Vascular anatomy of the presacral space in unembalmed female cadavers

Wieslander, Cecilia K.; Rahn, David D.; McIntire, Donald D.; Marinis, Spyridon I.; Wai, Clifford Y.; Schaffer, Joseph I.; Corton, Marlene M.

doi:10.1016/j.ajog.2006.07.045

Cited by 44 publications

(21 citation statements)

References 5 publications

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“…1 Contemporary descriptions of the procedure recommend graft attachment site at the sacral promontory (SP). 1,7,8 The presacral space is highly vascular and variable, 9,10 and surgeons may anchor the graft at different sacral levels to avoid vessels or nerves. In addition, the angle from L5 to S1 can range from 40e90 degrees.…”

mentioning

confidence: 99%

Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth

Balgobin

Good

Dillon

et al. 2013

American Journal of Obstetrics and Gynecology

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mentioning

confidence: 99%

Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth

Balgobin

Good

Dillon

et al. 2013

American Journal of Obstetrics and Gynecology

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“…The small basivertebral veins, which are very thin, allow the bidirectional passage of blood because they lack valves; these veins flow in long, tortuous channels through the spongy tissue of the vertebral bodies. The lateral sacral veins, the medial sacral vein, and the basivertebral veins constitute a wide network of anastomoses that form the venous plexus on the anterior sacral surface[4,6] (Figure 2). The medial sacral vein can be located to the left or the right of the midline and is duplicated in 80% of cases[7].…”

Section: Resultsmentioning

confidence: 99%

“…The medial sacral vein can be located to the left or the right of the midline and is duplicated in 80% of cases[7]. The vascular anastomoses between the medial sacral vein and the lateral veins are often less than 3 cm from the sacral promontory; specifically, this distance is 2 cm in 90% of cases, and the anastomosis is located at the level of the 3 rd and 4 th sacral foramen in 70% of cases[6,7]. The retrosacral fascia, also called Waldeyer's fascia, has been described as a sheet of connective tissue that extends from the periosteum of the sacrum to the posterior wall of the rectum approximately 3-4 cm above the anorectal junction.…”

Section: Resultsmentioning

confidence: 99%

Presacral venous bleeding during mobilization in rectal cancer

Núñez¹,

Vigorita²,

Poblador³

et al. 2017

WJG

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AIMTo analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.METHODSA review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.RESULTSThis is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.CONCLUSIONA series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.

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“…The sacral venous plexus is comprised of anastomoses between the middle and lateral sacral veins, and is located variably over the anterior surfaces of the S2, S3 and S4 vertebral bodies [10]. The risk of significant bleeding from injury to these vessels increases as dissection and suture placement are attempted more caudally on the sacrum.…”

Section: Discussionmentioning

confidence: 99%

Sacral Mesh Pullout Strength Based on Suture Location for Sacrocolpopexy

Shippey

Sutter

Belkoff³

et al. 2012

Gynecol Obstet Invest

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Background: We sought to compare the pullout strengths of the sacral end of the sacrocolpopexy mesh when attached using one suture at the first versus second sacral vertebral level (S1 vs. S2) in female cadaveric pelvises. Methods: The sacral vertebrae were isolated in 9 unembalmed female cadavers, and segments of polypropylene mesh were attached to the sacrum using stitches at either the S1 or S2 level. The free end of the mesh was pulled at a constant rate. Maximum tension prior to system failure was recorded for each specimen. Suture pullout strengths between the two groups were compared using the two-sample Wilcoxon rank-sum test. Results: In all but one specimen, failure of the system occurred at the point of suture attachment to the anterior longitudinal ligament. Among the nine specimens, median pullout strengths were 7.49 lb (interquartile range 7.95) at S1 and 3.15 lb (interquartile range 2.975) at S2 (p = 0.028). Conclusion: The pullout strength of sutures used to attach the sacrocolpopexy mesh to the sacrum is significantly higher at the S1 level than at the S2 level.

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Vascular anatomy of the presacral space in unembalmed female cadavers

Cited by 44 publications

References 5 publications

Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth

Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth

Presacral venous bleeding during mobilization in rectal cancer

Sacral Mesh Pullout Strength Based on Suture Location for Sacrocolpopexy

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