Poorly recognized age-related downward deviation of the inguinal ligament.
OBJECTIVE
To determine factors affecting actual inguinal ligament course in live human subjects.


OBJECTIVE
Although the expected inguinal ligament course is supposedly a straight line extending from anterior superior iliac spine to pubic tubercle, the actual inguinal ligament course is frequently depicted a priori by a downward bowing dotted line. There are no studies in a live subject supporting this assumption. We hypothesized this assumption is indeed valid and is related to among other factors a lifelong effect of gravity and lax abdominal musculature on the inguinal ligament course.


METHODS
We retrospectively reviewed 54 consecutive computed tomography scans of the abdomen and pelvis randomly distributed across all age groups. Actual inguinal ligament course was visualized by reconstructing images using Terracon software. Vertical distance from the lowest point of actual inguinal ligament course to the expected inguinal ligament course was measured. We used multiple linear regression analysis to study the correlation between degree of inguinal ligament deviation and several variables.


RESULTS
Actual inguinal ligament course was below the expected inguinal ligament course in 52 of 54 patients. The mean deviation was 8.2 ± 5.9 mm. Advanced age was significantly associated with greater downward bowing of the inguinal ligament (p = 0.001).


CONCLUSIONS
Actual inguinal ligament course is often well below the expected inguinal ligament course; this downward bowing of the inguinal ligament is especially pronounced with advancing age. Operators need to be mindful as this downward bowing can lead to supra-inguinal sticks causing vascular complications.
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Yassir
Y
Nawaz
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Mihir
M
Barvalia
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Gurinder
G
Rana
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
M Zain
MZ
Khakwani
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Khizr
K
Azim
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Rahul
R
Patel
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Sohira
S
Idrees
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Gail
G
Baker
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Marc
M
Cohen
Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Najam
N
Wasty
Cardiac catheterization; anatomic landmarks; femoral artery punctures