Applied Anatomic Study On Transcatheter Target Arterial Embolization Before Sacral Tumor Excision

Surgical Treatment is generally accepted means to treat the massive sacral tumor recently. It's important to decrease the violent and uncontrollable intraoperative hemorrhage. Preoperative selective arterial embolization is effective in decreasing intraoperative blood loss and can lead to excellent results。However, the arteries which should be embolized before operation aren't sure so far. Few literature have been published on the anatomic study of arteries relevant to transcatheter target arterial embolization before excision sacral tumor .The purpose of the current study was to analyze the arteries supply the sacrum and to find the vessel anastomosis between these arteries so that we can find which arteries should be embolization before operation.Part one: Anatomic study about the construction and distribution of arteries which supply sacrumObjective:To study the construction and distribution of arteries which supply sacrum. Methods:An analysis of adult cadaver arteries which supply sacrum was performed utilizing 28 cadavers embalmed with formalin and two pelvic arterial corrosion casts specimens. We measured the diameter of these arteries and distances from the midline of the sacral promontory, the distances from the horizontal line of the sacral promontory by dissecting the 28 Cadavers; and measured sagittal and coronal projection angles of these arteries of 17 Cadavers then analyzed relationship of these arteries. Results:The arteries which supply the sacrum were including median sacral artery, lateral sacral artery, iliolumbar artery, superior gluteal artery, inferior gluteal artery, internal pudendal artery etc. There were no branches of obturator artery supplied sacrum directly. There was no significant statistical difference between left and right arteries in diameter, distances and coronal projection angles. There was significant statistical difference between left and right arteries in sagittal projection angles. Conclusions: 1. Number of nutrient arteries of sacrum was big.2. Selective angiographic embolization could solve the bleeding problem. 3.With the analysis of variations in morphology of arteries and their branches it can be inferred that different projection angles artery should be angiographic embolization on a appropriate position.Part two: Anatomic study about the arterial anastomosis of arteries which supply sacrum.Objective: To study the arterial anastomosis of arteries which supply sacrum. Methods:An analysis of adult cadaver arteries which supply sacrum was performed utilizing 28 cadavers embalmed with formalin and two pelvic arterial corrosion casts specimens. Meanwhile we observed the arterial anastomosis of arteries which supply sacrum. Results:There was much arterial anastomosis surround the sacrum. Median sacral artery and lateral sacral artery netlikely anastomosed before the scrum, and supplied the sacrum anteriorly. Bilateral iliolumbar artery and lateral sacral artery directly anastomosed behind the body of sacrum, and supplied sacrum posteriorly. Bilateral lateral sacral artery anastomosed in the canalis sacralis. Conclusions: 1.Arterial anastomosis enriches the sources of blood supply sacrum and makes it multiple sources. Complicated relationship among arteries and extensive existence of the anastomosis makes the direction of the blood flow in the sacrum uncertain. When doing angiographic embolization before operation, the main arteries supplying tumors should be initially identified according to angiography. Selective embolization should be done on the arteries which supply sacral tumors directly, as well as their collateral anastomosis artery. In this way, the success rate of angiographic embolization can be improved.2.In order to reduce the ischemia or necrosis of important pelvic organ; we should choose the superselective embolization as far as we could.In short, with the Anatomic study about the construction, distribution and anastomosis of arteries which supply sacrum, we verified that the source of blood supply sacrum was affluent. It's important that we should choose transcatheter target arterial embolization before excision sacral tumor. The anatomic study will help to improve the success rate of angiographic embolization.