ABSTRACT
SUMMARY: Clear awareness of the vascular variations is critical in surgeries, which may cause massive hemorrhage during surgical procedures. During educational dissection of a male cadaver, we encountered a combined variation of the left obturator artery and ipsilateral aberrant inferior epigastric artery. The left obturator artery originated from the external iliac artery, then coursed inward, adherent to the superior pubic ramus. The left inferior epigastric artery originated from the femoral artery, and coursed behind the femoral vein. These anatomical variations shown in one person were extremely rare. This is particularly true with regard to these variations while performing pelvic and inguinal region surgeries.
El conocimiento claro de las variaciones vasculares es fundamental en las cirugías, ya que pueden causar una hemorragia masiva durante los procedimientos quirúrgicos. Durante la disección educativa de un cadáver de sexo masculino, encontramos una variación combinada de la arteria obturatriz izquierda y la arteria epigástrica inferior ipsilateral aberrante. La arteria obturatriz izquierda se originaba en la arteria ilíaca externa, luego discurrió hacia medial, adhiriéndose a la rama púbica superior. La arteria epigástrica inferior izquierda se originaba en la arteria femoral y discurría por detrás de la vena femoral. Estas variaciones anatómicas mostradas en una sola persona son extremadamente raras. Esto es importante de conocer estas variaciones cuando se realizan cirugías de las regiones pélvica e inguinal.
Subject(s)
Humans , Male , Arteries/abnormalities , Groin/blood supply , Cadaver , Epigastric Arteries/abnormalities , Femoral Vein/abnormalitiesSubject(s)
Humans , Male , Middle Aged , Aneurysm, False/diagnostic imaging , Epigastric Arteries/abnormalities , DrainageSubject(s)
Epigastric Arteries/abnormalities , Groin/injuries , Iliac Artery/pathology , Vascular Malformations/diagnosis , Computed Tomography Angiography , Epigastric Arteries/diagnostic imaging , Groin/blood supply , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/injuries , Male , Middle Aged , Vascular Malformations/etiologySubject(s)
Epigastric Arteries/abnormalities , Gelatin Sponge, Absorbable/administration & dosage , Postpartum Hemorrhage/therapy , Uterine Artery Embolization/methods , Uterine Artery/abnormalities , Vascular Malformations , Adult , Angiography , Epigastric Arteries/diagnostic imaging , Female , Humans , Postpartum Hemorrhage/diagnostic imaging , Postpartum Hemorrhage/etiology , Treatment Outcome , Uterine Artery/diagnostic imaging , Vascular Malformations/diagnostic imagingABSTRACT
Fetus in fetu is a rare congenital condition where a vertebrate fetus is found within the body of its host twin. It features a monozygotic parasitic twin attached via a vascular anastomosis to its host circulation. This report describes an instance of fetus in fetu with a variant presentation of its vascular pedicle to its host via the inferior epigastric vasculature.
Subject(s)
Epigastric Arteries/abnormalities , Fetus/abnormalities , Adult , Epigastric Arteries/diagnostic imaging , Female , Fetus/blood supply , Fetus/diagnostic imaging , Humans , Infant, Newborn , Magnetic Resonance Imaging , Male , Pregnancy , Radiography , Ultrasonography, PrenatalABSTRACT
Aberrant obturator artery (AOA) is an anatomical variation in the origin and course of the obturator artery, which is clinically important because of their vulnerability during surgical procedures performed in the pelvis. This article describes the case of a symmetrical AOA found in both hemipelvises of a male cadaver. Morphological and morphometric characteristics are presented, while their clinical significance is discussed.
La arteria obturatriz aberrante (AOA) es una variación anatómica del origen y trayecto de la arteria obturatriz que tiene importancia clínica debido a su vulnerabilidad durante los procedimientos quirúrgicos realizados en la pelvis. En este artículo se describe el caso de una AOA simétrica encontrada en ambas hemipelvis de un cadáver masculino. Se presentan sus características morfológicas y morfométricas, y se discute su importancia clínica.
Subject(s)
Humans , Male , Iliac Artery/abnormalities , Pelvis/blood supply , Anatomic Variation , Epigastric Arteries/abnormalitiesABSTRACT
PURPOSE: Severe and life-threatening bleeding has been reported in the literature after retropubic mid-urethral slings procedure, due to corona mortis damage. The aim of this study is to evaluate safety of transobturator passage of the tape in stress-urinary incontinence (SUI) correction and anchoring the mesh in pelvic-organ prolapse (POP) repair in the presence of corona mortis. MATERIALS AND METHODS: Thirteen women with a pre-operatory contrast-enhanced abdominal multidetector computed tomography were prospectively enrolled in the study between January 2009 and December 2014. Eight women underwent a Monarc® and one a Spark® Sling System procedures for SUI correction, and three an Elevate® Anterior and Apical prolapse system and one a Perigee procedure to repair anterior/apical POP. All procedures were performed by a single experienced pelvic surgeon. RESULTS: Surgery was uneventful in all cases. No major bleeding was seen during surgery. No pelvic hematoma was identified 24 hours after the procedure. All women were discharged 1 day after surgery. CONCLUSIONS: Transobturator surgery seems to be a safe way in the presence of the corona mortis. However, further studies are needed to confirm these preliminary findings.
Subject(s)
Epigastric Arteries/abnormalities , Iliac Artery/abnormalities , Pelvic Organ Prolapse/surgery , Suburethral Slings , Urinary Incontinence, Stress/surgery , Aged , Female , Hematoma/epidemiology , Humans , Incidence , Postoperative Complications/epidemiology , Prospective StudiesABSTRACT
Surgical procedures in the pelvic region are very challenging because of the complex anatomy of this region. "Corona mortis" is a term used to describe retro-pubic anastomosis between the obturator and external iliac vessels. It is considered as a key structure as significant haemorrhage may occur if the vessels are cut accidentally during pelvic surgeries. Earlier studies have documented a high frequency of venous anastomosis compared to its arterial counterpart. The objective of our study was to document the prevalence of venous corona mortis in South Indian human adult cadaveric pelvises. We conducted this study on 73 cadaveric pelvic halves. Out of the 73 hemi pelvises, 36 were normal without any variations of the obturator vessels while 37 hemi pelvises (51%) showed the presence of abnormal obturator vessels which proves to be a very high incidence in terms of variations. Out of the 37 hemi pelvises, 25 (68%) showed the presence of 2 obturator veins, out of which 1 was normal and the other was an abnormal obturator vein. 8 hemi pelvises (22%) had only abnormal obturator vein. Most of the abnormal obturator veins drained into the external iliac vein, while two veins drained into inferior epigastric veins. Venous corona mortis is said to be frequently encountered during surgery and is considered to be as important as arterial corona mortis in its clinical implications. Individual evaluation of this risky anatomical structure should be done prior to any surgical interventions.
Subject(s)
Arteriovenous Anastomosis/pathology , Epigastric Arteries/abnormalities , Iliac Artery/abnormalities , Obturator Nerve/abnormalities , Pubic Bone/anatomy & histology , Pubic Symphysis/blood supply , Aged , Aged, 80 and over , Cadaver , Epigastric Arteries/anatomy & histology , Epigastric Arteries/pathology , Female , Humans , Iliac Artery/anatomy & histology , Iliac Artery/pathology , India , Male , Middle Aged , Obturator Nerve/anatomy & histology , Obturator Nerve/pathology , Prevalence , Pubic Bone/blood supply , Pubic Symphysis/anatomy & histology , Urologic Surgical ProceduresABSTRACT
No disponible
Subject(s)
Female , Humans , Neoplasms/congenital , Neoplasms/metabolism , Epigastric Arteries/abnormalities , Epigastric Arteries/injuries , Mucinosis, Follicular/pathology , Lymph Nodes/abnormalities , Neoplasms/complications , Neoplasms/pathology , Epigastric Arteries/metabolism , Epigastric Arteries/pathology , Mucinosis, Follicular/metabolism , Lymph Nodes/metabolismABSTRACT
Femoral artery is the major artery of the lower limb. It shows some variations in its branching pattern. One of the rare but clinically important variations is the origin of deep circumflex iliac and inferior epigastric arteries from it instead of from external iliac artery. We report here the origin of inferior epigastric and deep circumflex iliac arteries from the femoral artery bilaterally. Both the arteries passed up deep to the inguinal ligament and had a normal course and distribution after crossing the inguinal ligament. Knowledge of these variations is of importance in plastic surgery, anterior approach to the hip joint, draining psoas abscess or reducing a femoral hernia.
La arteria femoral es la principal arteria del miembro inferior. Se observan algunas variaciones en su patrón de ramificación. Una variante rara, pero clínicamente importante es el origen común de las arterias circunfleja iliaca profunda y epigástrica inferior no desde la arteria ilíaca externa. Presentamos el origen bilateral de las arterias epigástricas inferiores y circunfleja ilíaca profunda desde la arteria femoral. Ambas arterias pasaron profundas al ligamento inguinal y tuvieron un curso y distribución normal después de cruzar el ligamento inguinal. El conocimiento de estas variaciones son de importancia en la cirugía plástica, en el acceso anterior a la articulación de la cadera, el drenaje absceso del músculo psoas mayor o para reducir una hernia femoral.
Subject(s)
Humans , Male , Middle Aged , Femoral Artery/abnormalities , Iliac Artery/abnormalities , Epigastric Arteries/abnormalities , Thigh/blood supply , Anatomic Variation , Cadaver , DissectionABSTRACT
The rectus abdominis flap offers a number of advantages over other flaps used in head and neck reconstruction. The flap can be harvested by a separate team and can be tailored to include skin, muscle, and fat. In addition, the available vascular pedicle is long and its large caliber provides an appropriate size match with recipient neck vessels. Central to reconstructive success is defining an arterial and venous pedicle that provides balanced perfusion to all components of the flap. Anomalous vascular anatomy presents principal challenges in reestablishing free flap perfusion. We present a case of double, right deep inferior epigastric arteries encountered during vertical rectus abdominis myocutaneous flap reconstruction of the tongue and floor of the mouth and discuss the clinical outcomes of this reconstruction.
Subject(s)
Carcinoma, Squamous Cell/surgery , Epigastric Arteries/abnormalities , Rectus Abdominis/blood supply , Surgical Flaps/blood supply , Tissue and Organ Harvesting , Tongue Neoplasms/surgery , Humans , Male , Middle Aged , Rectus Abdominis/transplantationABSTRACT
BACKGROUND: Minimally invasive procedures, such as the TVT-Secur™, have been linked to injury to the corona mortis. Injury during the insertion of the TVT-Secur™ happens due to the vessel's position close to the place of the margin (25-30 mm from the symphysis pubis). AIMS: Systematic description of the aberrant vessel anatomy so as to help gynaecologists determine the risk of peri- and postoperative complications during the TVT-Secur™ and related procedures. METHODS: In a cadaver study, the lesser pelvis of ten female cadavers with venous or arterial coronae mortis was dissected. The origin, diameter and course of the aberrant vessels, as well as the distance from the symphysis pubis, were documented. RESULTS: Arterial coronae mortis were found in eight hemipelvises. All vessels originated from the ipsilateral inferior epigastric artery and all crossed over the superior pubic rami. Average distance from the symphysis pubis was 52.4 mm. Average vessel diameter was 3 mm. Venous coronae mortis were identified in ten hemipelvises. Eight drained into the external iliac and four into the inferior epigastric artery. Nine vessels crossed over the superior pubic rami. Average distance from the symphysis pubis was 46.7 mm. Average vessel diameter was 3.13 mm. CONCLUSION: Although individual variation makes direct contact with the vessel possible, in most cases there is a window of eight millimetres at least between the margin of the TVT-Secur™ and most aberrant veins. Possible aberrant arteries seem to lie even further.
Subject(s)
Epigastric Arteries/abnormalities , Minimally Invasive Surgical Procedures , Pubic Symphysis/blood supply , Epigastric Arteries/anatomy & histology , Epigastric Arteries/injuries , Female , Humans , Intraoperative Complications , Minimally Invasive Surgical Procedures/instrumentation , Postoperative Complications , Pubic Symphysis/anatomy & histology , Surgical MeshSubject(s)
Arteriovenous Malformations/complications , Crohn Disease/complications , Cutaneous Fistula/etiology , Epigastric Arteries/abnormalities , Gastrointestinal Hemorrhage/etiology , Intestinal Fistula/etiology , Adult , Arteriovenous Malformations/diagnosis , Arteriovenous Malformations/surgery , Epigastric Arteries/surgery , Female , Humans , LigationABSTRACT
During the routine gross anatomical dissection of the right inguinal region of a 45-year-old male cadaver, a variation was observed both in the inferior epigastric artery and the inferior epigastric vein. In this case, the right inferior epigastric artery originated from the femoral artery 13 mm inferior to the inguinal ligament. Additionally, in this cadaver, the single right inferior epigastric vein drained into femoral vein 8 mm inferior to the inguinal ligament. The distal origin of the inferior epigastric artery from the femoral artery and the lower drainage of the single inferior epigastric vein to the femoral vein must be taken into consideration by surgeons.
Subject(s)
Epigastric Arteries/abnormalities , Femoral Artery/abnormalities , Femoral Vein/abnormalities , Inguinal Canal/blood supply , Cadaver , Dissection , Epigastric Arteries/anatomy & histology , Femoral Artery/anatomy & histology , Femoral Vein/anatomy & histology , Humans , Inguinal Canal/anatomy & histology , Male , Middle AgedABSTRACT
Uterine arteriovenous fistula (AVF) is a rare entity, but may lead to life-threatening hemorrhage. Although transcatheter embolization, surgical ligation, or hysterectomy would be considered for treatment of uterine AVF, there is poor knowledge as to how gynecologists can manage the uterine AVF with multiple large inflow arteries. Herein we report a uterine AVF successfully treated using multiple-step transcatheter embolization. The patient, a 58-year-old postmenopausal woman with a history of dilation and curettage, had intermittent massive uterine bleeding. Radiologic imaging revealed the presence of a large vasculature mass. The mass occupied the entire pelvis, and the source of hemorrhage was identified as an accompanying AVF. We thought that surgical intervention was contraindicated because of the potential risk of uncontrollable intraoperative bleeding. Multiple-step transcatheter embolization was performed, with complete resolution of the AVF. Thereafter, the patient had no further uterine bleeding. Multiple-step transcatheter embolization might be the most beneficial and efficient treatment option for a uterine AVF with multiple large inflow arteries.
Subject(s)
Arteriovenous Fistula/therapy , Embolization, Therapeutic , Epigastric Arteries/abnormalities , Iliac Vein/abnormalities , Ovary/blood supply , Uterine Artery/abnormalities , Arteriovenous Fistula/complications , Arteriovenous Fistula/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Radiography , Uterine Hemorrhage/etiologyABSTRACT
OBJECTIVES: Sclerotherapy is useful for the treatment of arteriovenous vascular malformations. However, intravascular administration of sclerotic agents into small arteriovenous niduses is often difficult. Extravascular administration of sclerotic agents causes reduction of vascular flow on Doppler echo during clinical sclerotherapy. Therefore, we aimed to investigate whether the extravascular injection of sclerotic agents affects tiny vessels. DESIGN: Animal study. MATERIALS: The effect of extravascular injection of sclerotic agents on vessels was investigated using rat femoral and superficial inferior epigastric vessels. METHODS: After surgical exposure of vessels, absolute ethanol, 5% ethanolamine oleate and 3% polidocanol were injected into perivascular surrounding tissues, and their effect on vessels was evaluated after 14 days using histology and coloured silicone rubber injection. RESULTS: The integrity of the vascular lumen, endothelial cells and vascular patency were not affected by injection of sclerotic agents. CONCLUSIONS: Attenuation of vascular flow of an arteriovenous shunt after extravascular injection of sclerotic agents is transient and/or trivial and does not cause disruption of vessels. Therefore, sclerotic agents should be delivered to obtain sufficient destruction of arteriovenous malformation lesions and blood flow.
Subject(s)
Arteriovenous Malformations/therapy , Epigastric Arteries/drug effects , Femoral Artery/drug effects , Femoral Vein/drug effects , Sclerosing Solutions/administration & dosage , Sclerotherapy/methods , Animals , Disease Models, Animal , Endothelium, Vascular/drug effects , Endothelium, Vascular/pathology , Epigastric Arteries/abnormalities , Ethanol/administration & dosage , Femoral Artery/abnormalities , Femoral Vein/abnormalities , Follow-Up Studies , Injections , Oleic Acids/administration & dosage , Polidocanol , Polyethylene Glycols/administration & dosage , Rats , Rats, Wistar , Solvents/administration & dosage , Tissue Adhesives , Treatment OutcomeSubject(s)
Epigastric Arteries/abnormalities , Epigastric Arteries/injuries , Fractures, Bone/complications , Hematoma/etiology , Lacerations/therapy , Pubic Bone/injuries , Accidents, Traffic , Aged , Embolization, Therapeutic , Epigastric Arteries/diagnostic imaging , Humans , Male , Radiography , Retroperitoneal SpaceABSTRACT
Precise preoperative imaging by multidetector computed tomographic (MDCT) angiography for planning of deep inferior epigastric artery perforator (DIEP) flap dissection has been reported for enormous advantages in terms of reduced operative time and minimized flap-related complications. This case report shows a particularly rare anatomical subfascia variant of deep inferior epigastric artery (DIEA) which can be preoperatively demonstrated by MDCT angiogram. Therefore, the intraoperative finding also confirms the radiologic data and results in meticulous flap harvesting during incision on anterior rectus sheath. Additionally, the authors emphasize on performing preoperative high quality imaging for DIEP intervention precisely for specific vulnerable course of subfascial plane DIEP, which is rare but tends to be at risk without foreknowing its exact course.