The iliac and femoral vessels: dimensions and tortuosity in a South African sample.

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dc.contributor.advisorKeet, Kerrien_ZA
dc.contributor.advisorBaatjes, Karinen_ZA
dc.contributor.advisorWitbooi, Lee-royen_ZA
dc.contributor.authorLunn-Collier, Robynen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences. Anatomy and Histology. Division of Clinical Anatomy.en_ZA
dc.date.accessioned2023-02-22T06:49:20Zen_ZA
dc.date.accessioned2023-05-18T06:59:00Zen_ZA
dc.date.available2023-02-22T06:49:20Zen_ZA
dc.date.available2023-05-18T06:59:00Zen_ZA
dc.date.issued2023-02-22en_ZA
dc.descriptionStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences. Anatomy and Histology. Division of Clinical Anatomy.en_ZA
dc.description.abstractENGLISH ABSTRACT: Arterial morphology varies between individuals and undergoes changes with increasing age. The safety and success of endovascular procedures, performed by accessing and traversing vessel pathways, are influenced by this variable morphology. Research exploring the iliofemoral arterial pathway is limited in South Africa, which may implicate the efficacy of endovascular procedures performed in this country. Therefore, the present study aimed to determine the mean length, luminal diameter, and tortuosity severity of the common iliac, external iliac, and common femoral arteries of adult males and females in a South African sample, and to determine the influence of increasing age on this arterial morphology. A retrospective, cross-sectional study was conducted using a sample of 224 computed tomography angiograms, accessed from Tygerberg Hospital, Cape Town, South Africa. The sample included 117 adult males and 107 adult females (aged 18-79). The arterial length and lumen diameter of the common iliac, external iliac, and common femoral arteries were measured. Tortuosity severity was assessed by a visual estimation and allocation into a phenotypic category. Furthermore, tortuosity was quantitatively assessed using the tortuosity index and inflection count metric. Regression analysis was used to adjust for estimated body height. The common iliac artery was the widest artery of the iliofemoral pathway, while the external iliac artery was the longest. The morphology of the external iliac artery varied bilaterally and with sex, with males presenting with increased tortuosity, particularly on the right side. The diameter of all arterial segments was larger in males, while the length of these arteries did not differ between the sexes, with the exception of the right external iliac artery being longer in females. The inflection count metric reported the external iliac arteries of males to be more tortuous. Regression analysis revealed a strong positive relationship between arterial tortuosity and increasing age. A tortuosity phenotype was most frequently observed in the external iliac artery. However, a c-shaped curving phenotype of tortuosity was observed in all arteries of interest. The tortuosity severity of the external iliac artery doubled throughout the adult lifetime, with increases in arterial tortuosity and changes in morphology commencing between 40-49 years of age. Severe tortuosity was typically reported in individuals aged 60 years and older. Arterial morphology of the iliofemoral pathway is variable both bilaterally and between the sexes. Furthermore, changes in arterial morphology become significant from 40-49 years of age and are most severe after 60 years of age. Thus, the vasculature of patients within this age range may present with challenging anatomy for endovascular procedures. Comparing the arterial dimensions and tortuosity of this South African sample to international measurements is challenging due to the varying methodologies employed in existing literature. Therefore, the demographic-specific measurements generated in this study serve to contribute to a reference database of expected arterial anatomy in a South African context.en_ZA
dc.description.abstractAFRIKAANS OPSOMMING: Die morfologie van arteries vertoon varieerbare verskille tussen individue en ondergaan verskeie veranderinge met toenemende ouderdom. Die veiligheid en sukses van endovaskulȇre prosedures wat gedoen word deur toegang en deurgang van bloedvate, word beïnvloed deur hierdie varieerbare morfologie. Navorsing wat toegang tot die ilio-femorale arterie eksploreer is beperk in die SuidAfrikaanse konteks. Dit mag die veiligheid van endovaskulȇre prosedures in hierdie groep beïnvloed. Die huidige studie het beoog om die gemene lengte, lumen deursnit en die graad van kronkeling van die gemene iliak, eksterne iliak en gemene femorale arteries in ‘n Suid-Afrikaanse steekproef te bepaal en die verhouding tussen ouderdom en veranderinge in arteriёle morfologie te bereken. ‘n Retrospektiewe, deursnit studie was uitgevoer deur die gebruik van ‘n steekproef van 224 rekenaar tomografie angiogramme, insluitend mans en vrouens (ouderdom 18-79 jaar), van Tygerberg Hospitaal, Kaapstad, Suid-Afrika. Arteriёle lengte en lumen deursnit van die gemene iliak, eksterne iliak en gemene femorale arteries is gemeet. Die graad van kronkeling was gemeet deur ‘n visuele skatting en kategorie bepaling van die fenotipe. Verder, was die kronkeling kwantitatief bepaal deur die kronkelingsindeks te gebruik en die infleksie te bereken. Regressie analise was aangepas vir die skatting van liggaamslengte. Die gemene iliak arterie was die wydste arterie, terwyl die eksterne iliak die langste arterie was. Die morfologie van die eksterne iliak arterie het bilateraal gevarieer, met die regterkant wat meer kronkeling vertoon. Die deursnit van alle arteriёle segmente was groter in mans, terwyl die lengte en kronkeling van hierdie arteries nie verskil het tussen die geslagte nie. Regressie analise het ‘n sterk positiewe verhouding tussen arteriёle kronkeling en toenemende ouderdom getoon. ‘n Kronkeling fenotipe was mees algemeen gevind in die eksterne iliak arterie, maar ‘n c-vormige kurwe fenotipe van kronkeling was waargeneem in alle arteriёle segmente van belang. Die kronkeling van die eksterne iliak arterie het verdubbel deur die leeftyd van die volwassene, met verergering in kronkeling en veranderinge in morfologie wat begin tussen 40-49 jaar. Ekstensiewe kronkeling was tipies waargeneem in individue in 60 jaar en ouer. Die afleiding van hierdie studie is dat die arteriёle morfologie van die ilio-femorale verloop varieerbaar is, beide bilateraal en tussen geslagte, asook verander met toenemende ouderdom. Verder, veranderinge in arteriёle morfologie word beduidend vanaf 40-49 jaar en is die mees opvallend na 60 jaar. Gebaseer hierop, dui data aan dat die vaskulatuur van pasiënte in hierdie ouderdomsgroep mag lei tot uitdagende anatomie vir endovaskulȇre prosedures. Die demografie-spesifieke berekeninge in hierdie studie dien as ‘n bydra tot ‘n verwysing databasis van verwagte arteriёle anatomie in ‘n SuidAfrikaanse konteks.af_ZA
dc.description.versionMastersen_ZA
dc.format.extentxx, 79 pages : illustrationsen_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/126989en_ZA
dc.language.isoen_ZAen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.subject.lcshBlood-vessels -- Endoscopic surgeryen_ZA
dc.subject.lcshMorphologyen_ZA
dc.subject.lcshIliac veinen_ZA
dc.subject.lcshFemoral veinen_ZA
dc.subject.lcshArteries -- Surgeryen_ZA
dc.titleThe iliac and femoral vessels: dimensions and tortuosity in a South African sample.en_ZA
dc.typeThesisen_ZA
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