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.

Femoral Nerve in Femoral Triangle: A Morphometric Study with Clinical Relevance

Background: Femoral nerve is a nerve of choice forfemoral nerve blockade. It enters the femoral triangle atthe midinguinal point. However, this point of entry neednot be the same always. Aim and Objectives: This studyis aimed at measuring the morphometry of the femoralnerve with the help of bony landmarks. Material andmethods: Forty adult lower limbs were dissected andthe morphometry of the femoral nerve was studied.Results: The mean distance from the Anterior SuperiorIliac Spine (ASIS) to the pubic tubercle was 12.66 ±1.48 cm. We found the FN from the ASIS at a meandistance of 6.38 ± 1.45 cm. Also, the FN was at a meandistance of 6.76 ± 1.12 cm from the pubic tubercle. Themean length of the FN trunk below the inguinalligament, i.e., in the femoral triangle before the divisionwas 2.19 ± 0.34 cm. However, in 8 lower limbs, the FNtrunk was divided before entering the femoral triangle.Conclusion: The findings of our study serve as anenabling guide to the surgeons, neurologists andanesthetist's in detecting the FN for various clinical andsurgical procedures.

Iliopectineal Ligament As An Important Landmark In Ilioinguinal Approach Of The Anterior Acetabulum: A Cadaveric Morphologic Study

Background: The iliopectineal ligament is the most stout anterior part of the iliopectineal membrane. It separates“lacuna musculorum” laterally from “lacuna vasorum” medially. This ligament is an important guide in the safeanterior approach to the acetabulum.Aim of the work: To study the detailed anatomy of the iliopectineal ligament demonstrating its importance as asurgical landmark in the anterior approach to the acetabulum.Material and methods: The material of this work included eight adult formalin preserved cadavers. Dissection ofthe groin was done for each cadaver in supine position with exposure of the inguinal ligament. The iliopectinealligament and the three surgical windows in the anterior approach to the acetabulum were revealed.Results: Results described the detailed morphological anatomy of the iliopectineal ligament as regard its thickness,attachments and variations in its thickness. The study also revealed important anatomical measurements inrelation to the inguinal ligament. The distance between the anterior superior iliac spine (ASIS) to the pubictubercle ranged from 6.7 to 10.1 cm with a mean value of 8.31±1.3. The distance between the anterior superioriliac spine (ASIS) to the blending point of the iliopectineal ligament to the inguinal ligament ranged from 1.55 to1.92 cm with a mean value of 1.78±0.15.Conclusion: The iliopectineal ligament detailed morphology and attachments are crucial when planning to doanterior approach of the acetabulum to decrease incidence of iatrogenic injury to the femoral vessels.

Microanatomy of the lateral femoral cutaneous nerve in relation to inguinal ligament and its clinical importance / Microanatomia do nervo cutâneo femoral lateral em relação ao ligamento inguinal e sua importância clínica

BACKGROUND: A better knowledge of the composition and properties of connective tissue related to the Lateral Femoral Cutaneous Nerve (LFCN) and to the Inguinal Ligament may be important to understand the diagnosis and treatment applicable to injuries such as meralgia paresthetica. OBJECTIVE: To determine the relative amounts of the non-fascicular components in the following areas: (i) proximal to the inguinal ligament [LFCN-1], (ii) deep to the inguinal ligament [LFCN-2], or (iii) distal to LFCN-2 [LFCN-3]. These amounts were discriminated as adipose [FAT] and non-adipose (connective) [NON-FAT] tissues. METHOD: Samples of LFCN-1, LFCN-2 and LFCN-3 from 21 human cadaveric samples were used. Paraffin sections of these structures were processed by Masson's trichrome stain for connective tissue. The number of fascicles was counted in each of these structures; FAT and NON-FAT areas were determined in the non-fascicular areas of the structures. RESULTS: There were more fascicles in LFCN-3 vs. LFCN-1 or LFCN-2; there was more NON-FAT vs. FAT in LFCN-2 vs. LFCN-1 and LFCN-3; inversely, there was more FAT vs. NON-FAT in LFCN-3 vs. LFCN-1 and LFCN-2. All of these comparisons were statistically significant. CONCLUSION: The presence of a higher content of NON-FAT in LFCN-2 and FAT in LFCN-3 may help to explain meralgia paresthetica resulting from compression or focal entrapment of the Lateral Femoral Cutaneous Nerve as it passes deep relative to the inguinal ligament.

TEMA: Um melhor conhecimento da composição e propriedades do tecido conjuntivo relacionadas ao Nervo Cutâneo Femoral Lateral (NCFL) e ao Ligamento Inguinal pode ser importante para compreender o diagnóstico e o tratamento aplicável a lesões como a meralgia parestética. OBJETIVO: Determinar as quantidades relativas dos componentes não-fasciculares nas seguintes áreas: (i) proximal ao ligamento inguinal [NCFL-1], (ii) em profundidade ao ligamento inguinal [NCFL-2], ou (iii) distal a NCFL-2 [NCFL-3]. Esses valores foram discriminados como tecido conjuntivo adiposo [FAT] ou não-adiposo [NON_FAT]. MÉTODO: Foram utilizadas amostras de NCFL-1, NCFL-2 e NCFL-3 a partir de 21 amostras de cadáveres humanos. As secções em parafina destas estruturas foram processadas por coloração Masson para tecido conjuntivo. O número de fascículos foi contado em cada uma destas estruturas; áreas de gordura e sem gordura foram determinadas nas áreas não-fasciculares das estruturas. RESULTADOS: Foram contados mais fascículos em NCFL-3 vs. NCFL-1 ou NCFL-2; havia mais NON-FAT vs. FAT em NCFL-2 vs. NCFL-1 e NCFL-3; inversamente, houve mais FAT vs. NON-FAT em NCFL-3 vs. NCFL-1 e NCFL-2. Todas estas comparações foram estatisticamente significativas. CONCLUSÃO: A presença de um maior teor de NONFAT em NCFL-2 e FAT em NCFL-3 pode ajudar a explicar o aparecimento de paresthetica meralgia resultante da compressão ou encarceramento focal do Nervo Cutâneo Femoral Lateral que passa profundamente ao ligamento inguinal.

Study of Profunda Femoris Artery of Human Cadavers in Rajkot City, India.

Background: The profunda femoris artery is the major branch of the femoral artery. It is at critical place in relation to femoral artery for various interventions. Aim: To study the origin of profunda femoris artery. And to compare the cross sectional area of profunda femoris artery between right and left limbs. Material and methods: In this cross sectional study, 51 human femoral triangles from 26 (18 male and 08 female) human cadavers in P.D.U. Government Medical College, Rajkot were dissected and studied during regular dissection classes. Site of origin of profunda femoris artery was noted in relation to femoral artery. The distance of origin of profunda femoris artery from the midpoint of inguinal point was measured and noted. Circumference of profunda femoris artery at the level of origin was measured. The cross sectional area was calculated. Collected data was analyzed by standard statistical formulas with the help of Microsoft excel 2007 and Epi info TM 7 software. Result: Most common (52.95% cases) site of origin was posterolateral from femoral artery. The mean distance of origin of profunda femoris artery from the midpoint of inguinal ligament was 30.17 mm. There was no significant difference in cross sectional area of right and left profunda femoris artery (at 95% confidence interval) Conclusion: Profunda femoris artery is used for angiography, ultrasonography and cardiac catheterization also. It is the major blood supply of the thigh. Its relations with femoral artery, femoral vein and femoral nerve makes it important structure for clinicians. Variations in origin of profunda femoris artery must be considered to avoid complication like aneurism and faulty passage of the catheter. High origin of profunda femoris artery is more prone to damage while accessing femoral artery.

Analysis of the Height of Origin of Profunda Femoris Artery from the Femoral Artery with regards to the Inguinal Ligament.

Background and aims: To determine the place of height of origin of profunda femoris artery from the femoral artery with regards to the inguinal ligament. Materials and methods: Routine dissection of 6 formalin fixed cadavers (3 males and 3 females) on both lower limbs (totally 12 lower limbs) allotted for the first year students of Kanyakumari Government Medical College, Aasaripallam, Nagercoil. Result: Among them an unusual origin of profunda femoris artery was observed on the left lower limb in a 60 years old female cadaver (8.33%). The profunda femoris artery arose laterally about 0.5 cms from the femoral artery distal to the inguinal ligament. It arose normally on the right lower limb(3.5 cms from the inguinal ligament). Conclusion: A variance in height of origin of profunda femoris artery and its branches will cause changing in the calibers strongly influencing vascularisation quality of belonging flaps. In occlusion of the superficial femoral artery, the profunda femoris artery forms an effective collateral bed between iliofemoral segment and the popliteal artery and its branches. Percutaneous femoral artery cannulation can cause pseudo aneurysms. When this occurs the puncture site is frequently in the profunda femoris artery, where anatomic relationships make hemostasis difficult to achieve. These complications landed up in the study of relations of these arterial complications in the palpable landmarks.