The prevalence and morphology of the corona mortis (Crown of death): A meta-analysis with implications in abdominal wall and pelvic surgery

Sanna, Beatrice; Henry, Brandon Michael; Vikse, Jens; Skinningsrud, Bendik; Pękala, Jakub R.; Walocha, Jerzy; Cirocchi, Roberto; Tomaszewski, Krzysztof A.

doi:10.1016/j.injury.2017.12.007

Cited by 44 publications

(46 citation statements)

References 31 publications

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“…Classically, CMOR is defined as an arterial anastomosis between the external iliac system and OA (arising from the internal iliac); however, there may also be venous interconnections and/or replaced OA (arising from either the external iliac or inferior epigastric, as in our study). Two recent meta-analyses have reported prevalence of the corona mortis to be 46 and 49.3%, respectively, 22,27 with arterial CMOR at 25% in the Noussios et al's study and 17% in the Sanna et al's study. Notably, most of the included studies in the meta-analyses were based on cadaver dissections, which may limit findings due to vascular disease or prior surgery.…”

Section: Discussionmentioning

confidence: 90%

“…The variant anatomy of the OA arising from the DIEA or external iliac artery or an anastomotic connection between the external iliac artery and the OA has both been classically described in anatomic literature as the "Corona Mortis," or "Crown of Death" 21,22 . "Corona" refers to the curve of the vessel as it arises from the DIEA and descends along the pelvic brim into the obturator foramen, and "mortis" because of the devastating hemorrhage that may result when this vessel is inadvertently encountered or transected in hernia repair, pelvic trauma, or other pelvic operations.…”

Section: Discussionmentioning

confidence: 99%

“…Prior anatomic studies have demonstrated variable anatomy of the OA and documented the prevalence of the "corona mortis" (CMOR). 19,[21][22][23][24][25][26] The reported prevalence depends on study methodology (intraoperative, cadaveric, radiologic), definition, and size criteria for the CMOR, and whether results are reported per patient or per hemipelvis. Classically, CMOR is defined as an arterial anastomosis between the external iliac system and OA (arising from the internal iliac); however, there may also be venous interconnections and/or replaced OA (arising from either the external iliac or inferior epigastric, as in our study).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence and Utilization of Obturator Artery Anatomic Variant in Autologous Breast Reconstruction

Muñoz

Powers

Zhang

et al. 2020

J Reconstr Microsurg

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Background The objective of this study is to quantify the prevalence and describe the utilization of an anatomic vascular variant in which the obturator artery (OA) arises from the trunk of the deep inferior epigastric artery (DIEA) in stacked/dual-pedicled autologous breast reconstruction. When this variant is identified preoperatively on computed tomography angiography (CTA), it may be utilized in a “flow-through” fashion to direct antegrade internal mammary artery (IMA) flow into a second free flap to facilitate anastomotic arrangement and optimize perfusion. Methods Preoperatively obtained abdomen/pelvis CTA imaging of 121 autologous breast reconstruction patients were retrospectively reviewed for the unilateral or bilateral presence of the OA branch arising from the DIEA (OA variant). The results were analyzed using descriptive statistics. Results Our analysis revealed the presence of the OA variant in 60 of the 121 (49.6%) breast reconstruction candidates, either unilaterally or bilaterally. Out of these patients, the variant was present unilaterally in 33 (55%) and bilaterally in 27 (45%) patients. Of the unilateral variants, 12 (36.4%) patients demonstrated right-sided laterality, while 21 (63.6%) patients demonstrated left-sided laterality. Clinically, this anatomic variant has been utilized in several cases of autologous breast reconstruction with flap survival in all cases. Conclusion Utilization of this anatomic variant in stacked or dual-pedicled autologous breast reconstruction results in antegrade IMA perfusion of both primary and secondary flaps, as well as improved size match compared with other anastomotic options. Knowledge of the vascular anatomy and variations in the inferior epigastric system is crucial to both preventing complications and optimizing flap planning and outcome.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and Utilization of Obturator Artery Anatomic Variant in Autologous Breast Reconstruction

Muñoz

Powers

Zhang

et al. 2020

J Reconstr Microsurg

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“…Another vessel that is not commonly injured and could be challenging to visualize is the corona mortis. Injury to the corona mortis can result in massive hemorrhage resulting from intraoperative injuries [ 9 ]. The corona mortis is a communicating vessel between the obturator and external iliac vessels and traverses posterior to the superior pubic ramus at a variable distance from the symphysis pubis [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Major Bleed Post Minimally Invasive Surgical Repair of Inguinal Hernia

Gupta¹,

Burgos²,

Rodriguez³

et al. 2020

Cureus

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At our center, over 200 patients undergo minimally invasive repairs of inguinal hernias every year using a laparoscope and a robotic-assisted technique. In three patients who underwent a minimally invasive procedure for uncomplicated indirect inguinal hernia, the postoperative course was complicated with bleeding and required an exploratory laparotomy. Post-procedure, the patients developed tachycardia and hypotension with a drop in hemoglobin, for which the patients required surgical re-exploration in an emergent fashion. The factors leading to bleeding were analyzed and are reported herein to increase awareness and prevent the occurrence of these complications during inguinal hernia surgery.

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“…Injuries to the aberrant obturator artery are susceptible to injuries in similar conditions. Additionally, the risk is predicted to further be less due the fact that the aberrant obturator artery only exits in 12%-41.5% of the population, based on cadaveric, angiography, CT, and peroperative studies (Adachi and Hasebe, 1928;Pick, 1942;Darmanis et al, 2007;Okcu et al, 2004;Requarth and Miller, 2011;Al Talalwah, 2016;Ates et al, 2016;Han et al, 2017;Hussami et al, 2017;Jensen et al, 2015;Steinberg et al, 2017;Wada et al, 2017;Zlotorowicz et al, 2018) and metaanalyzed to be approximately in 17% of cases (Sanna et al, 2018). This makes the overall estimated risk of injury to the aberrant obturator artery less than 1% (one patient in our multicenter study; Dzupa et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Where and what arteries are most likely injured with pelvic fractures?

et al. 2019

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Blood vessels passing through pelvic region come into intimate contact with pelvic bone and can be injured by the sharp edges of the dislocated fracture fragments. The aim of the study was to evaluate the influence of localization, shape, and dislocation of individual pelvic ring bones' fractures on arterial injuries. The study group consisted of 474 patients enrolled in a 1‐year prospective multicenter study. The pattern of pelvic fracture lines was characterized and recorded on a planar diagram of the subjected side of the pelvis. The diagram was subdivided into 11 designated areas. Frequency of injury at each 11 areas was recorded. The course of individual arteries in the 11 areas was also recorded in relation to each type of pelvic fractures. Out of the 474 investigated patients, the highest proportion of fractures occurred in the areas of the superior (62%) and inferior (59%) ramus of the pubis as well as in the lateral part of the sacrum (19%). These locations can be associated with injuries of the external iliac, obturator, internal iliac, and aberrant obturator arteries. The highest risk of arterial injuries was associated with vertically displaced fractures in the middle part of the superior and inferior pubic rami, along the ischial ramus, in the apex of the greater sciatic notch and in the vicinity of the ventral part of the sacroiliac joint, where the artery runs at a distance of less than 1 cm from the bone. Clin. Anat. 32:682–688, 2019. © 2019 Wiley Periodicals, Inc.

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The prevalence and morphology of the corona mortis (Crown of death): A meta-analysis with implications in abdominal wall and pelvic surgery

Cited by 44 publications

References 31 publications

Prevalence and Utilization of Obturator Artery Anatomic Variant in Autologous Breast Reconstruction

Prevalence and Utilization of Obturator Artery Anatomic Variant in Autologous Breast Reconstruction

Major Bleed Post Minimally Invasive Surgical Repair of Inguinal Hernia

Where and what arteries are most likely injured with pelvic fractures?

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