Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR)
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 dearterializa...
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| Format: | Article |
| Language: | English |
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Eco-vector
2024-01-01
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| Series: | Клиническая практика |
| Subjects: | |
| Online Access: | https://journals.eco-vector.com/clinpractice/article/viewFile/568027/pdf |
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| author | Denis L. Davidovich Pavel А. Filisteev Alexander V. Smirnov Andrey K. Burovskiy Alexander Y. Solomka Andrey M. Tariverdiev German S. Tomashevskiy Dmitry V. Razbirin Maksim S. Loshchenov |
| author_facet | Denis L. Davidovich Pavel А. Filisteev Alexander V. Smirnov Andrey K. Burovskiy Alexander Y. Solomka Andrey M. Tariverdiev German S. Tomashevskiy Dmitry V. Razbirin Maksim S. Loshchenov |
| author_sort | Denis L. Davidovich |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-24T23:42:16Z |
| format | Article |
| id | doaj.art-6290795d98a340d8b4f5d3edb5f384cd |
| institution | Directory Open Access Journal |
| issn | 2220-3095 2618-8627 |
| language | English |
| last_indexed | 2024-04-24T23:42:16Z |
| publishDate | 2024-01-01 |
| publisher | Eco-vector |
| record_format | Article |
| series | Клиническая практика |
| spelling | doaj.art-6290795d98a340d8b4f5d3edb5f384cd2024-03-15T11:16:13ZengEco-vectorКлиническая практика2220-30952618-86272024-01-01144263310.17816/clinpract56802778399Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR)Denis L. Davidovich0https://orcid.org/0000-0002-2406-037XPavel А. Filisteev1https://orcid.org/0009-0008-1024-9922Alexander V. Smirnov2https://orcid.org/0000-0003-3897-8306Andrey K. Burovskiy3https://orcid.org/0000-0003-4225-8635Alexander Y. Solomka4https://orcid.org/0000-0001-9515-6371Andrey M. Tariverdiev5https://orcid.org/0009-0009-2038-7293German S. Tomashevskiy6https://orcid.org/0000-0002-1108-0443Dmitry V. Razbirin7https://orcid.org/0000-0002-2644-6153Maksim S. Loshchenov8https://orcid.org/0009-0005-0952-6003Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyCentral Clinical Hospital of the Management Affair of President Russian FederationFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyBackground: 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.https://journals.eco-vector.com/clinpractice/article/viewFile/568027/pdfhemorrhoidsdesarterizationliftingligationhal-rar |
| spellingShingle | Denis L. Davidovich Pavel А. Filisteev Alexander V. Smirnov Andrey K. Burovskiy Alexander Y. Solomka Andrey M. Tariverdiev German S. Tomashevskiy Dmitry V. Razbirin Maksim S. Loshchenov Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR) Клиническая практика hemorrhoids desarterization lifting ligation hal-rar |
| title | Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR) |
| title_full | Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR) |
| title_fullStr | Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR) |
| title_full_unstemmed | Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR) |
| title_short | Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR) |
| title_sort | anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes hal rar |
| topic | hemorrhoids desarterization lifting ligation hal-rar |
| url | https://journals.eco-vector.com/clinpractice/article/viewFile/568027/pdf |
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