1
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Youm J, Choi MJ, Kim BM, Seo Y. Transcatheter embolization for hemorrhage from aberrant testicular artery after partial nephrectomy: A case report. World J Clin Cases 2023; 11:7852-7857. [DOI: 10.12998/wjcc.v11.i32.7852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/06/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Arterial bleeding typically involves the renal artery following partial nephrectomy; in this study, we present a case of bleeding originating from the testicular artery that has not been reported in previous studies.
CASE SUMMARY A 52-year-old man suffered hemorrhage from a perinephric branch of the aberrant left testicular artery after an open nephron-sparing surgery for renal cell carcinoma. Clinical signs of bleeding were manifested by the patient, such as fresh blood drainage from the catheter, decreased hemoglobin levels, and significant vital sign changes. Since computed tomography did not show evidence of active bleeding, transcatheter angiography was conducted to identify the bleeding site. Fluoroscopic spot images confirmed bleeding derived from a perinephric branch of the testicular artery originating from the segmental artery of the left renal artery. Using n-butyl-2-cyanoacrylate, successful transcatheter arterial embolization of the affected branch was performed. Immediately after the embolization procedure, the bleeding ceased, and the patient experienced complete recovery devoid of complications.
CONCLUSION In patients with postoperative arterial hemorrhage after partial nephrectomy, the testicular artery can be a rare but notable source of bleeding. Accurate bleeding site localization via angiographic evaluation, followed by transcatheter arterial embolization, can be instrumental for safe, prompt, and effective hemostasis.
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Affiliation(s)
- Juyoun Youm
- Department of Radiology, Dankook University Hospital, Cheonan 31116, South Korea
| | - Min-Jeong Choi
- Department of Radiology, Dankook University Hospital, Cheonan 31116, South Korea
| | - Bong Man Kim
- Department of Radiology, Dankook University Hospital, Cheonan 31116, South Korea
| | - Yumi Seo
- Department of Urology, Dankook University Hospital, Cheonan 31116, South Korea
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2
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Patel S, Ahmed I, Thomson B. Oh nuts, they've got a pelvic kidney - a tricky testicular vein embolisation. BJR Case Rep 2023; 9:20220130. [PMID: 37928700 PMCID: PMC10621584 DOI: 10.1259/bjrcr.20220130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/19/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Testicular vein embolisation for varicocele is a common interventional procedure performed in predominantly young, healthy males. Cross-sectional imaging is rarely performed for treatment planning and is often not available. In this case report, we describe a case of testicular vein embolisation in an ipsilateral pelvic kidney where cross-sectional imaging aided treatment planning resulting in successful embolisation.
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Affiliation(s)
- Sajal Patel
- Interventional Radiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | - Irfan Ahmed
- Interventional Radiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | - Benedict Thomson
- Interventional Radiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
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3
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Maughan KS, Romain M, Brown DB. Use of Ethylene Vinyl Copolymer for Embolization Outside the Central Nervous System: A Case Review. Semin Intervent Radiol 2023; 40:221-230. [PMID: 37333750 PMCID: PMC10275679 DOI: 10.1055/s-0043-1768611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Affiliation(s)
- Kyle S. Maughan
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mike Romain
- Meharry Medical College, Nashville, Tennessee
| | - Daniel B. Brown
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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4
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Pedrão I, Valeri MTA, Gonsalves DG, Afonso NM, Signori AG, Rissi R. Anomalous drainage of the right gonadal vein. Anat Sci Int 2023; 98:143-146. [PMID: 36107304 DOI: 10.1007/s12565-022-00684-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/06/2022] [Indexed: 01/20/2023]
Abstract
The present research aims to present and describe an unusual and rare anatomical variation in relation to the drainage of the right gonadal vein. This anatomical knowledge is crucial as it assists in the work of surgeons and health professionals in general. The dissection occurred in the anterior wall of the abdomen and, through observational analysis, an anatomical variation was found in the drainage of the right gonadal vein in a human cadaver, obtained by anonymous donation, male gender and without predetermined clinical characteristics, ethnicity, and age, belonging to the Padre Albino University Center collection. This research was approved by the Research Ethics Committee under protocol 12923919.8.0000.5430. The drainage of right gonadal vein is this variant occurs anastomosed with an innominate venous trunk that empties into the inferior vena cava. Furthermore, the presence of an accessory right renal vein is also noticed, which anastomoses with the innominate venous trunk and with the right renal vein, through a vein suggestively called interrenal, differing from the anatomical normality described in the literature. This variation is supposed to occur due to flaws in the development of the embryo, which generate venous changes in the origins of the right gonadal vein. Acknowledging the existence of it is relevant when performing surgical procedures in the region, as it differs from the most frequent anatomy found in the human population. The rare drainage of the right gonadal vein through an innominate trunk to the inferior vena cava and its importance is highlighted in this article.
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Affiliation(s)
- Isadora Pedrão
- Department of Medicine, Faculty of Medicine of Catanduva, Rua dos Estudantes, 225 - Parque Iracema, Catanduva, SP, Brazil.
| | - Maria Tereza Assunção Valeri
- Department of Medicine, Faculty of Medicine of Catanduva, Rua dos Estudantes, 225 - Parque Iracema, Catanduva, SP, Brazil
| | - Daniel Gregório Gonsalves
- Department of Medicine, Faculty of Medicine of Catanduva, Rua dos Estudantes, 225 - Parque Iracema, Catanduva, SP, Brazil
| | - Natália Magnabosco Afonso
- Department of Medicine, Faculty of Medicine of Catanduva, Rua dos Estudantes, 225 - Parque Iracema, Catanduva, SP, Brazil
| | - Amanda Geraldo Signori
- Department of Medicine, Faculty of Medicine of Catanduva, Rua dos Estudantes, 225 - Parque Iracema, Catanduva, SP, Brazil
| | - Renato Rissi
- Department of Anatomy, Faculty of Medicine of Catanduva, Rua dos Estudantes, 225 - Parque Iracema, Catanduva, SP, Brazil
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5
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D'Antoni AV, Tubbs RS, Patti AC, Higgins QM, Tiburzi H, Battaglia F. The Critical Appraisal Tool for Anatomical Meta-analysis (CATAM): A framework for critically appraising anatomical meta-analyses. Clin Anat 2022; 35:323-331. [PMID: 35015336 DOI: 10.1002/ca.23833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/06/2022] [Indexed: 11/06/2022]
Abstract
The hallmark of evidence-based medicine is the meta-analysis (MA). For much of its rich history, the field of anatomy has been dominated by descriptive, cadaveric studies. In the last two decades, quantitative measurements and statistical analyses have frequently accompanied such studies. These studies have directly led to the publication of anatomical MAs, which have ushered in the exciting field of evidence-based anatomy. Although critical appraisal tools exist for clinical MAs, none of them are specifically tailored for anatomical MAs. Therefore, the purpose of this paper is to provide a framework by which clinical anatomists and others can critically appraise anatomical MAs using the Critical Appraisal Tool for Anatomical Meta-analysis (CATAM). Using a running example from a recently published MA, we show how to use the CATAM rubric in a step-by-step fashion. Each scored section of the CATAM rubric is summated into a total score (maximum 50 points). This score is then referenced to a conversion chart, which assigns a qualitative value to the MA in a range from "very good" to "poor." Future studies can investigate the interrater reliability of the instrument, and possibly subject the CATAM rubric to a Delphi panel. As anatomical MAs become more commonplace at surgical grand rounds and journal clubs in academic medical centers throughout the world, we hope that the CATAM rubric can help facilitate meaningful discussions about the quality and clinical relevance of anatomical MAs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anthony V D'Antoni
- Physician Assistant Program, Wagner College, Staten Island, New York, USA.,Division of Anatomy, Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,University of Queensland, Brisbane, Australia
| | | | | | | | - Fortunato Battaglia
- Department of Medical Sciences and Neurology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
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6
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Messana G, Ambrosi L, Moramarco LP, Cionfoli N, Maestri M, Quaretti P. Testicular artery originating from the inferior mesenteric artery: an alert for interventionalists - A case report. Radiol Case Rep 2021; 16:2710-2713. [PMID: 34336075 PMCID: PMC8318830 DOI: 10.1016/j.radcr.2021.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
Testicular arteries usually arise from the abdominal aorta. During an elective embolization of superior rectal arteries for hemorrhoidal disease performed in a 52-year-old male patient, a previously unreported vascular variant was identified. On selective angiography, the inferior mesenteric artery split into left colic artery and left testicular artery, without any evidence of vascular supply to the hemorrhoidal cushions. Superior rectal arteries were embolized after catheterization of the median sacral artery. A thorough knowledge of vascular variations is essential for interventional radiologists in order to recognize them and avoid potential complications.
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Affiliation(s)
- Gaia Messana
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, 19 27100 Pavia PV, Italy
- Corresponding author.
| | - Ludovico Ambrosi
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, 19 27100 Pavia PV, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology - Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, Pavia PV, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology - Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, Pavia PV, Italy
| | - Marcello Maestri
- Department of General Surgery I, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, Pavia PV, Italy
| | - Pietro Quaretti
- Unit of Interventional Radiology - Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, Pavia PV, Italy
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7
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Wu S, Zuo D, Cai D, Chen Q, Li Y. Curated findings and implications in duplex ultrasound interrogation of the scrotum or varicoceles. Sci Rep 2020; 10:22028. [PMID: 33328507 PMCID: PMC7744525 DOI: 10.1038/s41598-020-78619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/27/2020] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to curate clustered findings of duplex ultrasound in the evaluation of spermatic venous varicoceles, and deliver more responses to the present concerns. Archives of 979 men who had undergone scrotum and spermatic venous plexus duplex ultrasound were reviewed. In the duplex ultrasound interrogation, the sizes of the larger vessels of the spermatic venous plexus, peritesticular vessels, and testicular volume and relevant parameters were measured. Findings of the vessels were analyzed. One hundred and eight-one out of 979 patients had varicoceles. Color Doppler flow signal was rendered in veins of pampiniform plexus but not in peritesticular vessels in 501 out of 979 patients; 101 out of 501 patients had veins of pampiniform plexus ≤ 3 mm, no color Doppler flow signal could be rendered in the veins in the 101 patients at supine and standing positions without Valsalva maneuver, color Doppler flow signal could be rendered in the veins in 82 out of 101 patients at supine and standing positions with Valsalva maneuver; no color Doppler flow signal could be rendered in the veins from 19 out of 101 patients with and without Valsalva maneuver at supine and standing positions. 37 out of 979 patients with 61 ipsilateral testicular volume ≤ 5 mL had no vessel diameter > 2 mm. The incidences of varicoceles corresponding to different ranges of testicular volume of 1-5 mL, 5.1-10 mL, 10.1-15 mL, 15.1-20 mL, 20.1-25 mL, and 25.1-30 mL were 0.0%, 6.9%, 8.3%, 6.63%, 20.94%, and 59.1%, respectively. The comparisons of incidences of varicocele between distribution percentages of different ranges of testicular volume of 1-5 mL and others (of 5.1 mL and more) were all significant (all P < 0.05). The correlation coefficient between the different ranges of testicular volume and the incidence of varicoceles was 0.829. Increased testicular volume may be also a factor for the development of varicoceles. Dilated peritesticular vessels may be collateral veins of spermatic veins, anterior and posterior scrotal veins, or proximal vas deferens.
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Affiliation(s)
- Size Wu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No. 31, Longhua Road, Haikou, 570102, China.
| | - Dongshen Zuo
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No. 31, Longhua Road, Haikou, 570102, China
| | - Dongyan Cai
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No. 31, Longhua Road, Haikou, 570102, China
| | - Qingfang Chen
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No. 31, Longhua Road, Haikou, 570102, China
| | - Ya Li
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, No. 31, Longhua Road, Haikou, 570102, China
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8
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Triple right testicular veins and their variant termination and communications. Heliyon 2020; 6:e05014. [PMID: 32995649 PMCID: PMC7511803 DOI: 10.1016/j.heliyon.2020.e05014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/07/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022] Open
Abstract
Testicular veins are known to show many variations in their origin, course and termination. Some of their variations can lead to male sterility. We report a unique variation of right testicular vein here. Pampiniform plexus reduced to three testicular veins (medial, middle and lateral) at the deep inguinal ring on the right side. The medial vein terminated into the right renal vein, the middle vein terminated into the inferior vena cava above the level of right renal vein (close to the suprarenal gland) and the lateral vein terminated partly into the veins in the capsules of the kidney and partly into the veins under the diaphragm. The medial and middle testicular veins were connected through an oblique communicating vein. The middle and lateral testicular veins were also connected to each other through another oblique communicating vein. Knowledge of this case could be useful to radiologists, nephrologists and surgeons in general.
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9
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Teng J, Jia Z, Ai X, Luo X, Guan Y, Hao X, Fei W. Robotic-assisted laparoscopic artery-sparing varicocelectomy using indocyanine green fluorescence angiography: Initial experience. Andrologia 2020; 52:e13774. [PMID: 32786090 DOI: 10.1111/and.13774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022] Open
Abstract
We reported our initial experience of robotic-assisted laparoscopic artery-sparing varicocelectomy using indocyanine green (ICG) fluorescence angiography in treatment of varicocele. A total of 45 varicocelectomies in 27 patients were performed. The mean operation time was 49.1 ± 8.5 min for unilateral and 65.6 ± 8.3 min for bilateral repair. 47.2 s after ICG injection, testicular artery (TA) was visualised. After an interval of 31.3 s, fluorescent veins were identified. Of all the 45 spermatic cords, 68.9% had a solitary artery, while 31.1% had 2 arteries. The mean hospital stay was 1.6 ± 0.9 days. Semen concentration and motility were significantly improved 6 months after surgery, no recurrence, hydrocele or testicular atrophy was observed. Our study demonstrated that robotic-assisted laparoscopic artery-sparing varicocelectomy using ICG fluorescence angiography is a safe, effective and promising technique in treatment of varicocele.
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Affiliation(s)
- Jingfei Teng
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhuomin Jia
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xing Ai
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao Luo
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yawei Guan
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xuemei Hao
- Department of Anesthesiology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Weiwei Fei
- Department of Anesthesiology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
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10
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Lee HB, Yang J, Maeng YH, Yoon SP. Bilateral multiple renal arteries with an extra-aortic origin and quadruple testicular veins. Anat Cell Biol 2019; 52:518-521. [PMID: 31949992 PMCID: PMC6952688 DOI: 10.5115/acb.19.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022] Open
Abstract
Although variations in the urogenital vessels are relatively common, a rare case of asymmetric bilateral multiple renal arteries originating not only from the aorta but also from the testicular artery was found in a 75-year-old Korean male cadaver. Three renal arteries arose from the lateral aspect of the abdominal aorta on the right side and four from the left side. Two additional renal parenchymal branches originated from the left testicular artery, accompanied by a pair of veins out of the four testicular veins on the left side. Embryological development of the urogenital vessels is of particular importance for anatomists and clinicians.
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Affiliation(s)
- Hyun-Bong Lee
- Medical Course, Jeju National University School of Medicine, Jeju, Korea
| | - Joseph Yang
- Medical Course, Jeju National University School of Medicine, Jeju, Korea
| | - Young Hee Maeng
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - Sang-Pil Yoon
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea.,Institute for Medical Science, Jeju National University, Jeju, Korea
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11
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Iwanaga J, Kikuta S, Tubbs RS. Breathing Life into the Cadaver: Introducing Air Dissection As a New Teaching and Dissecting Method for the Venous System. Clin Anat 2019; 32:566-572. [PMID: 30773730 DOI: 10.1002/ca.23354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/13/2019] [Indexed: 12/31/2022]
Abstract
Air insufflation has been used for various surgical procedures such as during laparoscopy. We hypothesized that the use of pressurized air might enable cadaveric dissection to differentiate smaller veins better than traditional dissection techniques. In three fresh-frozen cadavers, the inferior vena cava (IVC) and right or left femoral veins were exposed just distal to the inguinal ligament and a needle placed into one of them. Pressurized air was then placed into the cannulated femoral vein using an air compressor. In all specimens, the IVC and most of its tributaries, both left and right sides, were clearly insufflated. When the IVC was traced superiorly by resecting the diaphragm through the caval foramen, the right atrium and ventricle were also found to be dilated. Additionally, venous variants that would have not been obvious without dilatation of the IVC were identified. Air dissection of the venous system in fresh-frozen cadavers aids in anatomical dissection. Such a model might also serve as a surgical training model and teaching tool as it better mimics life-like anatomy and physiology. We term this technique "cadaveric air dissection." Clin. Anat. 32:566-572, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | | | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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