Aortic bifurcation

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

You are welcome to submit questions and suggestions using our "Contact Us" form. The information on this blog follows the terms on our "Privacy and Security Statement" and cannot be construed as medical guidance or instructions for treatment.

A Moment in History

Georg Eduard Von Rindfleisch
(1836 – 1908)

German pathologist and histologist of Bavarian nobility ancestry. Rindfleisch studied medicine in Würzburg, Berlin, and Heidelberg, earning his MD in 1859 with the thesis “De Vasorum Genesi” (on the generation of vessels) under the tutelage of Rudolf Virchow (1821 - 1902). He then continued as a assistant to Virchow in a newly founded institute in Berlin. He then moved to Breslau in 1861 as an assistant to Rudolf Heidenhain (1834–1897), becoming a professor of pathological anatomy. In 1865 he became full professor in Bonn and in 1874 in Würzburg, where a new pathological institute was built according to his design (completed in 1878), where he worked until his retirement in 1906.

He was the first to describe the inflammatory background of multiple sclerosis in 1863, when he noted that demyelinated lesions have in their center small vessels that are surrounded by a leukocyte inflammatory infiltrate.

After extensive investigations, he suspected an infectious origin of tuberculosis - even before Robert Koch's detection of the tuberculosis bacillus in 1892. Rindfleisch 's special achievement is the description of the morphologically conspicuous macrophages in typhoid inflammation. His distinction between myocardial infarction and myocarditis in 1890 is also of lasting importance.

Associated eponyms

"Rindfleisch's folds": Usually a single semilunar fold of the serous surface of the pericardium around the origin of the aorta. Also known as the plica semilunaris aortæ.

"Rindfleisch's cells": Historical (and obsolete) name for eosinophilic leukocytes.

Personal note: G. Rindfleisch’s book “Traité D' Histologie Pathologique” 2nd edition (1873) is now part of my library. This book was translated from German to French by Dr. Frédéric Gross (1844-1927) , Associate Professor of the Medicine Faculty in Nancy, France. The book is dedicated to Dr. Theodore Billroth (1829-1894), an important surgeon whose pioneering work on subtotal gastrectomies paved the way for today’s robotic bariatric surgery. Dr. Miranda.

Sources:
1. "Stedmans Medical Eponyms" Forbis, P.; Bartolucci, SL; 1998 Williams and Wilkins
2. "Rindfleisch, Georg Eduard von (bayerischer Adel?)" Deutsche Biographie
3. "The pathology of multiple sclerosis and its evolution" Lassmann H. (1999) Philos Trans R Soc Lond B Biol Sci. 354 (1390): 1635–40.
4. “Traité D' Histologie Pathologique” G.E.
Rindfleisch 2nd Ed (1873) Ballieres et Fils. Paris, Translated by F Gross

"Clinical Anatomy Associates, Inc., and the contributors of "Medical Terminology Daily" wish to thank all individuals who donate their bodies and tissues for the advancement of education and research”.

Click here for more information

Details: Written by: Efrain A. Miranda, Ph.D.; Published: November 13, 2014; Hits: 13688

Click for a larger image

The bifurcation of the aorta is the point at which the abdominal aorta ends distally. At this point the aorta bifurcates giving origin to the right and left common iliac arteries. These arteries trend anterolaterally towards the pelvic brim.

The aortic bifurcation is usually found anterior to the inferior border of the 4th lumbar vertebra vertebra, slightly to the left of the midline. In surface anatomy, the bifurcation corresponds to a point slightly left to the midline and just about two fingerbreadths (two centimeters) inferior to the umbilicus.

This is an important landmark in surface anatomy in laparoscopic surgery. When placing the first periumbilical trocar the surgeon must angle the trocar posteroinferiorly towards the pelvic basin as to avoid perforating or lacerating the abdominal aorta. This situation has been studied in many journal articles.

Inferior to the aortic bifurcation is the confluence of both common iliac veins which give origin to the inferior vena cava.

The middle sacral artery arises from the lower portion of the abdominal aorta and appears inferior to the aortic bifurcation in the midline an continuing on its way to the anterior aspect of the sacrum.

The fact that the aorta bifurcates in front of the 4th lumbar vertebra leaves the L5-S1 intervertebral disc free of major arteries (with the exception of the middle sacral artery) allowing surgeons access to the intervertebral disc to perform laparoscopic removal of the disc with implantation of a device to allow intervertebral fusion in the case of intervertebral disc disease.

Sources:
1. “Major vascular injuries during laparoscopic procedures” Nordestgaard, AG et al Am J Surg (1995) 169,5: 543–545
2. “Evaluation of the direct trocar insertion technique at laparoscopy” Byron. JW et al Obst Gyn (1989) 74:3, 423-425
3. “Open versus closed establishment of pneumoperitoneum in laparoscopic surgery” Bonjer, HJ et al Br J Surg, 84: 599–602
4. “Serious Trocar Accidents in Laparoscopic Surgery: A French Survey of 103,852 Operations” Champault G et al Surg Lap Endosc (1996) 6(5):367-70
5. “Major vascular injuries during gynecologic laparoscopy” Chapron CM et al J Am Coll Surg (1997) 185:5 461-465

Image property of:CAA.Inc.Artist: Victoria G. Ratcliffe

Aortic bifurcation

Recent