A1090. VISUALIZATION OF THE PELVIC VASCULAR STRUCTURES THROUGH THE PELVIS USING 3D-CT ANGIOGRAPH

Abstract

Vascular injury associated with hip surgery is a rare but serious complication. Hip surgeons need to understand the vascular anatomy around the acetabulum to avoid vascular injury. The aim of this study was to visualize the pelvic vascular structures thorough the osseous acetabulum using 3DCT angiography and to describe the three-dimensional relationship between the vessels and the acetabulum. A total of 100 patients who took 3DCT with intravenous contrast for intra-pelvic neoplastic disease were randomly chosen. Those patients with hip disease were excluded. Three examinations were performed.

First, dual-phase helical CT data were transferred to a workstation (M900;Zio,Tokyo,Japan) and 3D visualizations of the vascular structures through the pelvis were reconstructed.

Second, location of the external iliac, femoral and obturator vessels were investigated in axial CT images. Finally, influence of the age factor on the anatomical courses of the external iliac vessels was assessed.

Reconstructed 3D images were able to provide spatial relationship between courses of the pelvic vascular structures and the acetabulum. We could visualize the pelvic vascular structures thorough the pelvis from similar operative viewpoints. Axial CT examinations revealed the external iliac vessels locate very closely to the pelvis as they exit the pelvic cavity.

Especially, the left side vessels and vein were closer to the pelvis. The femoral vessels became closer to the acetabular edge with traveling distally. At the distal half of the acetabulum, the femoral vessels located just ventrally to the anterior acetabular edge. The obturator vessels courses inferiorly along the quadrilateral surface behind the acetabulum, they became very close to the inner cortex or the acetabulum. Straight type of the anatomical course of the external iliac vessels was the most common configuration in young patients, curved and the tortuous types were present in older patients.

The results of this study are useful to understand the anatomical orientation of the vessels around the acetabulum. To avoid vascular injuries in hip surgery, knowledge of the vascular orientation is of critical importance for the hip surgeon.