The anatomical relationship of the iliocava junction to the lumbosacral spine and the aortic bifurcation

Pirrò, N.; Ciampi, D.; Champsaur, Pierre; Marino, Vincent Di

doi:10.1007/s00276-004-0301-8

Cited by 43 publications

(26 citation statements)

References 15 publications

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“…Previous reports analyzed the interiliac vein anatomy in the lumbosacral area, with respect to the intervertebral disk 14,15) . However, the anatomical evaluation was limited to the normal vascular cases without anomalies.…”

Section: Discussionmentioning

confidence: 99%

Double inferior vena cava with interiliac vein: A case report and literature review

Chen

Emura

Nagasaki

et al. 2012

Okajimas Folia Anat. Jpn.

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Section: Discussionmentioning

confidence: 99%

Double inferior vena cava with interiliac vein: A case report and literature review

Chen

Emura

Nagasaki

et al. 2012

Okajimas Folia Anat. Jpn.

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“…Meanwhile, the confluence of the common iliac veins was found between the superior third of the L-4 vertebral body and the inferior third of the L-5 vertebral body. The anatomy of the abdominal vessels and its relationship to the lumbar spine has been previously studied by Moussallem et al 26 using CT, and Pirró et al 30 using cadaveric dissection. A larger study by Chithriki et al in 2002, 10 using MRI, reported the aortic bifurcation between the superior third of the L-3 vertebral body and the middle third of the L-5 vertebral body, which is slightly higher compared with our study (i.e., inferior third of L-3).…”

mentioning

confidence: 99%

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs: an MRI study

Molinares¹,

Davis²,

Fung³

2016

SPI

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OBJECT The purpose of this study was to analyze MR images of the lumbar spine and document: 1) the oblique corridor at each lumbar disc level between the psoas muscle and the great vessels, and 2) oblique access to the L5–S1 disc space. Access to the lumbar spine without disruption of the psoas muscle could translate into decreased frequency of postoperative neurological complications observed after a transpsoas approach. The authors investigated the retroperitoneal oblique corridor of L2–S1 as a means of surgical access to the intervertebral discs. This oblique approach avoids the psoas muscle and is a safe and potentially superior alternative to the lateral transpsoas approach used by many surgeons. METHODS One hundred thirty-three MRI studies performed between May 4, 2012, and February 27, 2013, were randomly selected from the authors’ database. Thirty-three MR images were excluded due to technical issues or altered lumbar anatomy due to previous spine surgery. The oblique corridor was defined as the distance between the left lateral border of the aorta (or iliac artery) and the anterior medial border of the psoas. The L5–S1 oblique corridor was defined transversely from the midsagittal line of the inferior endplate of L-5 to the medial border of the left common iliac vessel (axial view) and vertically to the first vascular structure that crossed midline (sagittal view). RESULTS The oblique corridor measurements to the L2–5 discs have the following mean distances: L2–3 = 16.04 mm, L3–4 = 14.21 mm, and L4–5 = 10.28 mm. The L5–S1 corridor mean distance was 10 mm between midline and left common iliac vessel, and 10.13 mm from the first midline vessel to the inferior endplate of L-5. The bifurcation of the aorta and confluence of the vena cava were also analyzed in this study. The aortic bifurcation was found at the L-3 vertebral body in 2% of the MR images, at the L3–4 disc in 5%, at the L-4 vertebral body in 43%, at the L4–5 disc in 11%, and at the L-5 vertebral body in 9%. The confluence of the iliac veins was found at lower levels: 45% at the L-4 level, 19.39% at the L4–5 intervertebral disc, and 34% at the L-5 vertebral body. CONCLUSIONS An oblique corridor of access to the L2–5 discs was found in 90% of the MR images (99% access to L2–3, 100% access to L3–4, and 91% access to L4–5). Access to the L5–S1 disc was also established in 69% of the MR images analyzed. The lower the confluence of iliac veins, the less probable it was that access to the L5–S1 intervertebral disc space was observed. These findings support the use of lumbar MRI as a tool to predetermine the presence of an oblique corridor for access to the L2–S1 intervertebral disc spaces prior to lumbar spine surgery.

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“…However, the greater security of the puncture in the left hypochondrium in comparison to the one in the umbilicus can only be deduced from considerations regarding the topographical relationships of the structures at risk, with special attention to the midline retroperitoneal great vessels 9 and to the preferential topography of the midline adhesions. There are reports of lower risk of iatrogenic injuries [12][13][14][15] when the puncture is made in the left hypochondrium because it is out of the midline, where there is greater chance of injury of major retroperitoneal vessels [12][13] .…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

“…The abdominal aorta and vena cava, as well as the common iliac vessels, are particularly prone to injury during Veress needle puncture in the vicinity of the umbilical scar 10 . Despite the low prevalence of this occurrence (0.05% to 0.5%), mortality rates range between 8% and 17%, reaching 21% when there is unnoticed associated intestinal lesions [4][5][6][7][8][9][10][11] . The severity of this type of iatrogenic injury is minimized when the punctures are made in locations away from the midline 12 15 .…”

Section: Original Articlementioning

confidence: 99%

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Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados

Becker

Azevedo

Azevedo³

et al. 2011

Rev. Col. Bras. Cir.

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Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients Original Article Original Article Original Article Original Article Original Article Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados pacientes não selecionados pacientes não selecionados pacientes não selecionados pacientes não selecionados OTÁVIO To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. Methods:Methods: Methods: Methods: Methods: Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test -AT; resistance to infusion -Pres; recovery of the infused fluid -Prec, dripping test -DT, and test of initial intraperitoneal pressure -IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential...

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The anatomical relationship of the iliocava junction to the lumbosacral spine and the aortic bifurcation

Cited by 43 publications

References 15 publications

Double inferior vena cava with interiliac vein: A case report and literature review

Double inferior vena cava with interiliac vein: A case report and literature review

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs: an MRI study

Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados

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