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International Urogynecology Journal

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Open Access 24-11-2023 | Sacrocolpopexy | Original Article

Iliac vein variation in the sacral promontory on three-dimensional computed tomography angiography: a prospective observational study before laparoscopic sacrocolpopexy

Authors: Hirotaka Sato, Miki Kurita, Takehiro Kato, Hirokazu Abe, Shota Otsuka, Sachiyuki Tsukada

Published in: International Urogynecology Journal | Issue 1/2024

Abstract

Introduction and Hypothesis

Venous injury may occur during exposure of the anterior longitudinal ligament at the anterior sacral promontory (SP). We aimed to quantitatively measure the extent of the vascular window (VW) in front of the SP in patients with internal iliac vein (IIV) variations using preoperative three-dimensional computed tomography angiography (3DCTA). We hypothesized that patients with IIV variations would have a narrow VW.

Methods

This prospective observational study included patients scheduled for laparoscopic sacrocolpopexy (LSC) between July 2022 and April 2023 who underwent preoperative 3DCTA. The primary endpoint was the VW measurement in the standard and variant IIV groups using 3DCTA before LSC. The secondary endpoint was the difference between the two IIV groups adjusted for age, body mass index, hypertension, and diabetes using an analysis of covariance (ANCOVA) model. Multiple regression analysis was performed to analyze the effect of factors on the distance from the SP to great vascular bifurcations.

Results

There were 20 cases of IIV variation (20.2%). VW was 28.8 ± 12.4 mm in the variant group and 39.6 ± 12.6 mm in the standard group (p = 0.001). In the ANCOVA model, IIV variations affected VW (coefficient, –11.8; 95% confidence interval [CI], –18.4 to –5.08, p < 0.001). Multivariate analysis revealed that the aorta–SP distance decreased with age (coefficient, −0.44; 95% CI, −0.77 to −0.11, p = 0.009).

Conclusions

One in five women has a vascular variant at the SP that restricts the “safe” zone of fixation to < 3 cm.

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Title: Iliac vein variation in the sacral promontory on three-dimensional computed tomography angiography: a prospective observational study before laparoscopic sacrocolpopexy
Authors: Hirotaka Sato
Miki Kurita
Takehiro Kato
Hirokazu Abe
Shota Otsuka
Sachiyuki Tsukada
Publication date: 24-11-2023
Publisher: Springer International Publishing
Keywords: Sacrocolpopexy
CT Angiography
Published in: International Urogynecology Journal / Issue 1/2024
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-023-05681-4

At a glance: The STEP trials

Springer Medicine

Iliac vein variation in the sacral promontory on three-dimensional computed tomography angiography: a prospective observational study before laparoscopic sacrocolpopexy

Abstract

Introduction and Hypothesis

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and Hypothesis

Methods

Results

Conclusions

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