title: Vascular anatomical relationships of the retropubic space and the sacrospinous ligament, using three-dimensional imaging.
abstract: OBJECTIVE
  Pelvic anatomy is complex and intimate knowledge of variabilities in anatomical relationships is critical for surgeons to safely perform surgical procedures. Three-dimensional Imaging provides the opportunity to analyze undisturbed anatomical relationships. The authors hypothesized that three-dimensional models created from pelvic computed tomography angiograms could be used to obtain vascular anatomical measurements, and that the measurements obtained from three-dimensional models would be similar to those from cadaver studies.
  
  
  METHODS
  We included all pelvic computed tomography angiograms that were acquired in female patients older than 18 years at our institution within the previous 5 years. Three-dimensional models were created using the Invivo5 software based on the Digital Imaging and Communications in Medicine files. Structures of interest were virtually dissected and measured replicating previous cadaver studies. Statistical analysis of demographics and measurements was performed.
  
  
  RESULTS
  The final analysis included 87 studies. The average age of the subjects was 66.9 years and their average BMI was 26.1 kg/m2. Of the 87 subjects, 12.6% had a history of hysterectomy, 2.3% a history of a continence procedure, and 1.1% a history of a prolapse procedure. The range of distance between the ischial spine and the pudendal artery was 3-17 mm. The closest vessels to the lower edge of the symphysis pubis were the obturator vessels. The aberrant corona mortis vessel was present in 27.9% of the subjects. Prior hysterectomy was associated with changes in the measurements of the obturator arteries with minimal changes in other measurements.
  
  
  CONCLUSIONS
  Our results indicate that this technology provides similar measurements to those found in previous unembalmed cadaver studies. This technology offers a great opportunity to study anatomical relationships in a native undisturbed state.
authors.affiliation: Obstetrics and Gynecology Department, Female Pelvic Medicine and Reconstructive Surgery Division, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA. omar.duenas@umassmemorial.org.
authors.forename: Omar F
authors.initials: OF
authors.lastname: Dueñas-Garcia
authors.affiliation: Obstetrics and Gynecology Department, Female Pelvic Medicine and Reconstructive Surgery Division, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA.|Mass Memorial Medical Center, University of Massachusetts, 119 Belmont Street, Worcester, MA, 01605, USA.
authors.forename: Youngwu
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Obstetrics and Gynecology Department, Female Pelvic Medicine and Reconstructive Surgery Division, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA.|Mass Memorial Medical Center, University of Massachusetts, 119 Belmont Street, Worcester, MA, 01605, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Leung
authors.affiliation: Obstetrics and Gynecology Department, Female Pelvic Medicine and Reconstructive Surgery Division, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA.|Mass Memorial Medical Center, University of Massachusetts, 119 Belmont Street, Worcester, MA, 01605, USA.
authors.forename: Michel K
authors.initials: MK
authors.lastname: Flynn
mesh_terms: D000368:Aged; D059925:Anatomic Landmarks / Q000098:blood supply / Q000000981:diagnostic imaging*; D002102:Cadaver; D000072226:Computed Tomography Angiography / Q000379:methods*; D019074:Epigastric Arteries / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007512:Ischium / Q000098:blood supply / Q000000981:diagnostic imaging; D008022:Ligaments / Q000098:blood supply / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010388:Pelvis / Q000098:blood supply / Q000000981:diagnostic imaging; D012187:Retroperitoneal Space / Q000098:blood supply / Q000000981:diagnostic imaging*; D012447:Sacrum / Q000098:blood supply / Q000000981:diagnostic imaging*
keywords: Retropubic; Sacrospinous; Three-dimensional; Vascular anatomy