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Corona mortis: anatomical data and clinical considerations
Alcestis Stavropoulou-Deli1, Sofia Anagnostopoulou
1Laboratory of Descriptive Anatomy, Department of Anatomy, University of Athens Medical School, Athens, Greece. alceste_delce@hotmail.com
Insights
Injury to the corona mortis during TVT-Secur™ procedures is a risk. This study details aberrant vessel anatomy, finding most veins and arteries lie further from the symphysis pubis than the device margin.
Area of Science:
- Anatomy
- Vascular Surgery
- Gynecology
Background:
- Minimally invasive procedures like TVT-Secur™ carry a risk of injury to the corona mortis.
- Vessel proximity to the insertion site (25-30 mm from symphysis pubis) contributes to potential injury during TVT-Secur™ insertion.
Purpose of the Study:
- To systematically describe aberrant corona mortis anatomy.
- To aid gynecologists in assessing peri- and postoperative complication risks associated with TVT-Secur™ and similar procedures.
Main Methods:
- Cadaveric dissection of the lesser pelvis in ten female subjects.
- Documentation of origin, diameter, and course of aberrant venous and arterial vessels.
- Measurement of vessel distance from the symphysis pubis.
Main Results:
- Arterial corona mortis (n=8) originated from the inferior epigastric artery, crossing superior pubic rami at an average of 52.4 mm from the symphysis pubis (average diameter 3 mm).
- Venous corona mortis (n=10) drained into external iliac or inferior epigastric arteries, crossing superior pubic rami at an average of 46.7 mm from the symphysis pubis (average diameter 3.13 mm).
Conclusions:
- Aberrant veins are typically at least 8 mm from the TVT-Secur™ margin, while arteries appear even further.
- Understanding aberrant vessel anatomy can help mitigate risks during urogynecological procedures.
Background:
Minimally invasive procedures, such as the TVT-Secur™, have been linked to injury to the corona mortis. Injury during the insertion of the TVT-Secur™ happens due to the vessel's position close to the place of the margin (25-30 mm from the symphysis pubis).
Aims:
Systematic description of the aberrant vessel anatomy so as to help gynaecologists determine the risk of peri- and postoperative complications during the TVT-Secur™ and related procedures.
Methods:
In a cadaver study, the lesser pelvis of ten female cadavers with venous or arterial coronae mortis was dissected. The origin, diameter and course of the aberrant vessels, as well as the distance from the symphysis pubis, were documented.
Results:
Arterial coronae mortis were found in eight hemipelvises. All vessels originated from the ipsilateral inferior epigastric artery and all crossed over the superior pubic rami. Average distance from the symphysis pubis was 52.4 mm. Average vessel diameter was 3 mm. Venous coronae mortis were identified in ten hemipelvises. Eight drained into the external iliac and four into the inferior epigastric artery. Nine vessels crossed over the superior pubic rami. Average distance from the symphysis pubis was 46.7 mm. Average vessel diameter was 3.13 mm.
Conclusion:
Although individual variation makes direct contact with the vessel possible, in most cases there is a window of eight millimetres at least between the margin of the TVT-Secur™ and most aberrant veins. Possible aberrant arteries seem to lie even further.
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