Anatomy of the middle rectal artery: a review of the historical literature.

The middle rectal artery is a very important anatomical structure in rectal cancer surgery. It is the only vessel that penetrates through the proper rectal fascia into the pelvic cavity, and therefore threatens the integrity of total mesorectal excision. Moreover, it is very closely related to the lateral lymphatic drainage root. The definition of the middle rectal artery is ambiguous, and different frequencies, origins, and trajectories have been reported in various papers. The frequency of the middle rectal artery is reported to range from 12 to 97 %. Traditionally, the middle rectal artery is described as an artery that penetrates the pelvic plexus from the lateral side along with the lateral ligament; the frequency of this lateral type of middle rectal artery ranges from 20 to 30 %. However, the reports that describe higher frequency values also consider another type of middle rectal artery, which penetrates the neuro-vascular bundle from the antero-lateral direction; this antero-lateral type of middle rectal artery tends to be a small vessel, and frequently forms a common trunk with the prostatic artery. With advancements in endoscopic surgery, the knowledge of the precise anatomy of this structure is becoming more crucial for optimal rectal cancer surgery.

Vasa nervorum in rat major pelvic ganglion are innervated by nitrergic nerve fibers.

INTRODUCTION: The vasa nervorum comprises a network of small diameter blood vessels that provide blood supply to nerves and ganglia. The cell bodies of autonomic nerves innervating the urogenital organs are housed in the major pelvic ganglia (MPG) in rats. The vasa nervorum of rat MPG have not been characterized previously, and it is not known whether these blood vessels are innervated by neuronal nitric oxide synthase (nNOS) containing nitrergic nerves. AIM: To characterize the blood vessels in and around the rat MPG and to assess their nitrergic innervation. MAIN OUTCOME MEASURES: Characterization of small blood vessels in and around the rat MPG and expression of nNOS in nerve fibers around those blood vessels. METHODS: MPG were obtained from healthy Sprague Dawley rats, fixed in paraformaldehyde, frozen and sectioned using a cryostat. The blood vessels and their nitrergic innervation were assessed with immunohistochemistry using antibodies against alpha-smooth muscle actin (smooth muscle marker), CD31 (endothelial marker), collagen IV (basal membrane marker) and nNOS. The immunofluorescence was imaged using a laser scanning confocal microscope. RESULTS: The neuronal cell bodies were contained within a capsule in the MPG. Blood vessels were observed within the capsule of the MPG as well as outside the capsule. The blood vessels inside the capsule were CD31-positive capillaries with no smooth muscle staining. Outside the capsule capillaries, arterioles and venules were observed. The extra-capsular arterioles and venules, but not the capillaries were innervated by nNOS-positive nerve fibers. CONCLUSIONS: This study, to our knowledge, is the first to demonstrate the blood vessel distribution pattern and their nitrergic innervation in the rat MPG. While similar studies in human pelvic plexus are warranted, these results suggest that the blood flow in the MPG may be regulated by nitrergic nerve fibers and reveal a reciprocal relationship between nerves and blood vessels.

Tratamiento de las arterias hipogástricas en la cirugía endovascular del aneurisma de aorta abdominal / Treatment of hypogastric arteries in endovascular surgery for abdominal aortic aneurysms

Introducción. La cirugía endovascular del aneurisma de aorta abdominal (EVAR) está suponiendo un cambioen los procedimientos terapéuticos en la cirugía vascular. Su menor agresividad hace que se indique preferentemente enpacientes de alto riesgo quirúrgico. Frecuentemente, es necesario modificar la anatomía del aneurisma para hacerlocompatible con una EVAR. El procedimiento más frecuente es el de excluir las arterias hipogástricas (AH), especialmenteante la presencia de aneurismas ilíacos. De este modo se evitarían las endofugas tipo II por reentrada a partir de laAH. Objetivo. Profundizar en las técnicas de exclusión de las AH, sus resultados, complicaciones y la etiopatogenia de laisquemia pélvica secundaria. Desarrollo. Del análisis de la literatura publicada respecto a estos temas emergen los resultados,y los más destacables son los siguientes: casi en el 15% de los pacientes candidatos a EVAR hay que considerarla exclusión de, al menos, una AH; la exclusión de la AH, aun siendo bilateral, no se sigue de las catastróficas consecuenciasobservadas en la cirugía abierta; la colateralidad pélvica es fundamentalmente ipsilateral; la claudicaciónglútea es la complicación más frecuente; y la cobertura simple es segura y eficaz. Conclusión. La exclusión de una o ambasAH incrementa el porcentaje de pacientes candidatos a EVAR, pero aumenta en éstos la tasa de complicaciones isquémicas

Introduction. Endovascular repair of the abdominal aortic aneurysm (EVAR) is bringing about a change inthe therapeutic procedures used in vascular surgery. The fact that it is less invasive means that it is especially indicatedin high surgical risk patients. The anatomy of the aneurysm often has to be modified to make it compatible with EVAR.The most common procedure consists in excluding the hypogastric arteries (HA), particularly in the presence of iliacaneurysms. By so doing, type II endoleaks due to re-entry from the HA can be avoided. Aim. To further our knowledgeof the techniques for excluding HA, their outcomes, complications and the aetiopathogenesis of secondary pelvicischaemia. Development. The most significant results found in an analysis of the literature published on these issues areas follows: in almost 15% of patients who are candidates for EVAR it must be taken into account that at least one HAwill have to be excluded; the exclusion of the HA, even if it is bilateral, is not followed by the catastrophic consequencesobserved in open surgery; pelvic collaterality is essentially ipsilateral; buttock claudication is the most frequentcomplication; and simple coverage is safe and effective. Conclusions. The exclusion of one or both HA increases thepercentage of patients who are candidates for EVAR, but raises the rate of ischaemic complications they experience

Ligadura de las arterias ilíacas internas: hipogástrica en cirugía obstétrica / Ligation of the internal iliac arteries: hypogastric in obstetrical surgery

Se presentan diez casos de ligadura de arteria hipogástrica de causa obstétrica. Describimos la técnica, se analiza las indicaciones, riesgos y complicaciones quirúrgicas. El procedimiento fue efectivo en controlar la hemorragia en todos los casos. La principal indicación fue la inercia uterina

Fístula arteriovenosa pélvica congênita, uma causa pouco comun de dor pélvico / Congenital pelvic-arterio-venous fistula: an unusual cause of pelvic pain

The authors report a case of pelvic congenital arteriovenous fistula from a 37 year old woman. They discuss the diagnosis and therapeutic options for this problem, reviewing the litterature on the subject.

The use of the hypogastric artery in the anastomosis of multiple renal arteries in the transplant patient.

Alternative techniques for handling multiple renal vessels in living related kidney transplants by use of the hypogastric artery are presented. This vessel can be used either as a tubular vascular graft or as a Carrel patch graft. Details of these techniques are discussed.

Aneurisma isolado da artéria hipogástrica: uma lesäo rara e potencialmente letal / Isolated hypogastric artery aneurysm: a rare and potentially lethal lesion

O aneurisma isolado da artéria hipogástrica é uma raridade: existem cerca de 60 casos relatados na literatura. Descrevem-se 4 casos de aneurismas isolados da artéria hipogástrica, um dos quais roto. Apesar de raríssimos, estes aneurismas têm interesse clínico por apresentarem uma clínica variada, por vezes bizarra, como: abdômen agudo com choque (nos casos de rotura); obstruçäo de um ou ambos os ureteres; obstruçäo ou hemorragia retal; ciática; obstruçäo do canal do parto; edema de membro inferior ou simplesmente uma massa pulsátil na pelve. O tratamento é sempre cirúrgico: endoaneurismorrafia, ou ligadura da artéria hipogástrica. A ressecçäo total do aneurisma é uma técnica condenada. Os pacientes que se apresentam com o aneurisma roto têm prognóstico: a mortalidade nestes casos é cerca de 75%

Impotence after aorto-iliac surgery: current concepts.

The retrospective study of 38 male patients undergoing aorto-iliac reconstructive and abdominal aortic aneurysm surgery was carried out. The study demonstrates the deficiency in the pre-operative, intra-operative, and post-operative evaluation of these patients regarding the factors affecting impotence. Recommendations are made, and a flow sheet is compiled to assist the vascular surgeon in the evaluation and management of these patients.

Arterial supply to the hypogastric and presacral nerves.

The hypogastric nerves take an arterial supply from the internal iliac artery either directly or from one of its main branches close to its origin from the parent trunk. Sometimes the supply is from the lower end of the common iliac artery. In half the cases examined the presacral nerve takes an arterial supply from the aorta at its bifurcation.