Anatomical variations of the arterial ”corona mortis”

Abstract

Introduction. The arterial anastomoses of the lower limb magisterial arteries are of great clinical significance in collateral circulation. The obturator artery is one of the branches of the anterior trunk of the internal iliac artery that supplies the pelvis and the thigh. The obturator artery gives off a pubic branch which anastomose with the obturator branch of the inferior epigastric artery, thus determining the anastomosis called „corona mortis” (Kirchner), because its injury in herniotomy can cause a fatal bleeding. A detailed comprehension and knowledge of the morphological, topographic and individual peculiarities of the ”corona mortis” will contribute to the avoidance of complications in surgery of the pubic and inguinal regions. Aim of the study. To mark out the anatomical variations of the”corona mortis” using modern imagistic methods. Materials and methods. We have studied the branches of the external iliac artery and the anterior trunk of the internal iliac artery on 197 selective angiographies that were obtained from the database of the Vascular Surgery Department of the Clinical Republican Hospital Timofei Moșneaga, Republic of Moldova. The angiographies on the patients in the study poll were made in order to conclude the severity of the peripheral occlusive syndrome. The age range of the patients was 20-80 years; the median age was 65 years. Depending on gender, 161 angiographies were made on male patients and 36 angiographies on female patients. The origin of the internal and external iliac arteries, their paths, branches and branching type, relations towards the neighboring vascular elements, and arterial anastomoses of the pubic region were examined on angiographic records. The obtained data were stored, analyzed and statistically processed using the Microsoft Excel and SPSS 6.0 software. Results. Anatomical variants were identified in 39% cases. A classification of the arterial ”corona mortis” based on the angiographic picture was done. Conclusions. 1. The most frequent type of the ”corona mortis” was the classical one, of Lambda minor type. 2. The bilateral ”corona mortis” was present in almost half of cases (44,15%), the second most frequent type was the left unilateral one (35%). 3. Knowledge regarding uncommon types of ”corona mortis”, are of clinical significance, due to high risk of lesions in surgery of the pubic and inguinal regions.