Vascular injuries are the main complication of the anterior approach to the lumbosacral spines. One of the key procedural steps is the identification and gentle manipulation of the aortic bifurcation to prevent the vascular injury and provide the adequate exposure during anterior lumbosacral operation. OBJECTIVE: The present study was to determine the level of abdominal aortic bifurcation in Thai cadavers. MATERIAL AND METHOD: The abdominal aortic bifurcation was studied on 187 cadavers (132 men, 55 women). The average ages of the cadavers were 67.3 +/- 0.8 years (range from 30 to 88 years). The accurate site of the abdominal aortic bifurcation was determined by the relationship of the bifurcation with the level of neighbor lumbosacral spine. RESULTS: The abdominal aorta descended and bifurcated into two common iliac arteries at the level of L4 vertebra in 131 cases (70.1%), at the fourth lumbar intervertebral disc in 23 cases (12.3%), and at the level of L5 vertebra in 33 cases (17.6%). CONCLUSION: The precise location of aortic bifurcation is useful for surgeons in the anterior approach of the lumbosacral spine to prevent harmful vascular injury.

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.

Abnormal branch of external iliac artery in the iliac fossa / Rama anormal de la arteria ilíaca externa en la fosa ilíaca

An abnormal artery arising from external iliac artery was found during routine dissection class for medical undergraduates. The artery took its origin from the external iliac artery midway between its origin from common iliac and termination as femoral artery. The abnormal artery divided into two branches; an ascending and a descending. The ascending branch supplied iliacus and iliac crest. The descending branch entered the femoral triangle by passing behind the femoral sheath. It supplied the muscles of femoral triangle and anastomosed with medial circumflex femoral artery. The knowledge of this variation may be of use for surgeons doing surgery of femoral hernia.

Una variación arterial proveniente de la arteria ilíaca externa fue encontrada durante una disección de rutina en Medicina de pregrado. La arteria se originaba de la arteria ilíaca externa a mitad de camino entre su origen desde la arteria ilíaca común y su terminación, la arteria femoral. La arteria se dividía en dos ramas: ascendente y descendente. La rama ascendente suministraba la irrigación al músculo ilíaco y a la cresta ilíaca. La rama descendente entraba en el trígono femoral pasando por detrás de la vaina femoral y daba la irrigación a los músculos del trígono femoral, anastomosándose con la arteria circunfleja femoral medial. El conocimiento de esta variación puede ser de utilidad para los cirujanos que realizan cirugía de hernia femoral.