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Periacetabular vascular anatomy in high-riding dysplastic hips: a CT angiographic study
Ismail Demirkale1, Yüksel Uğur Yaradılmış1, Selma Uysal Ramadan2
1Departments of Orthopaedics and Traumatology, University of Health Sciences, Keçiören HPRC, Ankara, Turkey.
Insights
Vascular structures like the external iliac artery and vein are significantly closer to the iliac bone in developmental hip dysplasia (DDH) patients. Surgeons must recognize this proximity to prevent vascular complications during hip surgeries.
Area of Science:
- Orthopedic Surgery
- Vascular Anatomy
- Medical Imaging
Background:
- Developmental hip dysplasia (DDH) is associated with osseous and neural abnormalities.
- Investigation into the vascular structures of dysplastic hips remains limited.
- This study evaluates periacetabular vascular structures in DDH.
Purpose of the Study:
- To assess the proximity of periacetabular vascular structures to the iliac bone in patients with developmental hip dysplasia.
- To compare vascular proximity in dysplastic hips versus healthy hips.
Main Methods:
- Computerised tomography angiography (CTA) was used to image 13 dysplastic hips and 20 healthy hips.
- Measurements of external iliac and obturator artery and vein proximity to the iliac bone were taken.
- Seven axial images were analyzed at 1 cm intervals, with the 4th image at the acetabular dome level.
Main Results:
- Dysplastic hips showed a tendency towards curved iliac arteries (53%) compared to straight arteries in healthy hips (p=0.037).
- External iliac veins were significantly closer to the bone in dysplastic hips at all levels (p<0.001).
- External iliac arteries were closest to the bone in dysplastic hips at levels 1-4 (p<0.001).
Conclusions:
- The external iliac artery and vein are in close proximity to the iliac bone in highly dislocated hips.
- This proximity poses risks during acetabular screw, reaming, or retractor placement.
- Surgeons must be aware of these vascular relationships to prevent complications in DDH surgery.
Background:
Developmental hip dysplasia (DDH) is shown to have osseous and neural abnormalities but literature is sparse with investigation of vascular structures. Therefore, we aimed to evaluate periacetabular vascular structures.
Methods:
By computerised tomography angiography (CTA), 13 highly dislocated hips of 11 patients' iliac bone to external iliac and obturatory artery and vein proximities were measured and compared with the same measurements of 20 healthy hips of 12 patients. Numbering from superior to inferior, a total of 7 axial images were created on the 2D CTA coronal images with 1 cm apart, the 4th being at the level of acetabular dome.
Results:
The mean age of the patients was 53 (18-72) years. Dysplastic hips tended to have curved (53%) and healthy hips tended to have straight iliac arteries (p = 0.037). As compared to healthy hips, external iliac veins were significantly closer to the bone at all levels, but the external iliac arteries were closest at 1st to 4th levels (p < 0.001) in dysplastic hips. The course of the obturatory arteries was similar in both groups (p = 0.147).
Conclusions:
The external iliac artery and vein is in close proximity to the iliac bone which dangers acetabular screw, acetabular reaming or retractor placement in highly dislocated hips. The surgeon should be aware of this proximity in operations of these hips to avoid vascular complications.
