Arterial anatomy of the anterior abdominal wall: evidence-based safe sites for instrumentation based on radiological analysis of 100 patients

Bowness, J., Seeley, J., Varsou, O. , McKinnie, A., Zealley, I., McLeod, G. and Grant, C. (2020) Arterial anatomy of the anterior abdominal wall: evidence-based safe sites for instrumentation based on radiological analysis of 100 patients. Clinical Anatomy, 33, pp. 350-354. (doi: 10.1002/ca.23463) (PMID:31444816)

Abstract

Introduction: 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. Materials & Methods: 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). Results: 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 to the umbilicus (72-79%) and ASIS (93-96%), on the left (χ (4) = 207.272; p < 0.001) and right (χ (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. Discussion: 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. This article is protected by copyright. All rights reserved.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Varsou, Dr Ourania
• Authors: Bowness, J., Seeley, J., Varsou, O., McKinnie, A., Zealley, I., McLeod, G., and Grant, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Life Sciences
• Journal Name: Clinical Anatomy
• Publisher: Wiley
• ISSN: 0897-3806
• ISSN (Online): 1098-2353
• Published Online: 24 August 2019
• Copyright Holders: Copyright © 2019 Wiley Periodicals, Inc.
• First Published: First published in Clinical Anatomy 33:350–354
• Publisher Policy: Reproduced in accordance with the publisher copyright policy