B. Hoerdeman1, T. P. Sprenkle1, M. D. Gothard2, M. L. McCarroll1, D. Rhodes1 1Pacific Northwest University Of Health Sciences,College Of Medicine,Yakima, WA, USA 2Biostats, Inc.,East Canton, OH, USA
Introduction: The corona mortis (CM) or “crown of death” is a clinically important common pelvic vascular variant. Its name is derived from its association with unexpected hemorrhage and possible exsanguination during surgical operations and trauma in the anterior pelvic and inguinal region. The CM is defined as any vascular anastomosis (arterial or venous) between the obturator and external iliac arterial systems. The incidence and location of the CM in relation to the pubic symphysis is well documented. However, the location of the CM in relation to the anterior superior iliac spine (ASIS) and pubic tubercle (PT), both palpable anatomic landmarks, have not been described previously. Our objective, was to analyze the arterial CM using measurements from these two anatomic reference points as a guide for determining the location of a possible CM. This could be useful in many clinical settings, giving physicians a quick and practical method to roughly estimate where this potential vessel could lie.
Methods: Seventy hemi-pelvises from embalmed cadavers were dissected. Any arterial anastomosis between the obturator and external iliac systems greater than 2 mm was identified and distances to the ASIS and PT were measured several times by two researchers, using both an electronic caliper and a ruler. Statistical analyses of measurements were conducted including: mean (with 95% confidence interval (CI)), median, Min – Max, a Shapiro-Wilks Test of Normality, a two-tailed t-tests. Data were analyzed both collectively and stratified by gender.
Results: Of the 35 cadavers (70 hemi-pelvises) dissected, 24 arterial corona mortis’ >2 mm were identified (34.3%), 17 in males and 7 in females. The mean distance from the PT to the CM for all specimens was 51.5 ± 8.1 mm (95% CI 48.0 – 54.9 mm), the median distance was 50.5 mm, and the range was 39.8 to 68.3 mm. The mean male PT to CM distance was significantly different from this measurement in females (p=0.028) indicating a gender difference in this distance. The ASIS to CM distance, as a proportion of the ASIS to ASIS distance had a mean percentage ratio of 43.5% ± 4.0% (95% CI 41.8% – 45.3%), a median of 43.2%, and a range of 39.9% to 51.1%, with no significant gender differences detected (p>0.05).
Conclusion: The ASIS and PT both can be used as anatomic landmarks to help determine the location of an arterial CM, if present. The clinical need to map the corona mortis is evident both by its high incidence in the general population (19% for arterial CM) and by the scarcity of the topic in the current literature. Our study gives clinicians measurements based off of two palpable anatomic landmarks (ASIS and PT) upon which to roughly estimate the location of a potential CM, assisting in the mapping of this important and complex anatomical area. We believe that our study lays the foundation upon which future studies can further fill this gap in the medical literature.