Abstract
Instrumenting the anterior abdominal wall carries a potential for vascular trauma. We previously assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries with computed tomography (CT). We now present a study using ultrasound (US) assessment of these arteries, to evaluate its use for real time guidance of percutaneous procedures involving the rectus sheath. Twenty-four participants (mean age 67.9 ± 9 years, 15 M:9 F [62:38%]) were assessed with US at three axial planes on the anterior abdominal wall: transpyloric plane (TPP), umbilicus, and anterior superior iliac spine (ASIS). An artery was visible least frequently at the TPP (62.5 - 45.8%), compared with the umbilicus (95.8-100%) and ASIS (100%), on the left, χ2 (2) = 20.571; p < .001, and right, χ2 (2) = 27.842; p < .001, with a moderate strength association (Cramer's V = 0.535 [left] and 0.622 [right]). Arteries were most commonly observed within the rectus abdominis muscle at the level of the TPP and umbilicus, but posterior to the muscle at the level of the ASIS (95.8-100%). As with the CT study, the inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it coursed superiorly. These data corroborate our previous results and suggest that the safest level to instrument the rectus sheath (with respect to vascular anatomy) is at the TPP. Such information may be particularly relevant to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion.
Highlights
Instrumenting the anterior abdominal wall carries a potential for vascular trauma
We have previously assessed the topography of the superior and inferior epigastric arteries on computed tomography (CT), with reference to Rectus sheath block (RSB), at readily determined locations in clinical practice (Bowness et al, 2019). These results suggest that the safest level at which RSB could be performed, with reference to vascular trauma, is at the transpyloric plane (TPP; midway between the xiphisternum and umbilicus)
This study provides a second description of anatomical variation of the arteries of the anterior abdominal wall, but with a new imaging modality
Summary
Instrumenting the anterior abdominal wall carries a potential for vascular trauma. We previously assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries with computed tomography (CT). Conclusions: These data corroborate our previous results and suggest that the safest level to instrument the rectus sheath (with respect to vascular anatomy) is at the TPP Such information may be relevant to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion. Knowledge of the topography and variation of these vessels is relevant to anesthetists, who typically use ultrasound (US) to guide needle insertion and catheter placement (Rucklidge & Beattie, 2018) This information is important to surgeons, who may perform the technique under “direct-vision” prior to closing the abdomen: Despite the nomenclature, this technique does not provide good visualization of the blood vessels; awareness of their likely pattern/presence is important
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