Two-detector Computed Tomography Map of the Inferior Epigastric Vessels for Percutaneous Transabdominal Intervention Procedures

Abstract

The routine application of various percutaneous abdominal interventions for diagnostic and treatment procedures, such as paracentesis, peritoneal dialysis catheter procedures, tru-cut or fine needle biopsies, manipulation of laparoscopic instruments, insertion of sutures and drains, radiofrequency thermal ablation, abscess drainage, and endoscopic gastrostomy, has increased over the past two decades. Although these procedures can be performed safely, with or without imaging guiding, some complications may occur. Inferior epigastric artery (IEA) injuries are one of the major types of puncture site-related complications that occur in mid and lower abdominal percutaneous interventions. Therefore, it is crucial to be aware of anatomical variations and the exact course of the IEA to prevent any complications during percutaneous abdominal interventions.Several computed tomography (CT) studies have been published documenting the distance from the IEA to the midline, at different levels in randomized patients (1), and mapping the IEAs and their branches in selected cases (2-4). However, few multidetector CT (MDCT) studies have been performed on the general population revealing the abdominal course of an IEA and measuring its distance to the midline at different levels (5, 6).The purpose of this study was to map the inferior epigastric vessels using reconstructed two-detector computed tomography (TDCT) images and to measure distances from the IEA to the midline to determine a safe route for percutaneous abdominal interventions. MATERIAL AND METHODS Patient populationThe study population was selected from among patients who underwent contrast-enhanced abdominal MDCT examinations in our picture archiving and communication system (PACS). Approval from the Ethical Committee of the hospital was obtained (TÜTF-GOKAEK 2013/49). Medical documentation for each of the selected patients was available. MDCT examinations were performed for various reasons including follow-up of known abdominal disorders, primary or metastatic tumor investigations of different organs, vascular pathologies, and to evaluate infectious diseases. Patients with Background: It is crucial to know anatomic variations and the exact course of an inferior epigastric artery (IEA) to prevent any complications during percutaneous abdominal interventions. Aims: The aim of this study was to map the inferior epigastric vessels using reconstructed two-detector computed tomography images and measure the distance from the inferior epigastric artery (IEA) to the midline to determine a safe route for percutaneous abdominal interventions. Study Design: Retrospective comparative study. Methods: Coronal reconstructed two-detector computed tomography images of 200 patients were evaluated to measure the distances between the IEA and midline at three levels (origin, middle, and distal). Vein and artery arrangements were documented. Results:The most frequently encountered arrangement (41.5%) was a single vein and artery on both sides. Mean distances on the right and left sides we...

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