Anatomy and Cell Biology

Korean Association of Anatomists (대한해부학회)
권호 표지
DOI QR코드

DOI QR Code

Anatomical classification of middle rectal arteries regarding detailed vasculature patterns

  • Hankyu Kim (Department of Anatomy, College of Medicine, The Catholic University of Korea) ;
  • Kwan Hyun Youn (Division in Biomedical Art, Incheon Catholic University Graduate School) ;
  • Yi-Suk Kim (Department of Anatomy, College of Medicine, The Catholic University of Korea)
  • Received : 2022.01.12
  • Accepted : 2022.03.03
  • Published : 2022.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

This study aimed to clarify the anatomy of middle rectal artery and pelvic vasculature patterns, and to provide schematic information in a manner applicable to the total mesorectal excision. Forty sides of pelvis from 20 formalinembalmed cadavers (10 male, 10 female) were dissected, and all the pelvic vasculatures from the internal iliac artery were investigated, focusing on the middle rectal artery. Middle rectal arteries were classified into major types depending on their vascular origins. Each type was subdivided into minor types according to variability of the pelvic vasculature. A middle rectal artery was identified in 18 out of 20 cadavers, and in 25 out of 40 pelvic sides. In most cases, the middle rectal artery originated from the internal pudendal artery or inferior gluteal artery. These two arteries arose directly from the anterior trunk of the internal iliac artery or were bifurcated from the gluteal-pudendal trunk. In rare cases, these arteries arose from the posterior trunk of the internal iliac artery. The other origins of the middle rectal artery included the gluteal pudendal trunk, inferior vesical artery, internal iliac artery, obturator artery, and the prostatic artery, and the pelvic vasculatures in these cases also presented variability. The detailed anatomical findings related to the middle rectal artery and pelvic vasculatures are noteworthy for their improved clinical applicability.

Keywords

Acknowledgement

The authors would like to thank the donors and their families without whom this research would not be possible. This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2018R1D-1A1B07048476).

References

  1. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;1:1479-82.
  2. Kapiteijn E, Putter H, van de Velde CJ. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Br J Surg 2002;89:1142-9.
  3. Knol J, Keller DS. Total mesorectal excision technique-past, present, and future. Clin Colon Rectal Surg 2020;33:134-43.
  4. Kiyomatsu T, Ishihara S, Murono K, Otani K, Yasuda K, Nishikawa T, Tanaka T, Hata K, Kawai K, Nozawa H, Yamaguchi H, Watanabe T. Anatomy of the middle rectal artery: a review of the historical literature. Surg Today 2017;47:14-9.
  5. DiDio LJ, Diaz-Franco C, Schemainda R, Bezerra AJ. Morphology of the middle rectal arteries. A study of 30 cadaveric dissections. Surg Radiol Anat 1986;8:229-36.
  6. Sato K, Sato T. The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia. Surg Radiol Anat 1991;13:17-22.
  7. Bilhim T, Pereira JA, Tinto HR, Fernandes L, Duarte M, O'Neill JE, Pisco JM. Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surg Radiol Anat 2013;35:517-22.
  8. Jones OM, Smeulders N, Wiseman O, Miller R. Lateral ligaments of the rectum: an anatomical study. Br J Surg 1999;86:487-9.
  9. Ayoub SF. Arterial supply to the human rectum. Acta Anat (Basel) 1978;100:317-27.
  10. Vogel P, Klosterhalfen B. [The surgical anatomy of the rectal and anal blood vessels]. Langenbecks Arch Chir 1988;373:264-9. German.
  11. Schuurman JP, Go PM, Bleys RL. Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis 2009;11:967-71.
  12. Standring S. Gray's anatomy: the anatomical basis of clinical practice. 41st ed. Amsterdam: Elsevier; 2016.
  13. Moore KL, Dalley AF, Agur AMR. Clinically oriented anatomy. 8th ed. Philadelphia: Wolters Kluwer; 2018.
  14. Clegg EJ. The arterial supply of the human prostate and seminal vesicles. J Anat 1955;89:209-16.
  15. Syed MI, Chaudhry N, Shaikh A, Morar K, Mukerjee K, Damallie E. Catheter-directed middle hemorrhoidal artery embolization for life-threatening rectal bleeding. Can J Gastroenterol 2007;21:117-23.