The aim of the study was to evaluate the origin of the inferior epigastric artery, in relation to the inguinal ligament, in various stages of human life. Surface anatomy of iea was defined in a study of posterior surface of anterior abdominal walls in 30 cadavers. These epigastric vessels form the lateral border of hesselbachs triangle, which outlines. The vascular roadmap depends on two crucial vessels, namely the inferior epigastric artery and the femoral vein. The inferior epigastric artery is a direct branch off the external iliac artery. Morphometric study of the right gastroepiploic and. Flaps can be harvested reliably on a single large perforator system. The most common pedicled myocutaneous flap is the transverse rectus abdominis myocutaneous, tram flap, perfused by the superior epigastric vessels. Rare origin of the inferior epigastric and medial circumflex femoral. A biosound phase ii scanner biosound, indianapolis, ind.
Pdf the anatomy of superficial inferior epigastric artery flap. The distal origin of the inferior epigastric artery from the femoral artery and the. Study of the course of inferior epigastric artery with reference to. Inferior epigastric artery radiology reference article. The lower abdominal flap can be vascularized by either the deep or the superficial inferior epigastric artery. These last vessels have their origin from external iliac artery fig.
Home ostmeddr rupture of the inferior epigastric artery with rectussheath hematoma reference url. Clinical significance collateralization in vascular disorder as well as aortic coarctation. The inguinal ligament is a site of origin for a part of. Inferior epigastric artery synonyms, inferior epigastric artery pronunciation, inferior epigastric artery translation, english dictionary definition of inferior epigastric artery. At the origin of the deep inferior epigastric artery, the mean diea diameter was 2. Epigastric definition is lying upon or over the stomach. Epigastric artery, inferior article about epigastric artery. Analysis of deep inferior epigastric artery perforating. Along its course, it is accompanied by a similarly named vein, the inferior epigastric vein. The inferior epigastric artery iea was introduced into clinical practice by puig et al1 in the 1980s. Duplex scanning of the inferior epigastric artery journal.
Inferior epigastric artery an overview sciencedirect topics. The inferior epigastric artery arises from the external iliac artery and is an important artery supplying the anterior abdominal wall. The rectus abdominis musculocutaneous flap has many advantages, but. In human anatomy, inferior epigastric vessels refers to the inferior epigastric artery and inferior epigastric vein. Definition of inferior epigastric vein in the dictionary. Branches of the superior epigastric artery perforate the rectus sheath and supply the skin of the. Along its course, it is accompanied by a similarly named artery, the inferior epigastric artery. The anatomy of superficial inferior epigastric artery flap. Figure 1 representation of the venous anatomy of the anterior abdominal wall, with the subcutaneous tissues drained by both superficial and deep venous systems, the superficial inferior epigastric vein siev and the deep inferior epigastric vein diev respectively, through diev perforators dievp reproduced with permission from. An anatomic study of deep inferior epigastric artery.
Inferior epigastric vein used as a noun is very rare. The superior epigastric artery originates at the level of the sixth or seventh costal cartilage. The color doppler signal in the hernia at us represents flow of ascites. This artery continues moving superiorly and medially for 46 cm before it enters the rectus abdominis muscle.
Find out information about epigastric artery, inferior. Aug 08, 2018 the superior epigastric artery gives lateral as well as medial branches and also it anastomoses around 4 cm above the umbilicus along with sections of the inferior epigastric artery. Therefore, the distal origin of the inferior epigastric artery from the femoral artery and the lower drainage of the single inferior epigastric vein to the femoral vein. Department of anatomy, all india institute of medical sciences, raipur, chhattisgarh, 1department of anatomy, christian medical. A series of 40 dissections were performed on 20 preserved or fresh male cadavers.
Superiorly the rectus abdominis is supplied by the superior epigastric artery, a continuation of the internal thoracic artery. Proper usage and audio pronunciation of the word inferior epigastric vein. The artery then passes between the posterior layer of the rectus sheath and the rectus muscle. Epigastric artery medical definition merriamwebster. Enajat m, rozen wm, whitaker is, smit jm, acosta r. A combined anatomical variation of inferior epigastric vessels.
Surface anatomy of the abdominal and pelvic cavities. In all examined bodies, the inferior epigastric artery originated mostly from the external iliac, or less commonly, from the femoral artery. Pdf a combined anatomical variation of inferior epigastric vessels. Epigastric vein, inferior definition of epigastric vein. In males, the lowest incidence of typical anatomical origin, over the ligament, was observed in the group aged 6069 years. An anatomical study of the superficial inferior epigastric. In human anatomy, inferior epigastric artery refers to the artery that arises from the external iliac artery and anastomoses with the superior epigastric artery. In human anatomy, superior epigastric artery refers to a blood vessel that carries oxygenated blood and arises from the internal thoracic artery referred to as the internal mammary artery in the accompanying diagram. The muscle is raised and retracted medially so that the proximal portion of the pedicle is freed, and the origin of the deep inferior epigastric vessels can be dissected from the underlying fatty tissue fig. Morphometric study of the right gastroepiploic and inferior. Main outcome measures complications of surgery and subsequent flap viability.
To describe the anatomical variations of superficial inferior epigastric artery siea flap as a musclesparing flap. The surgical importance of the inferior epigastric vessels. The superior epigastric artery is one of two terminal branches of the internal thoracic artery with the other being the musculophrenic artery gross anatomy origin and course. The deep inferior epigastric artery arises medially from the distal external iliac artery and courses superiorly, entering the rectus sheath just below the arcuate line. Collateral vessels to the thoracic aorta along with abdominal aorta are.
Many surgeons used this conduit, and many reports appeared in the early 1990s. Volumerendered ct images show a deep inferior epigastric artery with an unusually inferior origin arrow in a and perforating vessels arrows in b with origins medial to the rectus muscle. Epigastric definition and meaning collins english dictionary. Epigastric definition of epigastric by merriamwebster.
The inferior epigastric veins are accompanied by the inferior epigastric artery. The inferior epigastric artery is an important artery of the abdominal wall and arises from the external iliac artery and passes up via the transversalis fascia to the arcuate line where is pierces the rectus abdominis. Epigastric vein, inferior article about epigastric vein. Ctcae grade 4 biliary tree infection documented clinically or microbiologically with grade 3 or 4 neutrophils, nci thesaurusctcae. Rupture of the inferior epigastric artery with rectussheath. In human anatomy, inferior epigastric vein refers to the vein that drains into the external iliac vein and anastomoses from the superior epigastric vein. Transverse rectus abdominis musculocutaneous tram flap breast reconstruction following mastectomy provides excellent cosmetic results without the use of prosthetic implants. The pubic vein links the obturator vein and the posteromedial side of the external iliac vein. Aug 26, 2014 the inferior epigastric vein, a tributary to the external iliac vein on its medial side just above the level of the inguinal ligament, collects the venous blood from the inferior half of the ipsilateral rectus abdominis muscle. Pdf clinical anatomy of the inferior epigastric artery with special. Rupture of the inferior epigastric artery with rectus. Although the original abdominoinguinal incision was described with ligation and division of the inferior epigastric vessels and detachment of the lateral portion of the inguinal ligament o.
The rectus abdominis musculocutaneous flap has many advantages, but its disadvantages are also wellknown. The artery gives off several small branches as it runs from the external iliac artery to the muscle see figure 5. The origin of the inferior epigastric artery in relation. Because of varying lengths, diameters, and depths, a method of determining vessel adequacy before operation was needed.
Medially to the deep inguinal ring are the inferior epigastric vessels the deep inguinal ring crura gives origin to the internal spermatic fascia can see the vas deferens, genital branch of genitofemoral nerve and testicular vessels joining to form the spermatic cord. Internal from posterior to anterior view of right inguinal area of the male pelvis, with inferior epigastric vessels labeled at upper left. The inferior epigastric artery arises from the external iliac artery which supplies the pubic and umbilical regions. If the hernia sac is located lateral to the origin of the inferior epigastric artery and vein, it is an indirect inguinal hernia figures 24. They are found lateral to the obliterated umbilical vessels and medial to the deep inguinal ring, which can be identified by following the entry of the round ligament into the inguinal canal. Superficial inferior epigastric vessels the transverse rectus abdominus myocutaneous tram flap is currently the most widely used flap in autologous breast reconstruction. It descends to the anterior abdominal wall, crossing the diaphragm in the interval between the sternal and the costal. To link to this object, paste this link in email, im or document to embed this object, paste this html in website. Find out information about epigastric vein, inferior. As early as 1823, injury to the epigastric vessels during surgery was recognised. The superficial epigastric artery supplies the superficial tissue of the abdominal wall. We present two different manifestations of inferior epigastric vessel injury at laparoscopic surgery and how they were managed.
The inferior epigastric vessels are branches of the external iliac vessels. Laparoscopic management of inferior epigastric vessel bleeding. Inferior epigastric artery skin flaps without rectus abdominis muscle. A dependable and swift technique to control accidental inferior epigastric vessel bleeding using the anatomical stability of the vessel after its origin. Secondly, the inferior epigastric artery may be damaged during inguinal hernia repair. Based on earlier observations that the thickness of the intima and structure of the media may have an impact on the longterm patency of arterial conduits and the lack of detailed histologic studies of the right gastroepiploic and inferior epigastric arteries, we subjected both vessels to morphometric analysis with emphasis on their suitability as conduits in myocardial. The origin of the hernia arrowhead is medial to a dilated inferior epigastric vein arrow, making this a direct hernia.
By definition, the dieap flap is perfused only via one or. The distal origin of the inferior epigastric artery from the femoral artery and the lower drainage of the single inferior. Download citation the surgical importance of the inferior epigastric vessels the inferior epigastric artery arises just above the inguinal ligament from the medial side of the external iliac. Epigastric artery, inferior article about epigastric. Once all of the side branches are divided and the pedicle is free near its origin to the entrance into the subcutaneous abdominal. From january 2001 to july 2006, patients had laparoscopic inferior epigastric vessel ligation, of whom 123 patients had bilateral ligation. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The superior epigastric artery anastomoses with the inferior epigastric artery, which is a branch of the external iliac artery, providing an important alternate blood supply if the aorta becomes occluded see. Three branching patterns of the deep inferior epigastric artery have been described.
Ct angiography of inferior epigastric and gluteal perforating. Initial experience with laparoscopic inferior epigastric. Anatomy, abdomen and pelvis, epigastric artery statpearls ncbi. The most commonly injured vessels in laparoscopic procedures are the epigastric arteries, both the superficial and deeper vessels 2, 3. If a superficial inferior epigastric artery is present, as seen in about twothirds of cases, then the inferior epigastric artery is referred to as the deep inferior epigastric artery. Above the inguinal ligament the inferior epigastric veins drain into the external iliac vein. The deep inferior epigastric artery and venae via perforators through the rectus muscle. Use of inferior epigastric artery embolization to arrest.
Among free flaps, this is without pedicles, myocutaneous tissue is used including infraumbilical rectus abdominis, in the subsidiary area of the inferior epigastric vessels. These epigastric vessels form the lateral border of hesselbachs triangle, which outlines the area through which direct inguinal hernias protrude. Resection of chondrosarcoma of the pubic bone pdf free. The inferior epigastric vein, a tributary to the external iliac vein on its medial side just above the level of the inguinal ligament, collects the venous blood from the inferior half of the ipsilateral rectus abdominis muscle. It anastomoses with the inferior epigastric artery at the umbilicus and supplies the anterior part of the abdominal wall and some of the diaphragm. A type of breast reconstruction in which blood vessels called deep inferior epigastric perforators diep, and the skin and fat connected to them are removed from the lower abdomen and used for reconstruction. Start studying surface anatomy of the abdominal and pelvic cavities. Rare origin of the inferior epigastric and medial circumflex femoral arteries. The study was conducted on randomly selected 220 nonfixed cadavers, including 110 males and 110 females, from the age of the 7th month of prenatal life, to 82 years.
Inferior epigastric artery skin flaps without rectus. Fivemillimeter teflon clips were used to ligate the vessels near their origin. Rupture of the inferior epigastric artery with rectussheath hematoma. A vein running along the back wall of the thorax on the right side of the thoracic aorta. They course cephalad between the abdominal wall peritoneum and the rectus muscles. The deep inferior epigastric artery perforator diep flap. Along their way they divide into numerous small branches, some of which perforate the.
Therefore, the distal origin of the inferior epigastric artery from the femoral artery and the lower drainage of the single inferior epigastric vein to the femoral vein must be taken into consideration by surgeons. At the deep inferior epigastric artery at the lateral border of the rectus abdominis muscle, the mean diea diameter was 2. Use of the inferior epigastric artery for coronary. The origin of the inferior epigastric artery in relation to. Inferior epigastric artery an overview sciencedirect.