Superior rectal artery origin from the median sacral artery-angiographic appearance, developmental anatomy, and clinical implications

Comparison of different embolic particles for superior rectal arterial embolization of chronic hemorrhoidal bleeding: gelfoam versus microparticle

BACKGROUND

Whether different embolic particles with comparable diameter lead to similar beneficial effects in endovascular embolization of hemorrhoidal disease remains to be established. We sought to evaluate the efficacy and safety of different types of agents for superior rectal arterial embolization (SRAE) in patients with bleeding hemorrhoids.

METHODS

Patients with recurrent episodes of internal hemorrhoidal bleeding and chronic anemia treated by SRAE in three tertiary hospitals between March 2017 and June 2020 were retrospectively evaluated. The patients were divided into two study groups based on the embolic materials: embolization with coils (2-3 mm) + gelfoam particles at 350-560 μm (Group A, n = 23), embolization with coils (2-3 mm) + microparticles at 300-500 μm (Group B, n = 18). The technical success, preliminary clinical efficacy (percentage of patients without hematochezia), postoperative complications and short-term follow-up outcomes were analysed.

RESULTS

A total of 41 patients (27 males) with symptomatic hemorrhoids were included in the study, mean age was 47 ± 12 years (range 25-72). 39% (16) patients with grade II hemorrhoids while 61% (25) patients with grade III. The technical success rate of the embolization procedure was 100%, and the preliminary clinical efficacy (87.0% vs 88.9%) showed no significant difference between the 2 groups (p = 0.098). No patients reported post-procedural and short-term serious complications, such as infection, intestinal ischemia or massive hemorrhage during the follow-up period (range 6-15 months).

CONCLUSIONS

Both gelfoam particles and microparticles with comparable diameter in the endovascular treatment of hemorrhoidal bleeding demonstrated similarly good short-term efficacy and safety profile.

Testicular artery originating from the inferior mesenteric artery: an alert for interventionalists - A case report

Testicular arteries usually arise from the abdominal aorta. During an elective embolization of superior rectal arteries for hemorrhoidal disease performed in a 52-year-old male patient, a previously unreported vascular variant was identified. On selective angiography, the inferior mesenteric artery split into left colic artery and left testicular artery, without any evidence of vascular supply to the hemorrhoidal cushions. Superior rectal arteries were embolized after catheterization of the median sacral artery. A thorough knowledge of vascular variations is essential for interventional radiologists in order to recognize them and avoid potential complications.

The median sacral artery in rectal blood supply: A cadaveric study

INTRODUCTION

Insufficient blood supply to the posterior rectal remnant after proctectomy is a possible mechanism for anastomotic leakage. The median sacral artery (MSA) is not generally considered to participate in the rectal blood supply, although some case studies have reported the rectum being supplied by it. The aim of this study is to elucidate the anatomy of the MSA in relation to the posterior rectal wall.

METHODS

Nineteen embalmed cadavers (12 males, seven females; mean age: 76 ± 9 years) were injected with a colored radio-opaque mixture in the aortic bifurcation, radiographed and subsequently dissected along the sacrum. The relationship between the MSA and the rectum was observed and the diameter of the MSA was measured 2 cm below the aortic bifurcation.

RESULTS

MSAs were identified in 16 (84.2%) of the 19 cadavers. Nine MSAs (47.4%) reached the rectal wall and penetrated it. MSAs that reached the posterior rectum took two different routes in the presacral space. Dissection and radiography showed four penetrating MSAs (21.1%) ending in a branching pattern and five (26.3%) as a tapering vessel. Seven MSAs (36.8%) did not reach the rectal wall. The mean MSA diameter was 1.98 ± 0.12 mm.

CONCLUSIONS

Almost half the MSAs reached and penetrated the posterior rectal wall, suggesting possible participation in the rectal blood supply. A large portion of the MSAs that penetrate the rectal wall run outside surgical margins and could continue to provide blood supply to the rectal remnant, potentially preventing anastomotic leakage.

Spinal Vascular Anatomy

This article reviews the arterial and venous anatomy of the spine and spinal cord. Special emphasis is placed on vessels critical to the conduct and interpretation of spinal angiography, notably the intersegmental artery and its cranial and caudal derivatives: the vertebral, supreme intercostal, and sacral arteries.

Fetal median sacral artery anatomy study by micro-CT imaging

PURPOSE

The median sacral artery (MSA) is the termination of the dorsal aorta, which undergoes a complex regression and remodeling process during embryo and fetal development. The MSA contributes to the pelvic vascularization and may be injured during pelvic surgery. The embryological steps of MSA development, anastomosis formation and anatomical variations are linked, but not fully understood.

METHODS

The pelvic vascularization and more precisely the MSA of a human fetus at 22 weeks of gestation (GW) were studied using micro-CT imaging. Image treatment included arterial segmentations and 3D visualization.

RESULTS

At 22 GW, the MSA was a well-developed straight artery in front of the sacrum and was longer than the abdominal aorta. Anastomoses between the MSA and the internal pudendal arteries and the superior rectal artery were detected. No evidence was found for the existence of a coccygeal glomus with arteriovenous anastomosis.

CONCLUSIONS

Micro-CT imaging and 3D visualization helped us understand the MSA central role in pelvic vascularization through the ilio-aortic anastomotic system. It is essential to know this anastomotic network to treat pathological conditions, such as sacrococcygeal teratomas and parasitic ischiopagus twins (for instance, fetus in fetu and twin-reversed arterial perfusion sequence).