Cephalocaudal relationship ofabdominal aortic bifurcation relative toumbilicus and iliac crest vertex:a comparative study from imaging anatomical prospective / 实用医学杂志

Objective To studythe cephalocaudal relationship ofabdominal aortic bifurcation relative toumbilicus and iliac crest vertex and their correlations with abdominal adipose tissue thickness and age. Methods The vertical distances,cephalocaudal relationship and other related anatomic parameters of aortic bifurcation relative to umbilicus and iliac crest vertex in 108 patientswere measured by consecutive abdominal CT scanning. The correlations of the acquired data with abdominal adipose tissue thickness and age were analyzed using Pearson correlation coefficient. Results Umbilicus was located at cephalad to aortic bifurcation in 67 patients(62.0%), caudal in 34(31.4%)andthe same level in 7(6.5%),with the vertical distance of(4.53 ± 17.51)mm to the aortic bifurcation. No statistically significant relationship was found between abdominal adipose tissue thickness(P>0.05) or age(P>0.05). Iliac crest vertex relative to aortic bifurcationwas located at cephalad,caudal and the same level in 31,71 and 6 patients,taking up 28.7%,65.7%and 5.6%,respectively. Its vertical distance to the bifurcation was(-6.34 ± 14.49)mm,nonrelated with abdominal adipose tissue thickness(P>0.05),but positively correlated with age(P<0.01). The difference in the cephalocaudal relationship of aortic bifurcation relative to umbilicus and iliac crest vertex was statistically significant(P<0.01). Conclusion Compared with iliac crest vertex,umbilicus is an important landmark of locating abdominal aortic terminal occlusion position in vitro because it mostly lies cephalad to aortic bifurcation in the front of the body,not easy to vary with abdominal adipose tissue thickness and age.

Morphometric analysis of the inferior vena cava related to lumbar vertebra and the aortic bifurcation on Multidetector Computed Tomography (MDCT) / Análisis morfométrico de la vena cava inferior relacionado con las vértebras lumbares en la bifurcación aórtica mediante Tomografía Computadorizada Multidetector (TCMD)

Vascular structures are in greater danger during lumbar surgery. The purpose of this study is to describe the morphology of the inferior vena cava (IVC) related to the lumbar vertebra and aortic bifurcation (AB) and assessing the role of demographic values in these relations to decrease the risk of complications in the surgical interventions. The study was performed on Multidetector Computed Tomography (MDCT) images of 100 male and 100 female cases with an age range from 50 to 84 years. The morphometric values of the IVC obtained from the coronal, sagittal and the axial reformatted images were measured and compared with the demographic values. The distance from the IVC to the 1st lumbar vertebra (L1) and 2nd lumbar vertebra (L2) were measured as (26.5 mm and 18.1 mm) in males and (21.1 mm and 14.2 mm) in females with a high level of significance between genders; the distance from the IVC to the iliocaval confluence (IC), 3rd lumbar vertebra (L3) and 4rd lumbar vertebra (L4) were measured as (6.5 mm, 10.5 mm and 6.9 mm) in males and (4.9 mm, 9.1 mm and 5.5 mm) in females with significance between genders. The level of the IC was detected 46 % of males, 39 % of females at the level of lower third of L4. The vertical distance between the IC and the AB was measured and negative correlation between genders based on age was detected. Demographic values are important to consider the relationship of the IVC, the lumbar vertebra and the AB. The IVC was located further from the lumbar vertebra in males compared to females. Age increase played role in the approaching of the AB and the IC to each other in both gender and the IC to the promontory level in males.

Las estructuras vasculares corren gran peligro durante la cirugía lumbar. El propósito de este estudio fue describir la morfología de la vena cava inferior (VCI) en relación con las vértebras lumbares y la bifurcación aórtica (BA), junto con evaluar los valores demográficos de estas relaciones para disminuir el riesgo de complicaciones en las intervenciones quirúrgicas. Se utilizaron tomografías computadorizadas multidetector (TCMD) de 100 casos de hombres y mujeres entre 50 a 84 años de edad. Los valores morfométricos de la VCI se obtuvieron desde imágenes coronales y sagitales reformateadas, medidas y comparadas con los valores demográficos. Se midió la distancia de la VCI a la 1a (L1) y 2a vértebra lumbar (L2), en hombres de 26,5 mm y 18,1 mm respectivamente, y en mujeres de 21,1 mm y 14,2 mm, respectivamente, con un alto nivel de significancia entre el sexos. La distancia desde la VCI a la confluencia iliocava (CI), 3a (L3) y 4a vértebra lumbar (L4) fue para los hombres de 6,5 mm, 10,5 mm y 6,9 mm, respectivamente, y en mujeres de 4,9 mm, 9,1 mm y 5,5 mm respectivamente, con significancia entre los sexos. El nivel de la IC se detectó en 46 % de los varones y en el 39 % de las mujeres, a nivel de tercio inferior de L4. La distancia vertical entre la CI y la BA se tuvo una correlación negativa entre sexos en base a la edad. Los valores demográficos son importantes al considerar la relación de la VCI, las vértebras lumbares y la BA. La VCI se encuentra a una distancia mayor de las vértebras lumbares en hombres que en mujeres. El incremento de la edad jugó un papel importante en la aproximación de la BA y la IC, tanto entre sí como según sexo, con la CI a nivel del promontorio en los hombres.

The Results of Self-Expandable Kissing Stents in Aortic Bifurcation

PURPOSE: Kissing stent reconstruction is a widely used technique for the management of aortoiliac occlusive disease involving the aortic bifurcation or proximal common iliac arteries. The purpose of this study was to evaluate the results of self-expandable kissing stents in the aortic bifurcation. METHODS: We reviewed medical records of the patients treated with a kissing stent retrospectively from January 2007 to December 2012. The primary and secondary patencies were determined with Kaplan-Meier analysis, and Cox regression was used to determine the factors associated with patency. RESULTS: A total of 21 patients were included, and all were male (median age 53+/-15 years, range 48-78 years). Major symptoms were claudication (n=16, 61.9%), rest pain (n=5, 23.8%) and gangrene (n=5, 23.8%). Tans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II classification was A 2 (9.5%), B 5 (23.8%), C 7 (33.3%) and D 8 (38%). The mean follow-up was 40.7 months. Major complication occurred in only one case which consisted of distal limb ischemia by emboli. Six patients developed symptomatic restenosis or occlusion. There was no major amputation, but minor amputation occurred in 3 patients. There were 2 mortalities not associated with the procedure (lung cancer and intracranial hemorrhage). Primary patency was 89.6% at 1 year, 74.7% at 3 years and 64.0% at 5 years. Secondary patency was 94.1% at 1 year, 88.2% at 3 years and 68.6% at 5 years. No risk factors for restenosis or occlusion were identified. CONCLUSION: Self-expandable kissing stents can be used successfully with comparable patency for endovascular treatment of symptomatic atherosclerotic occlusive lesions in the aortic bifurcation area.

Vertical distance between umbilicus to aortic bifurcation on coronal view in Korean women

OBJECTIVE: To evaluate the vertical distance between umbilicus to aortic bifurcation on coronal view in Korean women and their relation with body mass index (BMI) and woman's age. METHODS: This retrospective study included 257 women who visited emergency center at university-based hospital from January to December 2011. All women underwent abdomino-pelvic computerized tomography (CT) due to various symptoms in a supine position. By using the electronic coronal CT images, the vertical distance between umbilicus and aortic bifurcation was measured. If aortic bifurcation was located below umbilicus, the distance was expressed as minus value (i.e., caudal to umbilicus). Age of woman, body weight, height and calculated BMI (kg/m2) were also recorded. RESULTS: Aortic bifurcation was located caudal to umbilicus in 52.9% and cephalad to umbilicus in 37.4%. The vertical distance had a negative relationship with BMI (r=.0.180, P=0.004), as well as woman's age (r=-0.382, P<0.001). However, a multivariate analysis revealed that the vertical distance had a significant negative relationship with woman's age (P<0.001) but not with BMI (P=0.510). An equation could be drawn to estimate the vertical distance by using woman's age and BMI: vertical distance (mm)=12.6-0.3x(age)-0.2x(BMI). CONCLUSION: The vertical distance from umbilicus to aortic bifurcation on coronal view showed a significant inverse correlation with woman's age, however, the distances varied widely. Most older or obese Korean women had aortic bifurcation caudal to umbilicus.

The Anatomical Relationship of the Aortic Bifurcation and the Iliocaval Junction to the Lumbar Vertebrae in a Korean Population

PURPOSE: The objective of this study was to determine the anatomic significance and the level of the abdominal aortic bifurcation and the iliocaval junction in relation to the lumbar spine. METHOD: We conducted a retrospective study of 79 patients who underwent prosthetic replacement of an intervertebral disc by the anterior approach. The location of the aortic bifurcation and iliocaval junction and the size of the aorta and IVC were evaluated using CT angiography. The levels of the aortic bifurcation and iliocaval junction were recorded in relation to the upper or lower half of the adjacent vertebral body or intervertebral disc. RESULT: The aorta was bifurcated at the lower half of the L4 vertebral body in 35.4% of the cases. The iliocaval junction was between L4 and L5, and it was most often at the upper half of L5 (43.0%). CONCLUSION: The variability of the aortic bifurcation and iliocaval junction is high and an accurate description may be useful for using the various retroperitoneal approaches for not only aortic and venacaval surgery, but also for the anterior approach for spinal surgery.

Magnetic Resonance Image Findings of Lumbar Prevertebral Aortocaval Structures in Korean Spinal Disorder Patients

OBJECTIVE: The purpose of this study is to evaluate the level of lumbar spine corresponding to the prevertebral major vascular structures and the distance of the prevertebral available disc space (DPADS) of L5-S1 between the common iliac arteries and veins with preoperative magnetic resonance imaging (MRI) study. METHODS: Three hundred and forty seven lumbar MRI films (200males and 147females) from spinal disorder patients were reviewed. The patients' age ranged 14 to 86 years (mean 45 years). The patients were divided into eight groups by 10-year interval from a teen to the eighties. There were evaluated age-related locational changes in the level of lumbar spine corresponding to the aortic bifurcation (AB) and the origin of inferior vena cava (OIVC). In addition, DPADS of L5-S1 between the common iliac arteries and veins were measured. RESULTS: The common sites of the AB for the entire subject group were at the upper body of L4 (from the upper body of L3 to the lower body of L5). The common sites of the OIVC for the entire subject group were at the level of the L4-L5 disc space (from the upper body of L4 to the lower body of L5). The age-related changes in the location of the AB with a downward shift were statistically significant (p< 0.05). Similarly, age-related changes were observed in the OIVC, although this was more prominent in females (p<0.05). The average DPADS of L5-S1 was 34.48+/-10.00 mm. There were 27 cases(7.8%) who had the DPADS less than 20mm, and this narrow DPADS could make it very difficult to access the anterior disc space of L5-S1 because recently the popularly used anterior lumbar fusion materials were over 10 mm in diameter. CONCLUSION: These results may be helpful to minimize potential vascular injury and morbidity in anterior lumbar spinal surgery.

Radiologic Localization and Lengths of Umbilical Artery Catheter to Major Aortic Branches Determined by Ultrasonography in Neonates

PURPOSE: Incorrect positioning of umbilical artery catheter (UAC) results in an increased incidence of complications and erroneous pressure measurements. We radiologically localized major aortic branches and calculated the length of catheter from umbilicus to celiac artery, renal artery and aortic bifurcation for optimal positioning of UAC. To determine the neonatal body measurement that best predicts optimal UAC lengths, we studied three commonly used parameters-birth weight (BW), total body length (TBL) and shoulder-umbilicus length (SUL). METHODS: Fifty one high type of UAC were routinely identified by sonographic scanning from the epigastrium in longitudinal projection and 42 low type of UAC from the flank in coronal projection. The distances from the catheter tip to the celiac artery, the renal artery and to the aortic bifurcation were measured by electronic calipers and were compared with the length of the catheter from umbilicus to the tip on the chest anteroposterior radiograph. RESULTS: The celiac arteries originated from T10-T12, renal arteries Ll-L2, and aortic bifurcations L3-L5. There was positive correlation between BW, TBL or SUL and the length of catheter to the celiac artery (r2=0.476, 0.749 or 0.753), to the renal artery (r2= 0.785, 0.847 or 0.720), and to the aortic bifurcation (r2=0.714, 0.809 or 0.747). CONCLUSION: Although any one of the three parameters can be used clinically, we prefer the TBL and SUL parameters for its reliability and usefulness in emergency settings. The use of a new distribution plot of origins of major branches and regression equations for calculation of the lengths may help deciding the optimal position of UAC.