Ανατομική και αγγειογραφική μελέτη της ανιούσας οσφυικής φλέβας στον άνθρωπο

Abstract

The surgical anatomy (geometrical features, metric relations, and drainage pattern) of the ascending lumbar vein (ALV) and iliolumbar vein (ILV) is clinically important. Notwithstanding, the available literature comprises but a small number of studies and a limited number of specimens examined. The present study constitutes a detailed description and classification of the drainage pattern of both these veins.The detailed anatomy of the of the inferior vena cava (IVC), common iliac veins (CIV), external iliac veins (EIV), internal iliac veins (ILV), ALV and ILV was examined in both sides in 59 embalmed adult human cadavers of Caucasian origin. Cases with anatomical variations (9 cadavers) of the IVC, CIV, EIV and IIV were examined and analyzed as a distinct group. In the remaining 50 cadavers (100 sides), which constituted the first group, two main drainage types of the lower end of ALV were found. In Type I (54%, 54/100) the ALV presented the same pattern in both sides. In Type II, the ALV differed in pattern from one side to the other (46%, 46/100). Four subtypes were recorded for each Type. An ALV–ILV common trunk occurred in 15% (15/100). The percentage of variations of ALV was 34% and ILV 91%. The number of variations of the two veins differed significantly (p < 0.001). No statistically significant difference was found relating to side or gender.Among the 59 cadavers, nine (9/59, 15.3%) presented anomalies of the major pelvic veins, as follows: anomalous drainage of both EIV and IIV in 8.5% of the specimens (5/59, Type I); variations of the IVC in 3.4% (2/59, Type II); duplication of the IIV (1/59 = 1.7%, Type III); anastomotic branch between the right IIV and the left CIV (1/59 = 1.7%, Type IV). In this group, we focused our attention on the drainage patterns of the ALV, ILV when there are variations in the major pelvic veins by highlighting and describing the variations themselves. ALV drained either into the CIV (8/18 sides, 44.4%) or in EIV (5/18 sides, 27.8%), while absence of ILV was the most frequent pattern (8/18 sides, 44.4%). A common trunk, joining the two veins, was observed in 5/18 sides (27.8%). Those drainage patterns were in accordance with the ones discovered in the first group. In Type I the two veins always drained into the EIV.Thorough knowledge of the surgical anatomy of ALV and ILV prevents injury, bleeding and further complication of many operations in the retroperitoneal space, pelvis and lumbosacral vertebral column. Awareness of the geometrical features of ALV and ILV helps avoiding or aids early recognition of a misplacement of a vascular catheter into the ALV during femoral vein catheterizations.