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Konarska-Włosińska M, Ostrowski P, Del Carmen Yika A, Dziedzic M, Bonczar M, Wojciechowski W, Walocha J, Koziej M. Exploring the Topography of the Obturator Artery and Corona Mortis: a Detailed Analysis with Surgical Implications. Int Urogynecol J 2024; 35:1051-1060. [PMID: 38635039 DOI: 10.1007/s00192-024-05774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The obturator artery (ObA) is described as a branch of the anterior division of the internal iliac artery. It arises close to the origin of the umbilical artery, where it is crossed by the ureter. The main goal of the present study was to create an anatomical map of the ObA demonstrating the most frequent locations of the vessel's origin and course. METHODS In May 2022, an evaluation of the findings from 75 consecutive patients who underwent computed tomography angiography studies of the abdomen and pelvis was performed. RESULTS The presented results are based on a total of 138 arteries. Mostly, ObA originated from the anterior trunk of the internal iliac artery (79 out of 138; 57.2%). The median ObA diameter at its origin was found to be 3.34 mm (lower quartile [LQ] = 3.00; upper quartile [UQ] = 3.87). The median cross-sectional area of the ObA at its origin was found to be 6.31 mm2 (LQ = 5.43; UQ = 7.32). CONCLUSIONS Our study developed a unique arterial anatomical map of the ObA, showcasing its origin and course. Moreover, we have provided more data for straightforward intraoperative identification of the corona mortis through simple anatomical landmarks, including the pubic symphysis. Interestingly, a statistically significant difference (p < 0.05) between the morphometric properties of the aberrant ObAs and the "normal" ObAs originating from the internal iliac artery was found. It is hoped that our study may aid in reducing the risk of serious hemorrhagic complications during various surgical procedures in the pelvic region.
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Affiliation(s)
- Monika Konarska-Włosińska
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Alicia Del Carmen Yika
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Wadim Wojciechowski
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland.
- Youthoria, Youth Research Organization, Kraków, Poland.
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AlJamal YN, Kitahara H, Johnson B, Grady K, Balkhy HH. Routine External Iliac Artery Cannulation in Robotic Cardiac Surgery: Role of the Corona "Vitae" in Distal Limb Perfusion. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241239911. [PMID: 38606852 DOI: 10.1177/15569845241239911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Femoral artery cannulation is the most commonly used approach for cardiopulmonary bypass (CPB) in robotic cardiac procedures. However, without adding a distal perfusion cannula, leg ischemia can occur in up to 11.5% of patients. There is a well-described 2 to 4 mm size arterial branch that originates from the medial side of the external iliac artery or inferior epigastric artery, immediately above the inguinal ligament, and connects to the obturator artery. Therefore, it was historically named the corona mortis, which means "crown of death" in Latin. When peripheral cannulation is performed above this branch in the external iliac artery, we consider it a corona "vitae" because of its role as a limb-saving collateral. We report herein our standard technique of peripheral cannulation without the need of a distal perfusion cannula and preventing limb ischemia. METHODS We included all patients who underwent robotic cardiac surgery with peripheral cannulation over a 16-month period at our institution. We cannulated just above the level of the inguinal ligament through a 2 to 3 cm transverse skin incision. The incidence of limb ischemia and vascular complications was recorded and analyzed. RESULTS During the study period, 133 patients underwent robotic cardiac procedures with peripheral "external iliac" CPB. The size of the cannula was 21F or larger in 73% and 23F in 54% of the patients. No leg ischemia or femoral artery complications requiring additional intervention occurred. CONCLUSIONS External iliac cannulation can be successfully performed in robot-assisted cardiac surgery using relatively large cannulas without the need of a distal limb perfusion catheter, with good results. In our view, given the importance of the corona mortis ("crown of death" in Latin) in perfusing the limb during CPB, we propose a new name for this artery in robotic cardiac surgery, namely, the corona vitae ("crown of life" in Latin).
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Affiliation(s)
- Yazan N AlJamal
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hiroto Kitahara
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
| | - Blaine Johnson
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
| | - Kaitlin Grady
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
| | - Husam H Balkhy
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
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Beya R, Jérôme D, Tanguy V, My-Van N, Arthur R, Jean-Pierre R, Thierry H, Cyril B, Jean-Pierre F. Morphodynamic study of the corona mortis using the SimLife ® technology. Surg Radiol Anat 2023; 45:89-99. [PMID: 36585462 DOI: 10.1007/s00276-022-03067-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Open book pelvic ring fractures are potentially life-threatening, due to their instability and major hemorrhage risk. During the open reduction and internal fixation, the pelvic approach remains a technical challenge, as the surgeon wants to prevent any iatrogenic damage of the vascular loop located in the retro-pubic area called corona mortis (CMOR). Recently, the cadaver perfused SimLife® technology has been developed to improve the surgeon training, out of the operating room. This study aimed to compare two models of cadaveric dissection, to assess the interest of the perfused SimLife® in providing dynamic aspect of anatomy in the identification of CMOR and its topography. METHODS Twelve human cadaveric pelvises have been dissected, following two protocols. 12 hemi-pelvises of the dissections were performed without perfusion (Model A), whereas the 12 other hemi-pelvises have been prepared with the SimLife® pulsatile perfusion (Model B). The prevalence and morphologic parameters determined: length, diameter and distance between the CMOR and the pubic symphysis. RESULTS The CMOR has been found in 66.67% of the cases. The length, the diameter, and the distance between the CMOR and the pubic symphysis were significantly higher in model B (respectively p = 0.029, p = 0.01, and p = 0.022). CONCLUSION These results suggest that the CMOR is easier to identify and to dissect with the SimLife® perfusion. As part of the surgical training of any trauma surgeon, this model could help him to keep in mind the CMOR topography, to improve the open book lesion management.
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Affiliation(s)
- Robert Beya
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France. .,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France.
| | - Danion Jérôme
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France.,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
| | - Vendeuvre Tanguy
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France.,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
| | - Nguyen My-Van
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France
| | - Renault Arthur
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France
| | - Richer Jean-Pierre
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France.,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
| | - Hauet Thierry
- INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
| | - Breque Cyril
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France
| | - Faure Jean-Pierre
- A B S Lab, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, 86073, Poitiers Cedex 9, France.,INSERM U1313-IRMETIST Unity, Research Institute, University, Poitiers, France
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Shi X, Li X, Wang A. Comparative efficacy and safety of the minimally invasive ilioinguinal approach for anterior pelvic ring fracture: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e28377. [PMID: 34967370 PMCID: PMC8718202 DOI: 10.1097/md.0000000000028377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Anterior pelvic ring contributes up to 40% of the stability of the pelvic ring and is located in close proximity to key pelvic organs, blood vessels, and nerves. An anterior pelvic ring fracture causes severe pain and is a potentially life-threatening condition in trauma patients. Currently available surgical repair methods are highly technical and include high risks of complications. The minimally invasive ilioinguinal approach (MIIA) is an emerging technique that reduces the risk of femoral nerve and external iliac vessel injury. However, the safety and efficacy of this technique have yet to be systematically scrutinized. This study outlines a proposed protocol for a network meta-analysis that investigates the efficacy of MIIA for anterior pelvic ring fracture. METHODS This study will utilize both Chinese and English language databases. All randomized controlled trials studying the use of MIIA for anterior pelvic ring fracture from January 2016 to May 2021 will be incorporated. Researchers will screen for literature that fits the inclusion criteria, followed by an assessment of risk bias and, finally, data extraction. RESULTS The Bayesian network meta-analysis will be used to evaluate all available Stata 14.0 and WinBUGS software. CONCLUSION Our research aims to uncover the clinical utility of the MIIA approach for anterior pelvic ring fractures. ETHICS AND DISSEMINATION Not required. INPLASY REGISTRATION NUMBER INPLASY2021110020.
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