Anandhi, V (2009) The Study of the Origin, Course, Distribution and Branching Pattern of the Inferior Epigastric Artery. Masters thesis, Madras Medical College, Chennai.
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Abstract
The inferior epigastric artery, the most important and largest blood vessel of the anterior abdominal wall, was studied in detail by conventional dissection, predissectional dye injection, angiographic and histological studies. The observations of the study have been correlated with the findings of already existing studies. The following conclusions are derived from the study. The origin of the inferior epigastric artery is from the anteromedial surface of the external iliac artery bilaterally at or just above the inguinal ligament. The inferior epigastric artery ascends between the rectus abdominis muscle and its sheath for a considerable distance before entering the rectus muscle in its middle third in 72%, lower third 20% and upper third 8%. Commonly the inferior epigastric artery has a single stem (86%), but double stem before entering the rectus muscle substance occurs in 14%. Abnormal obturator artery is found in 16%. In 87.5%, the abnormal obturator artery is related to the lateral border of the femoral ring, and in 12.5% it descends along the medial border of the femoral ring. The pubic branch of the inferior epigastric artery crosses the superior pubic ramus to anastomose with the pubic ramus of the obturator artery(corona mortis) where it is prone to injury in operations around the retropubic area like laparoscopic hernia repair and laparoscopic prostatectomy. Gross anastomoses between the superior and inferior epigastric arteries is observed in 28%, and it occurs above the level of the umbilicus, whereas no anastomoses is observed in 72%. In cases with anastomoses, Type I pattern (Moon & Taylor) is 16%, Type II 10% and Type III 2%. The average length of the inferior epigastric artery from the origin to the lateral rectus margin is 5.8 cm and from the origin to the entry into the rectus muscle substance is 10.4 cm. The diameter of the inferior epigastric artery observed by 64 slice CT angiographic study is 2.8 mm at the origin, and 2 mm at its entrance into the rectus abdominis. The distance of the inferior epigastric artery from the midline at various levels have been noted. Regardless of the abdominal level, the dangerous zone is found to be between 3 cm and 8 cm from the midline. Staying away from this area either medially or laterally will determine the safety zone of entry into the abdominal wall without risk of injury to the epigastric vessels. The combined thickness of the intima and media is lower in inferior epigastric artery than the internal thoracic artery. The media of the inferior epigastric artery consists of thickly packed smooth muscle fibres whereas in the internal thoracic artery, the media contains mainly elastic fibres. A comprehensive study of the origin, course, branches, anastomosis, length, diameter and distance of the inferior epigastric artery from important landmarks of the abdominal wall under a common umbrella will prove to be useful to the plastic surgeons who consider the lower abdomen skin and fat to be an ideal material for breast reconstruction, cardiothoracic surgeons evaluating the inferior epigastric artery as an alternative conduit for coronary artery bypass grafting, the laparoscopic surgeons and the general surgeons.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Branching Pattern; Inferior Epigastric Artery. |
| Subjects: | MEDICAL > Anatomy |
| Depositing User: | Kambaraman B |
| Date Deposited: | 22 Jun 2017 06:02 |
| Last Modified: | 22 Jun 2017 06:39 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/225 |
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