Nerve-preserving aortoiliac reconstruction surgery: anatomical study and surgical approach

Journal of Vascular Surgery
J van SchaikM C DeRuiter

Abstract

Dysfunctional ejaculation and, to a lesser extent, dysfunctional erection caused by disruption of efferent sympathetic pathways is a common complication after aortoiliac reconstruction surgery. The aim was to give an anatomic motivation for a nerve-preserving approach on the basis of right-sided unilateral disruption of lumbar splanchnic nerves. Anatomic and microscopic analysis of preaortic and para-aortic retroperitoneal regions in human cadavers was performed. Anatomic analysis was conducted of two aortoiliac reconstruction operations performed on human cadavers; one was performed according to a single-blind procedure, the second with a modified procedure. The lumbar splanchnic nerves supplying the superior hypogastric plexus from the right side were found to be less voluminous than the left-sided ones. The superior hypogastric plexus was found slightly shifted to the left of the midsagittal plane across the abdominal aorta and its bifurcation. Microscopic analysis revealed a thin fascia between the aorta and the subperitoneal tissue compartment. This fascia was used as a plain of dissection to mobilize the preaortic nerve-plexuses without damage from the aortic wall. Analysis of the specimens operated on showed a significan...Continue Reading

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Citations

Nov 30, 2013·The Urologic Clinics of North America·Elizabeth PhillipsRobert D Oates
Oct 16, 2010·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·João Antonio Pereira CorreiaRicardo De Ary-Pires
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Feb 24, 2015·Tumori·Paola BertocchiAlberto Zaniboni
Jul 30, 2020·The Spine Journal : Official Journal of the North American Spine Society·Shangxi DengQingchu Li

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