Topography of Aortic Bifurcation in a Black Kenyan Population

Abstract

Topography of aortic bifurcation is important for gynaecologists, surgeons and radiologists operating in the retroperitoneal area, in order for them to minimize vascular injury. It also influences the occurrence of aortic-iliac atherosclerosis. It shows ethnic variations, but data from African populations are scarce. This study therefore investigated the topography of aortic bifurcation in a black Kenyan population by dissection of 106 cadavers. After removal of abdominal viscera, peritoneum, fibrofatty connective tissue, inferior vena cava was removed to expose the termination of abdominal aorta. Vertebral level, angle and asymmetry of bifurcation were recorded. Data were analysed by SPSS version 17.0 for windows and are presented in tables and bar charts. All aortae terminated by bifurcating into 2 common iliac arteries. The most common level of bifurcation was L4 (73.6%). It bifurcated below L4 in 22.7% of the cases. Mean angle of bifurcation was 55.20 (range 23 – 780); 55.60 in males and 54.30 in females. Mean bifurcation asymmetry was 4.4 (range 0 – 23). Topography of aortic bifurcation in the black Kenyan population varies from conventional descriptions on over 20% of the individuals studied. Surgeons and radiologists must be aware of this to avoid inadvertent vascular injury. Higher bifurcation angles and asymmetry than those reported for Caucasian and Indo Asian populations suggest higher vulnerability to abdominal aortic atherosclerosis. Preoperative evaluation of terminal aorta, and follow up for atherosclerosis are recommended.