Jan van Schaik, Jary M. van Baalen, MD, PhDb, Michel J. T

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Presentation transcript:

Nerve-preserving aortoiliac reconstruction surgery: Anatomical study and surgical approach Jan van Schaik, Jary M. van Baalen, MD, PhDb, Michel J.T. Visser, MD, PhDb, Marcus C. DeRuiter, PhDa Journal of Vascular Surgery Volume 33, Issue 5, Pages 983-989 (May 2001) DOI: 10.1067/mva.2001.113306 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Schematic representation of main sympathetic pathways that supply intrapelvic organs, based on dissection specimen. A, Abdominal aorta; AAP, abdominal aortic plexus; AIE, external iliac artery; AII, internal iliac artery; AR, renal artery; CA, common iliac artery; CV, common iliac vein; I, inferior mesenteric artery; LSN 1, 2, 3, lumbar splanchnic nerves from lumbar level 1, 2, 3; R, left renal vein; SC, sympathetic chain; U, ureter; V, inferior vena cava. Journal of Vascular Surgery 2001 33, 983-989DOI: (10.1067/mva.2001.113306) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 a, Ventral view into abdomen. Visceral organs, peritoneum, and preaortic and para-aortic tissue except for nervous structures have been removed. Inferior vena cava (V) has been sectioned just below crossing of left renal vein (R) and retracted caudally. Inferior mesenteric artery (I) has been removed except for trunk. Because of arteriosclerotic disease, aorta has shifted left of midsagittal plane, thereby placing SHP in front of right common iliac artery instead of left common iliac artery, where it is usually situated. b, Detailed view of right-sided lumbar splanchnic nerves (LSNs) as shown in a (90-degree rotation). c, Detailed view of left-sided LSNs as shown in a (90-degree rotation). A, Abdominal aorta; CA, common iliac artery; P, psoas muscle; SC, sympathetic chain; U, ureter. LSNs are lifted by probe (asterisk). Journal of Vascular Surgery 2001 33, 983-989DOI: (10.1067/mva.2001.113306) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Microscopic sections of preaortic tissue. Ventral side of specimen is at top end of photograph. Preaortic fascia (PF) is closely aligned with adventitia of aortic wall (A).a, PF is separated from aorta by slight manipulation of specimen. Bar = 600 μm. b, Anatomic integrity is preserved. Bar = 200 μm. C, Connective tissue septum; F, fat tissue; N, nervous structures; VS, vascular structures. Journal of Vascular Surgery 2001 33, 983-989DOI: (10.1067/mva.2001.113306) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Ventral view into abdomen after removal of visceral organs. (a and b) View of retroperitoneal region after interposition of bifurcation graft (G) according to standard procedure. (b) Exposure of sympathetic pathways of specimen in a , which clearly shows total disruption of SHP. (c and d) View of retroperitoneal region after interposition of bifurcation graft according to nerve-preserving procedure. (d) Exposure of sympathetic pathways of specimen in c, which clearly shows only right-sided damage to LSNs. A, Abdominal aorta; CA, common iliac artery; CV, common iliac vein; E, endopelvic fascia; I, inferior mesenteric artery; P, psoas muscle; Pr, sacral promontory; R, left renal vein; U, ureter; V, inferior vena cava. Dotted lines correspond with incisions used to open peritoneum and subperitoneal tissue compartment. Journal of Vascular Surgery 2001 33, 983-989DOI: (10.1067/mva.2001.113306) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions