1
|
Marvanova Z, Kachlik D. The anatomical variability of obturator vessels: Systematic review of literature. Ann Anat 2024; 251:152167. [PMID: 37865385 DOI: 10.1016/j.aanat.2023.152167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/01/2023] [Accepted: 10/10/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To systematically assess available information about all variations of obturator vessels and to present the most surgically relevant types, their prevalence and calibre in order to provide a comprehensive overview for both anatomists and clinicians. MATERIALS AND METHODS A total of 2689 studies were found via searching the online databases. After applying exclusion criteria 44 studies were assessed. The cadaveric studies, CT angiographies, and clinical studies were included. Number of hemipelves, prevalence of each variation and calibre of identified vessels were studied. Each variation was classified as aberrant obturator artery/vein, aberrant accessory obturator artery/vein or anastomosis. RESULTS In included studies the average incidence of the variant obturator artery was 26% with the aberrant obturator artery being the most frequent type (with the mean calibre 2.10 mm, SD = 0.35 mm), while the overall incidence of the variant obturator vein was 55%. Presented venous structures had the mean calibre of 2.98 mm (SD = 0.56 mm). CONCLUSIONS According to reviewed studies, variant obturator vessels are present in a great number of patients. Due to their possible calibre larger than 3 mm they represent a structure of high clinical importance. It is important to unify the terminology and to stress out the significance to all clinicians.
Collapse
Affiliation(s)
- Zuzana Marvanova
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Centre for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Centre for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic.
| |
Collapse
|
2
|
Elhence A, Gupta A. Corona Mortise- anatomical variants and implications in pelvic-acetabular surgery: An evidence based review. J Orthop 2023; 37:9-14. [PMID: 36974088 PMCID: PMC10039118 DOI: 10.1016/j.jor.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/09/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023] Open
Abstract
Background Corona Mortise is the name given to the anastomotic vessels forming a communication between external and internal iliac vascular systems. These channels have a high tendency to cause uncontrollable bleeding if injured and are particularly at risk during the anterior approach to acetabulum. While previous studies have described them as arterial or venous connections or both, there is still a lack of consensus regarding exact nature and location of these vessels, which make their timely identification all the more challenging. Objective The present review is aimed at performing a comprehensive review of existing literature and discuss the anatomy and implications of correct identification of Corona Mortise in pelvic-acetabular surgery. Conclusion Corona Mortise is more commonly venous than arterial. This not only makes haemorrhage control more challenging but also precludes the use of pre-operative angiography. However, most authors do not recommend a change in surgical approach for fear of damaging these vessels.
Collapse
Affiliation(s)
- Abhay Elhence
- Department Of Orthopaedics, All India Institute Of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Akshat Gupta
- Department Of Orthopaedics, All India Institute Of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| |
Collapse
|
3
|
Sume BW, Mulu A. Anatomical variations of obturator artery and its clinical significances: A systematic review and meta-analysis. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
|
4
|
Post-surgical pseudoaneurysm of the corona mortis artery treated by arterial embolization from two arteries: A case report. Radiol Case Rep 2022; 17:1132-1135. [PMID: 35169415 PMCID: PMC8829527 DOI: 10.1016/j.radcr.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/15/2022] [Indexed: 12/02/2022] Open
Abstract
Post-surgical pseudoaneurysm in the pelvis is rare. However, when it does occur, it may cause life-threatening hemorrhage. Hemostatic treatment for pelvic pseudoaneurysms may be complicated because the blood vessels in the pelvis may present with various anastomoses. Herein, we describe a case of a pseudoaneurysm that necessitated embolization of two arteries. A 47-year-old woman had undergone a total hysterectomy, a bilateral adnexectomy, and a pelvic lymphadenectomy for endometrial cancer; 13 days after surgery, she complained of sudden abdominal pain. Contrast-enhanced computed tomography revealed a retroperitoneal hematoma and a pseudoaneurysm with contrast leakage. The pseudoaneurysm had two feeding arteries (from the external and internal iliac systems). The first feeding artery was the obturator artery, which arose from the anterior trunk of the internal iliac artery. The second feeding artery was the aberrant obturator artery, which arose from the medial femoral circumflex artery. Both feeders were embolized and hemostasis was achieved. Pseudoaneurysms in the pelvis may have double origins from the external and internal iliac systems, and the aberrant obturator artery may arise from the medial femoral circumflex artery. Therefore, radiologists should be aware of these variations to effectively address post-surgical pseudoaneurysms of the corona mortis artery.
Collapse
|
5
|
Liu X, Li M, Liu J, Liu Z, Zhang L, Tang P. [Research progress of different surgical approaches in treatment of acetabular both-column fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:661-666. [PMID: 34142489 DOI: 10.7507/1002-1892.202012113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of different surgical approaches in the treatment of acetabular both-column fractures. Methods The domestic and foreign related research literature on surgical approaches for acetabular both-column fractures was extensively consulted. The anatomical characteristics, exposure ranges, advantages, disadvantages, and indications of various common surgical approaches for both-column fractures were mainly summarized. Results The ilioinguinal approach is more suitable for both-column fractures if the anterior column fracture is complicated or combined with the anterior wall fracture while the posterior column fracture is simple and stable. The modified Stoppa approach or the lateral (para) rectus abdominal approach is the preferred choice when both-column fractures are combined with a quadrilateral fracture or femoral head dislocation. What's more, the Kocher-Langenbeck approach is required when the posterior column fractures are complicated or combined with posterior wall fractures. In addition, the simultaneous ilioinguinal and Kocher-Langenbeck approaches are the first choices when the both-column fractures possessing extremely severe and obvious displacement. Conclusion The reasonable choice of surgical approach is extremely important for acetabular both-column fractures. Each surgical approach has its advantages and limitations. It is necessary to take the precise reposition of the acetabular joint surface as the principle, and comprehensively judge the fracture types and severity of anterior column, posterior column, and square area, and then select the optimal surgical approach for surgical treatment.
Collapse
Affiliation(s)
- Xiao Liu
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Ming Li
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Jianheng Liu
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Zhongyang Liu
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Licheng Zhang
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Peifu Tang
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| |
Collapse
|
6
|
Cardoso GI, Chinelatto LA, Hojaij F, Akamatsu FE, Jacomo AL. Corona Mortis: A Systematic Review of Literature. Clinics (Sao Paulo) 2021; 76:e2182. [PMID: 33886786 PMCID: PMC8024925 DOI: 10.6061/clinics/2021/e2182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Our systematic review evaluates surgically relevant information about corona mortis (CM), such as anatomical structure, size, laterality, incidence, and anthropometric correlations. This study aimed to provide data about anastomosis in an attempt to avoid iatrogenic damage during surgery. Articles were searched online using the descriptor "Corona Mortis" in PubMed, Biblioteca Virtual em Saúde (BVS) (Literatura Latino-Americana e do Caribe em Saúde [LILACS], MEDLINE, indice bibliografico espaãol en ciencias de la salud [IBECS]), and SciELO database. The time range was set between 1995 and 2020. The articles were selected according to their titles and later the abstracts' relation to our research purpose. All the selected articles were read entirely. A manual search based of the references cited in these articles was also conducted to identify other articles or books of interest. Forty references fulfilled the criteria for this review. The mean incidence of CM was 63% (the majority venous) among 3,107 hemipelvises. The incidence of bilateral CM was lower than that of unilateral variations based on the analysis of 831 pelvises. The mean caliber of the anastomosis was 2.8 mm among 1,608 hemipelvises. There is no consensus concerning the anthropometric influences in CM. Finally, we concluded that CM is not an unusual anatomical variation and that we must not underestimate the risk of encountering the anastomosis during surgery. Anatomical knowledge of CM is, therefore, essential in preventing accidents for surgeons who approach the inguinal and retropubic regions.
Collapse
Affiliation(s)
| | | | - Flavio Hojaij
- Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Flávia Emi Akamatsu
- Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alfredo Luiz Jacomo
- Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
7
|
Bhoil R, Aggarwal N, Aggarwal V, Surya M, Sharma S, Ahluwalia A, Bhoil S, Singh SP, Thakur M, Sood S. "Crown of Death"; Corona Mortis, a Common Vascular Variant in Pelvis: Identification at Routine 64-Slice CT-Angiography. Bull Emerg Trauma 2020; 8:193-198. [PMID: 32944580 PMCID: PMC7468229 DOI: 10.30476/beat.2020.84118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: To establish the incidence of arterial corona mortis variant in angiographic studies being performed using a 64 slice CT scan machine in a series of patients. Methods: This was a prospective cross-sectional study including 100 consecutive patients undergoing routine clinically indicated, standard protocol, CT-angiography for the abdominal aorta and/or lower limbs using a 64 slice CT scanner. Patients having severe arterial insufficiency (Grade 4 stenosis on CT angiography), pelvic infections and tumours, patients with past pelvic trauma and those who had previous pelvic surgery were excluded from the study. In total 200 hemi-pelvises were evaluated for the presence or absence of corona morti. Results: Overall, we included 100 patients in this series including 67 men and 33 women with mean age of 40.1±2.3 (ranging from 22-74) years. The arterial variant was identified on thin, 0.625-mm-thick images in 24 out of 100 patients studied (unilateral in 20 patients and bilateral in 4 patients; 28 out of 200 hemipelvises evaluated, having an incidence of 14%). We found that the distance of corona mortis artery from the symphysis was significantly greater for women compared to men, both on right (p=0.034) and left sides (p=0.046). Conclusion: Corona mortis may be prospectively identified at contrast-enhanced multidetector CT especially in pelvic trauma patients and help guide subsequent endovascular embolization or surgical interventions.
Collapse
Affiliation(s)
- Rohit Bhoil
- Department of Radiodiagnosis, IGMC Shimla, India
| | | | | | - Mukesh Surya
- Department of Radiodiagnosis, IGMC Shimla, India
| | | | | | - Sabina Bhoil
- Department of Cardiac Anesthesia, IGMC Shimla, India
| | | | | | | |
Collapse
|
8
|
Frequency and Clinical Review of the Aberrant Obturator Artery: A Cadaveric Study. Diagnostics (Basel) 2020; 10:diagnostics10080546. [PMID: 32751771 PMCID: PMC7459979 DOI: 10.3390/diagnostics10080546] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022] Open
Abstract
The occurrence of an aberrant obturator artery is common in human anatomy. Detailed knowledge of this anatomical variation is important for the outcome of pelvic and groin surgeries requiring appropriate ligation. Familiarity with the occurrence of an aberrant obturator artery is equally important for instructors teaching pelvic anatomy to students. Case studies highlighting this vascular variation provide anatomical instructors and surgeons with accurate information on how to identify such variants and their prevalence. Seven out of eighteen individuals studied (38.9%) exhibited an aberrant obturator artery, with two of those individuals presenting with bilateral aberrant obturator arteries (11.1%). Six of these individuals had an aberrant obturator artery that originated from the deep inferior epigastric artery (33.3%). One individual had an aberrant obturator artery that originated directly from the external iliac artery (5.6%).
Collapse
|
9
|
Noussios G, Galanis N, Chatzis I, Konstantinidis S, Filo E, Karavasilis G, Katsourakis A. The Anatomical Characteristics of Corona Mortis: A Systematic Review of the Literature and Its Clinical Importance in Hernia Repair. J Clin Med Res 2020; 12:108-114. [PMID: 32095180 PMCID: PMC7011932 DOI: 10.14740/jocmr4062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 11/11/2022] Open
Abstract
Background Inguinal hernia repair is one of the most common daily operations in general surgery. However, the anatomical structures of the region, such as the corona mortis (the crown of death), make this procedure quite challenging. A comprehensive knowledge of its anatomy is essential, since massive hemorrhage may occur if the vessel is injured. The current review of the literature aimed to report the frequency and anatomical variations of vascular corona mortis. Methods A substantial study was coordinated through PubMed, Scopus and Google Scholar. The Prisma guidelines were used for the systematic review of the articles found. A total of 13 studies and 1,455 patients were included for the statistical analysis. Results The results showed that corona mortis was present in about half the hemi-pelvises, and to be more accurate, the prevalence was 46%. Venous corona mortis was more frequent than the arterial type (42% vs. 25%). Conclusions Considering the percentages mentioned above, every surgeon who schedules an operation on the retro-pubic area, especially during a hernioplasty procedure, should evaluate the possibility of the presence of corona mortis. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the corona mortis during surgery.
Collapse
Affiliation(s)
- George Noussios
- School of Physical Education and Sports Sciences of Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikiforos Galanis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iosif Chatzis
- Department of General Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece
| | | | - Eva Filo
- Department of General Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece
| | - George Karavasilis
- Department of Business Administration, Technological Educational Institute of Central Macedonia, Serres, Greece
| | | |
Collapse
|
10
|
de Oliveira Leite TF. Superselective transcatheter arterial embolization of iatrogenic inferior epigastric artery after paracentesis: Unusual manifestation of hemoperitoneum. Int J Surg Case Rep 2020; 74:32-35. [PMID: 32777764 PMCID: PMC7417668 DOI: 10.1016/j.ijscr.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/05/2022] Open
Abstract
Hemoperitoneum is a rare complication in paracentesis. Paracentesis should be guided by ultrasound. Embolization of the lower epigastric artery is feasible and safe.
Introduction Paracentesis is a safe procedure and can be performed as a therapy or diagnosis in cancer patients, liver cirrhosis, heart or liver failure. Presentation of case 59-year-old man with alcoholic liver cirrhosis with ascites and coagulation abnormalities. After diagnostic paracentesis he presented hemodynamic instability with signs of hypovolemic shock and hemoperitoneum. Computed angiotomography with signs of active bleeding and pseudoaneurysm at the site of paracentesis. Discussion The interventional radiology unit was referred and submitted to arteriography, which demonstrated active bleeding from the left lower epigastric artery. It was successfully treated by transcatheter embolization with 100−300 μm PVA particles. Conclusion Transcatheter embolization with PVA particles is a fast, safe, minimally invasive, reliable method with a high technical success rate for the treatment of active bleeding resulting from injury to the lower epigastric artery.
Collapse
Affiliation(s)
- Tulio Fabiano de Oliveira Leite
- Medical School of Ribeirão Preto, University of São Paulo, Rua Rafael Rinaldi, 365, APT 601, Uberlândia, Minas Gerais, 38400.384, Brazil.
| |
Collapse
|