The Majority of Corona Mortis Are Small Calibre Venous Blood Vessels: A Cadaveric Study of North Indians

Abstract

PurposeCorona mortis is an abnormal arterial or venous anastomosis between the external iliac and the obturator system of vessels and may cause significant hemorrhage during pelvi-acetabular fracture surgeries, hernia repair and laparoscopic gynecological procedures. Previous studies have estimated a prevalence of corona mortis between 34% and 70%. This cadaveric study was conducted to estimate the prevalence of corona mortis in the North Indian population.Materials and MethodsTwelve cadavers (24 hemipelvises; 11 males and 1 female) with a mean age of 68 (range, 54–82) years were included in this study.ResultsCorona mortis was observed in 14 hemipelvises (58.3%). A total of 19 (79.2%) vascular anastomoses of diameter greater than 1 mm were observed; 5 hemipelvises (20.8%) had corona mortis on the right side, 9 hemipelvises (37.5%) on the left side and bilateral in 5 (41.7%) cases. Two hemipelvises (8.3%) had an arterial connection. An aberrant obturator artery was observed in 1 (4.2%) hemipelvis. A venous connection was found in 14 specimens (58.3% of hemipelvises). The average distance of the connecting vein from the symphysis pubis was 41 (35–70) mm. A vessel diameter of greater than 4 mm was observed in 4/24 (16.7%) of hemipelvises.ConclusionThe frequency of venous corona mortis was higher than arterial corona mortis and the majority (83.3%) were small calibre (<4 mm). The presentation pattern and the number of arterial or venous anastomoses were different in the majority of hemipelvises and dissimilar in both hemipelvises of the same cadaver in the majority of cases.

Frequency and Clinical Review of the Aberrant Obturator Artery: A Cadaveric Study

“…Previous studies have reported a frequency of as many as 55.1% of individuals [ 3 , 4 , 21 , 27 , 28 ]. It can arise from the DIEA (2.6–44%); directly from the EIA (1.1–10%); or from the femoral artery (FA) (1.1–1.66%) with the OV draining into the deep inferior epigastric vein (DIEV), the external iliac vein (EIV), or into the femoral vein (FV) [ 2 , 3 , 5 , 7 , 8 , 12 , 13 , 16 , 19 , 21 , 22 , 23 , 25 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Many studies have found an AOA origin from the DIEA to be more common in females than males.…”

“…Thus, a thorough understanding of the IIA branching patterns and their possible vascular variations is essential for obstetric surgeons [ 10 , 11 , 34 , 54 ]. Such knowledge is also crucially important for general surgeons and interventional radiologists performing other types of pelvic procedures (i.e., hernia repairs or pelvic fractures), as well as for anatomists teaching pelvic vasculature [ 3 , 19 , 23 , 27 , 29 , 32 , 38 , 39 , 50 , 51 , 55 , 56 , 57 ].…”

“…Understanding the possible OA origin variations is important while performing pelvic and groin surgeries requiring appropriate ligation. In instances of acute pelvic or groin trauma, such varying origins may be a significant source of persistent hemorrhages that are difficult to manage [ 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Thus, OA origin variations are an important anatomical topic for a range of medical fields as varied as gynecology, orthopedics, and urology [ 25 , 26 ].…”

“…A thorough understanding of the IIA branching patterns and their possible vascular variations is essential for obstetric surgeons, general surgeons, and interventional radiologists performing other types of pelvic procedures (i.e., hernia repairs or pelvic fractures) (see Section 3.4 for more details) [ 3 , 10 , 11 , 19 , 23 , 27 , 29 , 32 , 34 ].…”

The Anatomical Characteristics of Corona Mortis: A Systematic Review of the Literature and Its Clinical Importance in Hernia Repair

“…CMOR is the vascular anastomosis between the obturator and external iliac or inferior epigastric vessels (Fig. 1); this connection is usually regarded as arterial, but it may be venous or both venous and arterial [1][2][3][4][5][6][7]. It has been found that, sometimes, an enlarged pubic branch of the inferior epigastric artery that descends into the obturator foramen may replace the obturator artery, and an enlarged pubic vein that joins the iliac vein may replace the obturator vein [8,9].…”