Arterial Anatomy of the Anterior Abdominal Wall: Evidence‐Based Safe Sites for Instrumentation Based on Radiological Analysis of 100 Patients. Issue 3 (8th September 2019)

• Record Type: Journal Article
• Authors: Bowness, James; Seeley, Jonathan; Varsou, Ourania; McKinnie, Angela; Zealley, Ian; McLeod, Graeme; Grant, Calum
• Is Part Of: Clinical anatomy. Volume 33:Issue 3(2020)
• Page Start: 350
• Page End: 354
• Publication Date: 2019-09-08
• Subjects: Anatomical variation -- epigastric artery -- rectus sheath block -- complications; Anatomy -- Periodicals; Anatomy -- Periodicals; 611
• DOI: 10.1002/ca.23463
• Languages: English
• ISSNs: 0897-3806

Abstract

Abstract : 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 ( χ 2 (4) = 207.272; P < 0.001) and right ( χ 2 (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.