Inferior Epigastric Artery Pseudoaneurysm Following Trocar Injury

Splinter, Karen L.; Cook, Colleen L.

doi:10.1016/j.jmig.2010.08.404

Cited by 3 publications

(5 citation statements)

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“…Plastic and reconstructive breast surgery relies on the presence of these vessels for deep inferior epigastric perforator (DIEP) flap breast reconstruction after mastectomy (Molina et al, ). Therefore, knowledge of their structure is of importance in this field, as it is also for general and gynecological surgeons to avoid vascular trauma during port‐site insertion surgery, or other clinicians during invasive procedures of the anterior abdominal wall (Procacciante et al, ; Ko et al, ; Splinter and Cook, ).…”

Section: Discussionmentioning

confidence: 99%

“…Complications may occur following such procedures, including damage to the superior and inferior (deep) epigastric arteries that run within the anterior abdominal wall, which may result in rectus sheath hematoma or epigastric artery pseudoaneurysm (Yuen and Ng, ; Kawamura et al, ; Standring, ; Procciante et al, ; Yarwood and Berrill, ; Ko et al, ; Splinter and Cook, ). The incidence of vascular injury during these techniques is unknown.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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 (χ2(4) = 207.272; P < 0.001) and right (χ2(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. Clin. Anat. 33:350–354, 2020. © 2019 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…IEA injury can result in haemorrhage, haematoma and pseudoaneurysm . Managements include bipolar coagulation, tamponade, suturing, open surgery, embolisation, and ultrasound‐guided thrombin injection or compression …”

Section: Management Of Iea Injurymentioning

confidence: 99%

“…They achieved a primary technical success rate of 90% and secondary success rate of 100% . Pseudoaneurysm resulting from IEA injury can also be managed successfully with TAE or ultrasound‐guided percutaneous thrombin injection …”

Section: Management Of Iea Injurymentioning

confidence: 99%

Inferior epigastric artery: Surface anatomy, prevention and management of injury

Wong

Merkur

2015

Aust N Z J Obstet Gynaecol

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The anatomical position of the inferior epigastric artery (IEA) subjects it to risk of injury during abdominal procedures that are close to the artery, such as laparoscopic trocar insertion, insertion of intra-abdominal drains, Tenckhoff(®) catheter (peritoneal dialysis catheter) and paracentesis. This article aims to raise the awareness of the anatomical variations of the course of the IEA in relation to abdominal landmarks in order to define a safer zone for laparoscopic ancillary trocar placement. Methods of managing the IEA injury as well as techniques to minimise the risk of injury to the IEA are reviewed and discussed.

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“…However, RSB is not without complications (Rucklidge & Beattie, 2018;Yarwood & Berrill, 2010). Rectus sheath block and other percutaneous instrumentation of the anterior abdominal wall have resulted in damage to the epigastric arteries, leading to bleeding, rectus sheath hematoma, and arterial pseudoaneurysm (Kawamura, Piemonte, Nesto, & Gossman, 2006;Ko, Choi, Malhotra, & Lee, 2010;Procacciante, Diamantini, Paolelli, & Picozzi, 2009;Splinter & Cook, 2012;Standring, 2008;Yuen & Ng, 2004). As continuous RSB is considered particularly suitable in patients taking antiplatelet agents or anticoagulants, and those with coagulopathy (Rucklidge & Beattie, 2018), avoiding such complications is important.…”

Section: Introductionmentioning

confidence: 99%

Arterial anatomy of the anterior abdominal wall: Ultrasound evaluation as a real‐time guide to percutaneous instrumentation

et al. 2020

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Introduction: Instrumenting the anterior abdominal wall carries a potential for vascular trauma. We previously assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries with computed tomography (CT). We now present a study using ultrasound (US) assessment of these arteries, to evaluate its use for real time guidance of percutaneous procedures involving the rectus sheath. Materials and Methods: Twenty-four participants (mean age 67.9 ± 9 years, 15 M:9 F [62:38%]) were assessed with US at three axial planes on the anterior abdominal wall: transpyloric plane (TPP), umbilicus, and anterior superior iliac spine (ASIS). Results: An artery was visible least frequently at the TPP (62.5-45.8%), compared with the umbilicus (95.8-100%) and ASIS (100%), on the left, χ 2 (2) = 20.571; p < .001, and right, χ 2 (2) = 27.842; p < .001, with a moderate strength association (Cramer's V = 0.535 [left] and 0.622 [right]). Arteries were most commonly observed within the rectus abdominis muscle at the level of the TPP and umbilicus, but posterior to the muscle at the level of the ASIS (95.8-100%). As with the CT study, the inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it coursed superiorly. Conclusions: These data corroborate our previous results and suggest that the safest level to instrument the rectus sheath (with respect to vascular anatomy) is at the TPP. Such information may be particularly relevant to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion.

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Inferior Epigastric Artery Pseudoaneurysm Following Trocar Injury

Cited by 3 publications

References 0 publications

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

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

Inferior epigastric artery: Surface anatomy, prevention and management of injury

Arterial anatomy of the anterior abdominal wall: Ultrasound evaluation as a real‐time guide to percutaneous instrumentation

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