Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR)
- Authors: Davidovich D.L.1, Filisteev P.А.2, Smirnov A.V.1, Burovskiy A.K.1, Solomka A.Y.1, Tariverdiev A.M.1, Tomashevskiy G.S.1, Razbirin D.V.1, Loshchenov M.S.1
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Affiliations:
- Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
- Central Clinical Hospital of the Management Affair of President Russian Federation
- Issue: Vol 14, No 4 (2023)
- Pages: 26-33
- Section: Original Study Articles
- URL: https://journal-vniispk.ru/clinpractice/article/view/253943
- DOI: https://doi.org/10.17816/clinpract568027
- ID: 253943
Cite item
Abstract
Background: To date, there is no single standard for conducting HAL-RAR operations. The constant discussion raises the question of the number of terminal branches of the superior rectal artery, which must be ligated in the submucosal layer of the rectum in order to provide the adequate dearterialization of hemorrhoids. Aim: To study the anatomy of the branches of the superior rectal artery and to develop recommendations for the optimal ligation of the terminal branches of the superior rectal artery. Methods: 150 protocols of the previous operations have been studied. In order to further objectify our results, the results of radiation diagnostics (CT and MRI) were revised for 100 patients without pathological changes of the rectum and anal canal to study the variant anatomy of the superior rectal artery and its terminal branches in the rectal wall. Results: In 148 patients, 6 terminal branches were identified, in 2 (1.333%) patients, 5 branches were found. 100 cases without pathological changes were also analyzed (60 MRI and 40 CT scans). In all the cases, 6 terminal branches of the superior rectal artery were determined, located at 1, 3, 5, 7, 9 and 11 o'clock positions of the conventional dial. At the same time, a large number of identified anatomical options for the branching of the VPA and the method for reaching the rectal wall should be noted, which we used as a basis to propose a classification. Conclusion: In the vast majority of cases, there are 6 terminal branches of the superior rectal artery, located in the lower ampulla of the rectum at approximately 1, 3, 5, 7, 9 and 11 hours of the conventional dial. A number of variants of the vascular anatomy of the proximal branches are possible, but 6 distal branches are involved in the direct blood supply of the hemorrhoids. When performing selective Doppler-controlled dearterialization of hemorrhoids, it is expedient to ligate 6 arterial vessels.
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##article.viewOnOriginalSite##About the authors
Denis L. Davidovich
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Author for correspondence.
Email: denisdavidovich@mail.ru
ORCID iD: 0000-0002-2406-037X
MD, PhD
Russian Federation, MoscowPavel А. Filisteev
Central Clinical Hospital of the Management Affair of President Russian Federation
Email: pavel.filisteev@mail.ru
ORCID iD: 0009-0008-1024-9922
SPIN-code: 6461-8861
Russian Federation, Moscow
Alexander V. Smirnov
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: alvsmirnov@mail.ru
ORCID iD: 0000-0003-3897-8306
SPIN-code: 5619-1151
MD, PhD
Russian Federation, MoscowAndrey K. Burovskiy
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: Drun-bur@mail.ru
ORCID iD: 0000-0003-4225-8635
Russian Federation, Moscow
Alexander Y. Solomka
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: dr.solomkaa@gmail.com
ORCID iD: 0000-0001-9515-6371
Russian Federation, Moscow
Andrey M. Tariverdiev
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: a.tariverdiev@surgeons.ru
ORCID iD: 0009-0009-2038-7293
Russian Federation, Moscow
German S. Tomashevskiy
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: german.tomash@mail.ru
ORCID iD: 0000-0002-1108-0443
Russian Federation, Moscow
Dmitry V. Razbirin
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: razbirin@gmail.com
ORCID iD: 0000-0002-2644-6153
Russian Federation, Moscow
Maksim S. Loshchenov
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: m.s.loschenov@yandex.ru
ORCID iD: 0009-0005-0952-6003
Russian Federation, Moscow
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