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

ABSTRACT

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.