open access

Ahead of Print
Original article
Published online: 2020-06-03
Submitted: 2020-05-08
Accepted: 2020-05-26
Get Citation

Case series and a systematic review concerning the level of the aortic bifurcation

E. Panagouli, I. Antonopoulos, G. Tsoucalas, D. Chrysikos, A. Samolis, V. Protogerou, D. Venieratos, T. Troupis
DOI: 10.5603/FM.a2020.0064
·
Pubmed: 32488853

open access

Ahead of Print
ORIGINAL ARTICLES
Published online: 2020-06-03
Submitted: 2020-05-08
Accepted: 2020-05-26

Abstract

Background: Aim of this study is to present the level of aortic bifurcation in a sample of Greek origin (case series) and to perform an up-to-date systematic review in the existing literature.

Materials and methods: Seventy-six formalin-fixed adult cadavers were dissected and studied in order to research the level of aortic bifurcation. Additionally, PUBMED and Google Scholar databases were searched for eligible articles concerning the level of aortic bifurcation for the period up to February 2020.

Results: The mean level of aortic bifurcation according to our case series was the lower third of the L4 vertebral body (21/76, 27.6%). The level of aortic bifurcation ranged between the lower third of the L3 vertebral body and the lower third of the L5 body. No statistically significant correlation was found between the two sexes. The systematic review of the literature revealed 31 articles which were considered eligible and a total number of 3537 specimens was retracted. According to the recorded findings the most common mean level of aortic bifurcation was the body of L4 vertebra (1495/3537 cases, 42.2%), while the range of aortic bifurcation was described to occur from upper third of L3 vertebrae to the upper third of the S1 vertebrae in the 52.8% of the cases (1866/3537).

Conclusions: The mean level of AA corresponds to the body of L4 and presents a great range (form L3U to S1U). Knowledge of the mean level of aortic bifurcation and its probable ranges is of great significance for interventional radiologists and especially vascular surgeons that deal with aneurism proximal to the aortic bifurcation.

Abstract

Background: Aim of this study is to present the level of aortic bifurcation in a sample of Greek origin (case series) and to perform an up-to-date systematic review in the existing literature.

Materials and methods: Seventy-six formalin-fixed adult cadavers were dissected and studied in order to research the level of aortic bifurcation. Additionally, PUBMED and Google Scholar databases were searched for eligible articles concerning the level of aortic bifurcation for the period up to February 2020.

Results: The mean level of aortic bifurcation according to our case series was the lower third of the L4 vertebral body (21/76, 27.6%). The level of aortic bifurcation ranged between the lower third of the L3 vertebral body and the lower third of the L5 body. No statistically significant correlation was found between the two sexes. The systematic review of the literature revealed 31 articles which were considered eligible and a total number of 3537 specimens was retracted. According to the recorded findings the most common mean level of aortic bifurcation was the body of L4 vertebra (1495/3537 cases, 42.2%), while the range of aortic bifurcation was described to occur from upper third of L3 vertebrae to the upper third of the S1 vertebrae in the 52.8% of the cases (1866/3537).

Conclusions: The mean level of AA corresponds to the body of L4 and presents a great range (form L3U to S1U). Knowledge of the mean level of aortic bifurcation and its probable ranges is of great significance for interventional radiologists and especially vascular surgeons that deal with aneurism proximal to the aortic bifurcation.

Get Citation

Keywords

aorta, intervertebral discs, lumbar vertebra, bifurcation, anatomy

About this article
Title

Case series and a systematic review concerning the level of the aortic bifurcation

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Original article

Published online

2020-06-03

DOI

10.5603/FM.a2020.0064

Pubmed

32488853

Keywords

aorta
intervertebral discs
lumbar vertebra
bifurcation
anatomy

Authors

E. Panagouli
I. Antonopoulos
G. Tsoucalas
D. Chrysikos
A. Samolis
V. Protogerou
D. Venieratos
T. Troupis

References (39)
  1. Anson B, McVay C. The topographical positions and the mutual relations of the visceral branches of the abdominal aorta. A study of 100 consecutive cadavers. Anat Rec. 1936; 67(1): 7–15.
  2. Appaji AC, Kulkarni R, Pai D. Level of Bifurcation of Aorta and Iliocaval Confluence and Its Clinical Relevance. IOSR-JDMS. 2014; 13(7): 56–60.
  3. Attwell L, Rosen S, Upadhyay B, et al. The umbilicus: a reliable surface landmark for the aortic bifurcation? Surg Radiol Anat. 2015; 37(10): 1239–1242.
  4. Barrey C, Ene B, Louis-Tisserand G, et al. Vascular anatomy in the lumbar spine investigated by three-dimensional computed tomography angiography: the concept of vascular window. World Neurosurg. 2013; 79(5-6): 784–791.
  5. Bečulić H, Sladojević I, Jusić A, et al. Morphometric study of the anatomic relationship between large retroperitoneal blood vessels and intervertebral discs of the distal segment of the lumbar spine: a clinical significance. Med Glas (Zenica). 2019 [Epub ahead of print]; 16(2).
  6. Bergman RA, Afifi AK, Miyauchi R. Illustrated Encyclopedia of Human Anatomic Variation. http://www.anatomyatlases.org/AnatomicVariants/AnatomyHP.shtml (last revised: 2006).
  7. Butoi G, Iliescu DM, Baz R, et al. Morphology of the terminal aorta. ARS Medica Tomitana. 2013; 19(2): 61–111.
  8. Cauldwell E, Anson B. The visceral branches of the abdominal aorta: Topographical relationships. Am J Anat. 2005; 73(1): 27–57.
  9. Chithriki M, Jaibaji M, Steele RD. The anatomical relationship of the aortic bifurcation to the lumbar vertebrae: a MRI study. Surg Radiol Anat. 2002; 24(5): 308–312.
  10. Clemente C, Clemente C. Clemente's anatomy dissector. Lippincott Williams & Wilkins, Philadelphia, Pa 2010: 131–160.
  11. Datta JC, Janssen ME, Beckham R, et al. The use of computed tomography angiography to define the prevertebral vascular anatomy prior to anterior lumbar procedures. Spine (Phila Pa 1976). 2007; 32(1): 113–119.
  12. Deswal A, Tamang BK, Bala A. Study of aortic- common iliac bifurcation and its clinical significance. J Clin Diagn Res. 2014; 8(7): AC06–AC08.
  13. George R. Topography of the Unpaired Visceral Branches of the Abdominal Aorta. J Anat. 1935; 69(Pt 2): 196–205.
  14. Goyal R, Aggarwal A, Gupta T, et al. Reappraisal of the classical abdominal anatomical landmarks using in vivo computerized tomography imaging. Surg Radiol Anat. 2020; 42(4): 417–428.
  15. Gregory LS, McGifford OJ, Jones LV. Differential growth patterns of the abdominal aorta and vertebrae during childhood. Clin Anat. 2019; 32(6): 783–793.
  16. Henry BM, Tomaszewski KA, Ramakrishnan PK, et al. Development of the anatomical quality assessment (AQUA) tool for the quality assessment of anatomical studies included in meta-analyses and systematic reviews. Clin Anat. 2017; 30(1): 6–13.
  17. Henry BM, Tomaszewski KA, Walocha JA. Methods of evidence-based anatomy: a guide to conducting systematic reviews and meta-analysis of anatomical studies. Ann Anat. 2016; 205: 16–21.
  18. Inamasu J, Kim DH, Logan L. Three-dimensional computed tomographic anatomy of the abdominal great vessels pertinent to L4-L5 anterior lumbar interbody fusion. Minim Invasive Neurosurg. 2005; 48(3): 127–131.
  19. Kawahara N, Tomita K, Baba H, et al. Cadaveric vascular anatomy for total en bloc spondylectomy in malignant vertebral tumors. Spine (Phila Pa 1976). 1996; 21(12): 1401–1407.
  20. Keskinoz E, Salbacak A, Akin D, et al. Morphometric analysis of the inferior vena cava related to lumbar vertebra and the aortic bifurcation on multidetector computed tomography (MDCT). Int J Morphol. 2016; 34(2): 620–627.
  21. Khamanarong K, Sae-Jung S, Supa-Adirek C, et al. Aortic bifurcation: a cadaveric study of its relationship to the spine. J Med Assoc Thai. 2009; 92(1): 47–49.
  22. Kornreich L, Hadar H, Sulkes J, et al. Effect of normal ageing on the sites of aortic bifurcation and inferior vena cava confluence: a CT study. Surg Radiol Anat. 1998; 20(1): 63–68.
  23. Lakchayapakorn K, Siriprakarn Y. Anatomical variations of the position of the aortic bifurcation, iliocava junction and iliac veins in relation to the lumbar vertebra. J Med Assoc Thai. 2008; 91(10): 1564–1570.
  24. Lee CH, Seo BoK, Choi YC, et al. Using MRI to evaluate anatomic significance of aortic bifurcation, right renal artery, and conus medullaris when locating lumbar vertebral segments. Am J Roentgenol. 2004; 182(5): 1295–1300.
  25. Lerona PT, Tewfik HH. Bifurcation level of the aorta: landmark for pelvic irradiation. Radiology. 1975; 115(3): 735.
  26. Marchi L, Oliveira L, Amaral R, et al. Morphometric study of the areolar space between the great vessels and the lumbar spine. Coluna/Columna. 2015; 14(4): 271–275.
  27. McHanwell S, Brenner E, Chirculescu ARM, et al. The legal and ethical framework governing Body Donation in Europe: a review of current practice and recommendations for good practice. Eur J Anat. 2008; 12: 1–24.
  28. Mirjalili SA, McFadden SL, Buckenham T, et al. A reappraisal of adult abdominal surface anatomy. Clin Anat. 2012; 25(7): 844–850.
  29. Molinares DM, Davis TT, Fung DA. Retroperitoneal oblique corridor to the L2-S1 intervertebral discs: an MRI study. J Neurosurg Spine. 2016; 24(2): 248–255.
  30. Moon MS. Anatomical location, running pattern, and bifurcation level of abdominal aorta over the lumbosacral spine: computed tomography angiographic study. J Spinal Surg. 2017; 4(3): 97–101.
  31. Ogeng’o J, Olabu B, Ongeti K, et al. Topography of aortic bifurcation in a black kenyan population. Anat J Africa. 2014; 3(2).
  32. Panagouli E, Lolis E, Venieratos D. A morphometric study concerning the branching points of the main arteries in humans: relationships and correlations. Ann Anat. 2011; 193(2): 86–99.
  33. Pennington N, Soames RW. The anterior visceral branches of the abdominal aorta and their relationship to the renal arteries. Surg Radiol Anat. 2005; 27(5): 395–403.
  34. Pirró N, Ciampi D, Champsaur P, et al. The anatomical relationship of the iliocava junction to the lumbosacral spine and the aortic bifurcation. Surg Radiol Anat. 2005; 27(2): 137–141.
  35. Rajini T, Mokhasi V, Geethanjali BS, et al. The abdominal aorta and its branches: anatomical variations and clinical implications. Folia Morphol. 2011; 70(4): 282–286.
  36. Sharma M, Sharma T, Singh R. Variations in the aortic - common iliac bifurcation in man: a cadaveric study. Nat J Clin Anat. 2020; 02(02): 056–060.
  37. Vaccaro AR, Kepler CK, Rihn JA, et al. Anatomical relationships of the anterior blood vessels to the lower lumbar intervertebral discs: analysis based on magnetic resonance imaging of patients in the prone position. J Bone Joint Surg Am. 2012; 94(12): 1088–1094.
  38. Watt I, Park WM. The abdominal aorta in spina bifida cystica. Clin Radiol. 1978; 29(1): 63–68.
  39. White HJ, Bordes S, Borger J. Anatomy, Abdomen and Pelvis, Aorta. In: StatPearls. StatPearls Publishing, Treasure Island (FL) 2020.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By  "Via Medica sp. z o.o." sp.k., Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl