Anatomical variations of the internal iliac veins in the presacral area: Clinical implications during sacral colpopepxy or extended pelvic lymphadenectomy

Chong, Gun Oh; Lee, Yoon Hee; Hong, Dae Gy; Cho, Young Lae; Lee, Yoon Soon

doi:10.1002/ca.22482

Cited by 15 publications

(5 citation statements)

References 13 publications

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“…That is why a profound knowledge of the distribution and constitution of the IIV is, in the majority of cases, bleed sparing. This is true for the scheduled as well as for the urgent surgical scenario [6][7][8] .…”

Section: Discussionmentioning

confidence: 96%

Venas extrapélvicas posteriores tributarias de las venas iliacas internas: morfometría, tipos y variantes

Sat-Muñoz¹,

Balderas-Peña²,

Cortes-Torres³

et al. 2020

CIRU

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Background: In the distribution of the veins, it corresponds in the path and by its affluent to their arterial counterpart. For the pelvic surgeon faced with pelvic surgical pathology, the knowledge of the distribution of the venous vessels is especially important in view of novel surgical techniques and current approaches. The majority of the reports are on common iliac vein (CIV) or the inferior vena cava. To the best of our knowledge, there are no papers describing posterior extrapelvic affluents that drain into the internal iliac vein (IIV). Objective: The aim of this work was to describe the pattern of the constitution of the IIV in 17 dissection specimens taken at our institution. Materials and methods: We dissected and registered the anatomic variations of the posterior extrapelvic tributaries to the IIVs. Results: Moreover, we describe the presence of a vein here that is, as far as we know, the first report of a vein that is formed from the posterior extrapelvic veins that drain exactly onto the anterior surface of the CIV. We also describe herein the variants that we have found. Conclusions: The ignorance of the anatomic variations in the posterior extra-pelvic tributaries to the IIVs (internal iliac veins) can lead to fatal consequences in the patients undergoing pelvic surgery.

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Section: Discussionmentioning

confidence: 96%

Venas extrapélvicas posteriores tributarias de las venas iliacas internas: morfometría, tipos y variantes

Sat-Muñoz¹,

Balderas-Peña²,

Cortes-Torres³

et al. 2020

CIRU

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“…In addition, when performing LLND, after performing one side, the branch patterns of the IIV on the opposite side can be predicted. Certainly, some studies demonstrated the complex anatomy of IIVs and their branches [16][17][18][19][20]. However, the patterns of the IIV can basically be divided into two patterns: Adachi's classification Types I and IV.…”

Section: Discussionmentioning

confidence: 99%

“…To solve those problems, several studies have attempted to investigate the branch patterns of the IIVs. However, these studies focused on common internal and external iliac veins, and the peripheral sides of the veins were not well investigated [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Anatomical Validation of Internal Iliac Vessels Assessed by Three-dimensional Angiographic Analysis

Takenaka

Beppu

Otani

et al. 2023

J Anus Rectum Colon

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Objectives: Anatomical understanding of the internal iliac vessels is important with the increasing frequency of minimally-invasive pelvic surgery. We aimed to investigate the branch patterns of internal iliac vessels, especially the veins. Methods: This study included 30 patients with 60 half-pelvises who underwent minimally-invasive pelvic surgery. Branch patterns were assessed on surgical videos with a multi-detector computed tomography-based three-dimensional simulation. Branch patterns of the superior gluteal artery and vein (SGA and SGV), inferior gluteal artery and vein (IGA and IGV), internal pudendal artery and vein (IPA and IPV), and obturator artery and vein (ObA and ObV) were investigated. Results: In the most frequent internal iliac vein (IIV) branch pattern, 67% of SGV branched from the IIV, 95% of the IGV branched from the IPV and 82% of the ObV branched from the IPV. According to Adachi's classification, 62% of IIVs were Type I and 33% Type IV. Although IIV branch patterns are heterogeneous, in individual patients with the most frequent branch patterns, good correlation (75-100%) of the branch patterns was observed between the internal iliac artery (IIA) and IIV, and between the right and left IIVs. Conclusions: This study clarified the branch patterns of IIV. In patients with the most frequent branch patterns, good correlation of the branch patterns was observed between the IIA and IIV, and between right and left IIV. We believe this helps secure the safety and standardization of minimally-invasive pelvic surgery.

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“…The right ureter should be seen throughout the entire dissection process in order to avoid damages to the right iliac vessels and ureter. The vascular anatomy is extremely variable [8]. To date, the literature has strongly emphasized these variants which must be known to avoid bleeding complications, while the bone component and the study of the bone promontory were less explored.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic monolateral suspension for vaginal vault prolapse: a report of an exit surgical strategy during sacralcolpopexy

et al. 2020

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Background Vaginal vault prolapse is the most frequent long-term complication in patients undergoing hysterectomy and sacralcolpopexy is considered the gold standard. We report our surgical strategy maintaining single-arm mesh when the sacral promontory is not accessible to fix the mesh for an unknown sacral osteophytosis during a laparoscopic sacralcolpopexy. This is significant because, to our knowledge, the bone variant as a procedure limiting factor has never been described before. This opens new horizons for the sacralcolpopexy surgery, because it becomes necessary to know of a valid surgical alternative with mesh maintenance if this complication occurs again or to perform an assessment of the accessibility of the sacral promontory immediately after its dissection. Case presentation We present a case of a 75-year-old woman with recurrence of vaginal vault prolapse. A laparoscopic sacralcolpopexy was recommended. During surgery, we found that the procedure was not feasible due to the presence of an unknown osteophytosis of the sacrum which prevented the fixing of the mesh to the sacral promontory. We decided to proceed with a single-arm lateral suspension by using a modified approach of the original technique, maintaining the mesh originally shaped for the sacral colpopexy. At follow-up, the vaginal vault is well suspended. Conclusion This exit strategy may represent a valid surgical alternative when laparoscopic sacral colpopexy is not possible for anatomical variants, allowing to keep the laparoscopic approach using mesh. To our knowledge, cases in which the anatomical bone variant prevented access to the sacral promontory have never been described in the literature, as bone evaluation has never been considered a limiting element of this procedure.

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Anatomical variations of the internal iliac veins in the presacral area: Clinical implications during sacral colpopepxy or extended pelvic lymphadenectomy

Cited by 15 publications

References 13 publications

Venas extrapélvicas posteriores tributarias de las venas iliacas internas: morfometría, tipos y variantes

Venas extrapélvicas posteriores tributarias de las venas iliacas internas: morfometría, tipos y variantes

Anatomical Validation of Internal Iliac Vessels Assessed by Three-dimensional Angiographic Analysis

Laparoscopic monolateral suspension for vaginal vault prolapse: a report of an exit surgical strategy during sacralcolpopexy

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