The Corona Mortis, a Frequent Vascular Variant Susceptible to Blunt Pelvic Trauma: Identification at Routine Multidetector CT

Smith, Jason C.; Gregorius, John C.; Breazeale, Bretton H.; Watkins, Gregory E.

doi:10.1016/j.jvir.2009.01.007

Cited by 44 publications

(27 citation statements)

References 23 publications

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“…AOAs have also been given the name of "corona mortis"; however, there is no consensus on the definition of the corona mortis. Some authors consider the corona mortis to be limited to AOAs, whereas others consider it to be any venous or arterial communication between the external and internal iliac systems through the obturator vessels (3,6). In this study, AOAs were defined as any obturator artery arising from the inferior epigastric artery (78%) or directly from the external iliac artery (22%) (3,6).…”

Section: Discussionmentioning

confidence: 99%

“…Nine patients with prostatic arteries arising from AOAs were included. AOAs were classified as (i) obturators arising from the inferior epigastric artery, (ii) obturators arising directly from the external iliac artery, or (iii) codominant obturators originating from both the external and the internal iliac artery systems (3).…”

Section: Methodsmentioning

confidence: 99%

“…However, the obturator artery may arise from the inferior epigastric artery or directly from the external iliac artery and be named an accessory or aberrant obturator artery (AOA). An AOA is a common variation that may be present in 30% of pelvic sides (3). Prostatic arteries arising from AOAs are a possible variant of particular relevance when performing PAE.…”

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confidence: 99%

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The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

Bilhim

Pisco²,

Pinheiro

et al. 2014

Journal of Vascular and Interventional Radiology

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In 9 of 491 patients (1.8%) who underwent prostatic arterial embolization (PAE) for benign prostatic hyperplasia from March 2009-November 2013, prostatic arteries arose from the external iliac artery via an accessory obturator artery (AOA). Computed tomography angiography performed before the procedure identified the variant and allowed planning before the procedure. The nine AOAs were catheterized from a contralateral femoral approach. Bilateral PAE was technically successful in the nine patients. There was a mean decrease in international prostate symptom score of 6.5 points and a mean prostate volume reduction of 15.1% (mean follow-up, 4.8 mo) in the nine patients. ABBREVIATIONSAOA = accessory obturator artery, DSA = digital subtraction angiography, IPSS = International Prostate Symptom Score, PAE = prostatic arterial embolization, PVA = polyvinyl alcohol, QoL = quality of life Prostatic arterial embolization (PAE) to relieve lower urinary tract symptoms in patients with benign prostatic hyperplasia is a challenging procedure partly because of the highly variable origin and complex anatomy of the prostatic arteries (1). Computed tomography (CT) angiography performed before PAE has been used to help identify the prostatic arteries and to guide the procedure (2). The prostatic arteries may arise from the different branches of the internal iliac artery, including from the obturator artery, in 13% of pelvic sides (1,2). However, the obturator artery may arise from the inferior epigastric artery or directly from the external iliac artery and be named an accessory or aberrant obturator artery (AOA). An AOA is a common variation that may be present in 30% of pelvic sides (3). Prostatic arteries arising from AOAs are a possible variant of particular relevance when performing PAE. The purpose of this report is to clarify this anatomic variation and report successful catheterization and embolization in nine patients with lower urinary tract symptoms related to benign prostatic hyperplasia. MATERIALS AND METHODSThe institutional review board waived the need to obtain permission to perform this retrospective analysis. From March 2009-November 2013, PAE was performed in 491 patients to relieve lower urinary tract symptoms secondary to benign prostatic hyperplasia. Nine patients with prostatic arteries arising from AOAs were included. AOAs were classified as (i) obturators arising from the inferior epigastric artery, (ii) obturators arising directly from the external iliac artery, or (iii) codominant obturators originating from both the external and the internal iliac artery systems (3).Among the nine patients evaluated, mean patient age was 62.9 years (range, 51-74 y). Mean International Prostate Symptom Score (IPSS) was 18.9 points (range, 14-21 points), mean quality of life (QoL) score was 4.0 points (range, 3-6 points). Mean peak flow rate was 11.2 mL/s (range, 5.9-13.5 mL/s), mean postvoid residual & SIR, 2014

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

Bilhim

Pisco²,

Pinheiro

et al. 2014

Journal of Vascular and Interventional Radiology

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“…However, the pelvis counts with a very rich arterial collateral system and bleeding sites are frequently fed by a combination of branches from different territories like the external iliac, contralateral iliac, inferior mesenteric, lumbar, or profunda femoral arteries [33•]. For example, it has been found that the obturator artery has a replaced origin to the external iliac artery in over 30 % of cases; this vessel variant is the so-called corona mortis of pelvic trauma [36]. If the situation allows, at the very least, selective bilateral internal and external iliac angiograms are recommended to identify hemorrhagic arterial branches frequently obscured to the non-selective pelvic angiogram [37•].…”

Section: Musculo-skeletal Vessel Injurymentioning

confidence: 99%

Interventional Radiology: Interventions and Techniques in Trauma

Garza-Berlanga

Lopera

2016

Curr Trauma Rep

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Purpose of Review The purpose of the review was to describe how interventional radiology procedure contribute in the management of the trauma patient, distinguish the situations where evidence has demonstrated improved outcomes with its use, acknowledge the limitations and controversies of the techniques and their place on management algorithms, and mention some particular situations where, despite lack of evidence, the procedures are commonly employed. Recent Findings CT seems to be a better indicator of significant vascular injury with the associated high risks when compared to a discordant negative conventional angiogram. Empiric embolization of the injured segments might improve outcomes in these settings. Finding a subcapsular splenic hematoma in CT is an independent risk factor associated with high rates of NOM failure. Prophylactic interventions are recommended, even in low grade splenic injuries, when a subcapsular splenic hematoma is present. In liver trauma, the injured liver is more susceptible to ischemic injury from arterial embolization with subsequent infarct, biloma, and abscess formation. When needed, angio-embolization should be performed as selective as possible. Subsequent surveillance for ischemic liver injury complications should be instated and, if required, timely therapeutic interventions considered.Summary The initial CT scan findings of Bcontrast blush^and high-grade solid organ injury are some of the best early predictors for failure of the non-operative management (NOM) in the trauma patient. Endovascular interventions improve the outcomes of NOM when clinical or imaging findings indicate a high risk for continued or delayed hemorrhage. Angioembolization improves the outcomes of unstable hemorrhagic pelvic fractures and is useful as complement of damage control surgeries or when the surgical interventions fail to control vascular injuries.

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“…El origen anómalo de esta arteria es lo que hace que se le considere arteria obturatriz aberrante (Darmanis et al, 2007;Sakthivelavan et al, 2010). Otra variación anatómica es la llamada arteria corona mortis, en cuyo caso la arteria obturatriz presenta su patrón normal de origen en el tronco anterior de la iliaca interna, pero existe una arteria adicional y de menor calibre, originada en la arteria iliaca externa o en la epigástrica inferior, que se arquea sobre el ramo superior del pubis, pasa por detrás de él y se anastomosa con la arteria obturatriz (Sakthivelavan et al;Rusu et al, 2010;Berberoglu et al, 2001;Mahato 2009;Stavropoulou-Deli & Anagnostopoulou, 2013;Smith et al, 2009). Teniendo en cuenta esta distinción conceptual, cabe anotar que ambas formas de variación suponen un riesgo en las intervenciones quirúrgicas que involucran la parte inferior de la pared abdominal anterior, ya que en ambas los vasos discurren por encima y por detrás del ramo superior del pubis.…”

Section: Introductionunclassified

Corona Mortis: Importancia Anatomo Clínica y Ocurrencia en una Muestra de la Población Colombiana

2015

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BAENA, G. ; ROJAS, S. & PEÑA, E.Corona mortis: importancia anatomo -clínica y ocurrencia en una muestra de la población colombiana. Int. J. Morphol., 33(1):130-136, 2015. RESUMEN:Corona mortis es una variación anatómica referida a la anastomosis de los vasos iliacos externos e internos, mediante vasos que se arquean por encima y por detrás del ramo superior del pubis. En caso de resultar lesionados iatrogénicamente, se pueden presentar hemorragias de difícil manejo. El objetivo del estudio fue caracterizar los vasos obturatrices en una muestra cadavérica de la población colombiana, para determinar su morfometría y la frecuencia con que se presentan los diferentes patrones venosos y arteriales. Se estudiaron hemipelvis de 14 cadáveres, pertenecientes al anfiteatro del Departamento de Morfología de la Universidad del Valle en Cali, Colombia. Tras acceder a la cavidad pélvica y completar la disección de todos los vasos que se relacionaban con el canal obturador y la cara pélvica del ramo superior del pubis, se determinaron sus características morfológicas y sus dimensiones. Las variaciones arteriales, corona mortis y arteria obturatriz aberrante, se presentaron en el 35,7% de las hemipelvis y las variaciones venosas en el 82,1%. La arteria corona mortis sólo se presentó en el 3,6% de las hemipelvis y el 32,1% presentaron arteria obturatriz aberrante. La moda de las frecuencias absolutas de los patrones venosos fue la vena corona mortis que se presentó en el 75,0% de las hemipelvis. El conocimiento de los patrones arteriales y venosos de los vasos obturatrices y de sus variaciones anatómicas para la población colombiana es indispensable para evitar lesionarlos durante procedimientos clínico -quirúrgicos que comprometan el anillo pélvico anterior y la región inguinal. INTRODUCCIÓNLa arteria obturatriz suele originarse de la arteria iliaca interna, emerge por el canal obturador a la región femoral medial y pueden presentarse variados patrones de anastomosis entre ella y las arterias iliaca externa y epigástrica inferior. Igual patrón suele presentarse para las venas (Standring, 2005;Chatain & Bustamante, 1986;Pró, 2012). Una de estas variaciones es la arteria obturatriz aberrante, la cual no se origina de la iliaca interna, sino de la arteria iliaca externa o de la epigástrica inferior y emerge a la región femoral por el canal obturador. El origen anómalo de esta arteria es lo que hace que se le considere arteria obturatriz aberrante (Darmanis et al., 2007;Sakthivelavan et al., 2010). Otra variación anatómica es la llamada arteria corona mortis, en cuyo caso la arteria obturatriz presenta su patrón normal de origen en el tronco anterior de la iliaca interna, pero existe una arteria adicional y de menor calibre, originada en la arteria iliaca externa o en la epigástrica inferior, que se arquea sobre el ramo superior del pubis, pasa por detrás de él y se anastomosa con la arteria obturatriz (Sakthivelavan et al.;Rusu et al., 2010;Berberoglu et al., 2001;Mahato 2009;Stavropoulou-Deli & Anagnostopoulou, 2013;Smith et al....

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The Corona Mortis, a Frequent Vascular Variant Susceptible to Blunt Pelvic Trauma: Identification at Routine Multidetector CT

Cited by 44 publications

References 23 publications

The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

Interventional Radiology: Interventions and Techniques in Trauma

Corona Mortis: Importancia Anatomo Clínica y Ocurrencia en una Muestra de la Población Colombiana

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The Corona Mortis, a Frequent Vascular Variant Susceptible to Blunt Pelvic Trauma: Identification at Routine Multidetector CT

Cited by 44 publications

References 23 publications

The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

Interventional Radiology: Interventions and Techniques in Trauma

Corona Mortis: Importancia Anatomo ­ Clínica y Ocurrencia en una Muestra de la Población Colombiana

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Corona Mortis: Importancia Anatomo Clínica y Ocurrencia en una Muestra de la Población Colombiana