Arterial Anatomy of the Anterior Abdominal Wall: Evidence-Based Safe Sites for Instrumentation based on Radiological Analysis of 100 Patients

James Bowness (Lead / Corresponding author), Jonathan Seeley, Ourania Varsou, Angela McKinnie, Ian Zealley, Graeme McLeod, Calum Grant

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1 Citation (Scopus)

Abstract

Multiple medical interventions require percutaneous instrumentation of the anterior abdominal wall, all of which carry a potential for vascular trauma. We assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries to determine the safest site with respect to vascular anatomy of the rectus sheath. In a review of 100 arterial phase, contrast-enhanced abdominal computed tomography scans, anterior abdominal wall arteries were assessed bilaterally at three axial planes: transpyloric, umbilicus, and anterior superior iliac spine (ASIS). The mean age of patients was 69.2 years (SD ± 15), with 62 male and 38 female. An artery was visible least frequently at the transpyloric plane (5%), compared with the umbilicus (72–79%) and ASIS (93–96%), on the left (χ 2(4) = 207.272; P < 0.001) and right (χ 2(4) = 198.553; P < 0.001), with a moderate strength association (Cramer's V = 0.588 (left) and 0.575 (right)). The arteries were most commonly observed within the rectus abdominis muscle at the level of the umbilicus and ASIS on both sides (62–68%). The inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it travelled superiorly. These data suggest that the safest site to instrument the rectus sheath, with respect to vascular anatomy, is at the transpyloric plane. This information on anatomical variation of the anterior abdominal wall vasculature may be of particular interest to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion.

Original languageEnglish
Number of pages17
JournalClinical Anatomy
Early online date24 Aug 2019
DOIs
Publication statusE-pub ahead of print - 24 Aug 2019

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Abdominal Wall
Umbilicus
Anatomy
Epigastric Arteries
Blood Vessels
Spine
Arteries
Rectus Abdominis
Tomography
Muscles
Wounds and Injuries

Keywords

  • Anatomical variation
  • complications
  • epigastric artery
  • rectus sheath block

Cite this

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title = "Arterial Anatomy of the Anterior Abdominal Wall: Evidence-Based Safe Sites for Instrumentation based on Radiological Analysis of 100 Patients",
abstract = "Multiple medical interventions require percutaneous instrumentation of the anterior abdominal wall, all of which carry a potential for vascular trauma. We assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries to determine the safest site with respect to vascular anatomy of the rectus sheath. In a review of 100 arterial phase, contrast-enhanced abdominal computed tomography scans, anterior abdominal wall arteries were assessed bilaterally at three axial planes: transpyloric, umbilicus, and anterior superior iliac spine (ASIS). The mean age of patients was 69.2 years (SD ± 15), with 62 male and 38 female. An artery was visible least frequently at the transpyloric plane (5{\%}), compared with the umbilicus (72–79{\%}) and ASIS (93–96{\%}), on the left (χ 2(4) = 207.272; P < 0.001) and right (χ 2(4) = 198.553; P < 0.001), with a moderate strength association (Cramer's V = 0.588 (left) and 0.575 (right)). The arteries were most commonly observed within the rectus abdominis muscle at the level of the umbilicus and ASIS on both sides (62–68{\%}). The inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it travelled superiorly. These data suggest that the safest site to instrument the rectus sheath, with respect to vascular anatomy, is at the transpyloric plane. This information on anatomical variation of the anterior abdominal wall vasculature may be of particular interest to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion.",
keywords = "Anatomical variation, complications, epigastric artery, rectus sheath block",
author = "James Bowness and Jonathan Seeley and Ourania Varsou and Angela McKinnie and Ian Zealley and Graeme McLeod and Calum Grant",
note = "No Funding. This article is protected by copyright. All rights reserved.",
year = "2019",
month = "8",
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T2 - Evidence-Based Safe Sites for Instrumentation based on Radiological Analysis of 100 Patients

AU - Bowness, James

AU - Seeley, Jonathan

AU - Varsou, Ourania

AU - McKinnie, Angela

AU - Zealley, Ian

AU - McLeod, Graeme

AU - Grant, Calum

N1 - No Funding. This article is protected by copyright. All rights reserved.

PY - 2019/8/24

Y1 - 2019/8/24

N2 - Multiple medical interventions require percutaneous instrumentation of the anterior abdominal wall, all of which carry a potential for vascular trauma. We assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries to determine the safest site with respect to vascular anatomy of the rectus sheath. In a review of 100 arterial phase, contrast-enhanced abdominal computed tomography scans, anterior abdominal wall arteries were assessed bilaterally at three axial planes: transpyloric, umbilicus, and anterior superior iliac spine (ASIS). The mean age of patients was 69.2 years (SD ± 15), with 62 male and 38 female. An artery was visible least frequently at the transpyloric plane (5%), compared with the umbilicus (72–79%) and ASIS (93–96%), on the left (χ 2(4) = 207.272; P < 0.001) and right (χ 2(4) = 198.553; P < 0.001), with a moderate strength association (Cramer's V = 0.588 (left) and 0.575 (right)). The arteries were most commonly observed within the rectus abdominis muscle at the level of the umbilicus and ASIS on both sides (62–68%). The inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it travelled superiorly. These data suggest that the safest site to instrument the rectus sheath, with respect to vascular anatomy, is at the transpyloric plane. This information on anatomical variation of the anterior abdominal wall vasculature may be of particular interest to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion.

AB - Multiple medical interventions require percutaneous instrumentation of the anterior abdominal wall, all of which carry a potential for vascular trauma. We assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries to determine the safest site with respect to vascular anatomy of the rectus sheath. In a review of 100 arterial phase, contrast-enhanced abdominal computed tomography scans, anterior abdominal wall arteries were assessed bilaterally at three axial planes: transpyloric, umbilicus, and anterior superior iliac spine (ASIS). The mean age of patients was 69.2 years (SD ± 15), with 62 male and 38 female. An artery was visible least frequently at the transpyloric plane (5%), compared with the umbilicus (72–79%) and ASIS (93–96%), on the left (χ 2(4) = 207.272; P < 0.001) and right (χ 2(4) = 198.553; P < 0.001), with a moderate strength association (Cramer's V = 0.588 (left) and 0.575 (right)). The arteries were most commonly observed within the rectus abdominis muscle at the level of the umbilicus and ASIS on both sides (62–68%). The inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it travelled superiorly. These data suggest that the safest site to instrument the rectus sheath, with respect to vascular anatomy, is at the transpyloric plane. This information on anatomical variation of the anterior abdominal wall vasculature may be of particular interest to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion.

KW - Anatomical variation

KW - complications

KW - epigastric artery

KW - rectus sheath block

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