Understanding the Aorta-Spine Relation in Idiopathic Scoliosis: Value of Noncontrast CT-Derived Curved Coronal Reformats and 3D Volume Images

Aortic Replacement for a Crawford II Thoracoabdominal Aneurysm With a Right-Sided Descending Aorta: A Case Report

A 53-year-old woman was diagnosed with a Crawford II thoracoabdominal aortic aneurysm involving the right-sided descending aorta. The patient underwent aortic replacement via a thoracoabdominal approach. The right-sided descending thoracic aortic aneurysm was excluded. The patient had a favorable postoperative course. The excluded thoracic aneurysm had completely thrombosed without intercostal inflow. The right-sided descending aorta is a rare malformation. The exclusion technique was appropriate because there was no retrograde flow from the intercostal arteries and the Adamkiewicz artery originated from the lumbar region.

The Importance of Lumbar Lordosis During Laparoscopic Trocar Entry

STUDY OBJECTIVE

Investigating the effect of lumbar lordosis on the relationship between abdominal trocar entry points and major vascular structures.

DESIGN

Retrospective cohort.

SETTING

Tertiary referral center.

PATIENTS

Distances between the skin and the aorta and inferior vena cava at the trocar entry points, both at the umbilicus and 3 cm and 5 cm superior to the umbilicus, were measured at entry angles of 90 and 45 degrees in 101 abdominal computer tomography images.

INTERVENTIONS

The relationship of these values with lumbar lordosis was investigated concerning menopausal status, body mass index (BMI), and parity differences. To assess the isolated effect of lumbar lordosis, a simulated 30-degree increase in the lordosis angle was applied to the patients' computed tomography images. The impact of this increased lumbar lordosis angle on the distances between the skin and major vessels was then evaluated at both the umbilical and supraumbilical trocar entry sites.

MEASUREMENTS AND MAIN RESULTS

In the tomographic images of all patients, the distances from the skin to vascular structures were measured at a 90-degree entry angle, resulting in measurements of 8.97 cm ± 2.81 at the umbilicus, 10.89 cm ± 3.02 at 3 cm above the umbilicus, and 11.36 cm ± 2.88 at 5 cm above the umbilicus. These distances exhibited significant differences between patients with BMI <30 and BMI ≥30, as well as between premenopausal and postmenopausal patients. However, at a 45-degree entry angle, vascular structures were observed in only a few patients during trocar projection, and no measurable values were determined. In the simulation, it was found that a 1-degree increase in lumbar lordosis angle resulted in a decrease of 0.272 mm ± 0.018 in the distance between the skin and vascular structures at the umbilicus, 0.425 mm ± 0.024 at 3 cm above the umbilicus, and 0.428 mm ± 0.024 at 5 cm above the umbilicus.

CONCLUSION

An increase in the degree of lumbar lordosis reduces the distance between trocar entry points and major vascular structures. Along with other factors during Veress and trocar entry, lumbar lordosis should be carefully considered.