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Ma C, Wang Y, Zhang H, Duan F, Wang MQ. Partial splenic embolization with embosphere microspheres (700-900 µm) for the treatment of hypersplenism: comparison of selective superior splenic artery embolization and inferior splenic artery embolization. MINIM INVASIV THER 2024:1-10. [PMID: 38606756 DOI: 10.1080/13645706.2024.2339917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
Objective: To compare clinical outcomes of superior versus inferior splenic artery embolization in partial splenic embolization (PSE) and identify predictors of major complications. Material and methods: This retrospective case-control study included 73 patients who underwent PSE between May 2005 and April 2021. They were divided into two groups: the superior and middle splenic artery embolization group (Group A, n = 37) and the inferior and middle splenic artery embolization group (Group B, n = 36). Outcome differences and major complications between the groups were assessed. Logistic regression was used to analyze potential predictors of major complications, and the optimal cutoff value for splenic embolization rates was determined using the Youden index. Results: There were no significant differences in laboratory and radiological outcomes between the two groups. Group A had a significantly lower incidence of major complications than Group B (p = 0.049), a lower Visual Analog Scale (VAS) score for pain (p = 0.036), and a shorter hospital stay (p = 0.022). Independent risk factors for major complications included inferior and middle splenic artery embolization (odds ratio [OR] = 3.672; 95% confidence interval [CI] = 1.028-13.120; p = 0.045) and a higher spleen embolization rate (OR = 1.108; 95% CI = 1.003-1.224; p = 0.044). The optimal cutoff for spleen embolization rate to predict major complications was 59.93% (sensitivity 77.8%, specificity 63.6%). Conclusion: Using 500-700 µm microspheres for PSE, targeting the middle and superior splenic artery yields similar effects to targeting the middle and inferior artery, but results in lower rates of major complications and shorter hospital stays. To effectively minimize the risk of major complications, the embolization rate should be kept below 59.93%, regardless of the target vessel.
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Affiliation(s)
- Chao Ma
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Yan Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Heng Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Feng Duan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Mao-Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
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Bilek E, Keven A, Arslan AG. Comprehensive analysis of splenic artery variations using computed tomography angiography: development of the IPALGEA classification system. Surg Radiol Anat 2024; 46:363-376. [PMID: 38305853 DOI: 10.1007/s00276-024-03301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The splenic artery, an essential component of abdominal vascular anatomy, exhibits significant variations with clinical implications in surgical and radiological procedures. The lack of a standardized classification system for these variations hinders comparative studies and surgical planning. This study introduces the IPALGEA classification system, based on computed tomography angiography (CTA) findings, to address this gap. METHODS A retrospective analysis was conducted on 302 patients who underwent CTA at a tertiary university hospital between August 2021 and January 2022. The study focused on the evaluation of splenic artery variations, including the origin, course, terminal branching patterns, and the relationship between the inferior polar artery and the left gastroepiploic artery. The IPALGEA classification was developed to standardize the reporting of these variations. RESULTS The study highlighted a significant prevalence of splenic artery variations, with the most common pattern being a superior course relative to the pancreas. The IPALGEA classification effectively categorized these variations, emphasizing the relationship between the inferior polar artery and the left gastroepiploic artery. The findings revealed that the bifurcation distance of the celiac trunk varied significantly between genders and that the presence of an inferior polar artery correlated with a shorter hilus distance. CONCLUSION The IPALGEA classification offers a comprehensive and standardized approach to categorize splenic artery variations. This system enhances our understanding of abdominal vascular anatomy and has significant implications for surgical and radiological procedures, potentially reducing surgical complications and improving patient outcomes.
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Affiliation(s)
- Enis Bilek
- Department of Radiology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ayşe Keven
- Department of Radiology, Akdeniz University School of Medicine, Antalya, Turkey.
| | - Ahmet Gökhan Arslan
- Department of Radiology, Akdeniz University School of Medicine, Antalya, Turkey
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Nikov A, Gürlich R, Kachlík D, Whitley A. The posterior gastric artery: A meta-analysis and systematic review. Clin Anat 2023; 36:1147-1153. [PMID: 37096869 DOI: 10.1002/ca.24051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023]
Abstract
The aim of this study was to review the literature on the posterior gastric artery, estimate its prevalence and summarize its reported origins. The databases Pubmed, Scopus, Web of Science and Google Scholar were searched to find all studies describing the prevalence and origin of the posterior gastric artery. Pooled prevalences were estimated using a random effects model. Thirty-eight studies with a total of 3366 subjects were included in the analysis. The overall prevalence of the posterior gastric artery was 57.4% (95% CI = 49.1%-65.7%). The prevalence of the posterior gastric artery was significantly higher in surgical studies than in cadaveric and angiographic studies. There were no differences in prevalence between multi-detector computed tomography studies and cadaveric studies, nor were there differences when comparing geographical location or study size. Origin data were extracted from 34 studies, with a total of 1533 cases. The posterior gastric artery arose as a single vessel from the splenic artery in 1160 cases (pooled prevalence 86.5% [95% CI = 78.5%-94.7%]), from the superior polar splenic artery in 339 cases (pooled prevalence 11.8% [95% CI = 3.7%-19.9%]) and from other origins in 50 cases (pooled prevalence 0.27% [95% CI = 0.00-0.71%]). The posterior gastric artery is present in 57.4% of cases and most commonly arises from the splenic artery. It should be identified before gastric resections as it may be an important source of blood to the gastric stump. Multi-detector computed tomography has sufficient sensitivity to detect it before surgery.
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Affiliation(s)
- Andrej Nikov
- Department of Surgery, University Hospital Kralovske Vinohrady, Prague, Czechia
- Department of Surgery, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Robert Gürlich
- Department of Surgery, University Hospital Kralovske Vinohrady, Prague, Czechia
- Department of Surgery, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - David Kachlík
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czechia
- Centre for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Adam Whitley
- Department of Surgery, University Hospital Kralovske Vinohrady, Prague, Czechia
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czechia
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czechia
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Lombardi PD, Li ASR, Sue MS, Bola HS, Bentley DC. Atypically Taut Superior Polar Splenic Artery Discovered in a Human Cadaver. Cureus 2023; 15:e49627. [PMID: 38033438 PMCID: PMC10687485 DOI: 10.7759/cureus.49627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/02/2023] Open
Abstract
The splenic artery is the largest branch of the celiac trunk and frequently presents with anatomical variability. These variations relate to its origin, trajectory, location relative to the pancreas, terminal branching pattern, and the potential presence of polar arteries. Knowledge of the splenic artery's variability may inform gastrointestinal surgeons as they plan and execute surgical interventions, resulting in improved success rates while minimizing both operative complications and procedural time. The case presentation of a splenic artery dissected from an elderly male cadaver initially demonstrated normal anatomical arrangement. The artery branched off the celiac trunk of the abdominal aorta and followed a tortuous suprapancreatic route to split into two lobar arteries terminating in the spleen. However, upon closer inspection, a superior polar splenic artery was uncovered with two unique characteristics. Firstly, the presented polar artery lacked branching gastric arteries, a rare variation with a prevalence of only 3.27%. Secondly, the distance between the origin of the superior polar splenic artery and the splenic hilum was greater than what is often reported in clinical literature. While similar previous case reports have observed arterial origins of greater distance, these have often been accompanied by a compensatory arterial length. Interestingly, the case presented in this report contained a superior polar splenic artery with an arterial length shorter than its distance to the splenic hilum, resulting in an atypically taut vessel. This bears clinical importance, as this arterial presentation may be susceptible to a surgical rupture if neglected. By including this anatomical variation in the expanding library of splenic artery variations, surgeons and their collaborative healthcare teams may broaden their understanding of splenic artery anatomy as they conceptualize new techniques for pancreatomy and splenectomy procedures that consider arterial variations while minimizing surgical complications, operative time, and patient blood loss.
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Affiliation(s)
| | - Annie Shi Ru Li
- Faculty of Arts & Science, University of Toronto, Toronto, CAN
| | - Michelle S Sue
- Faculty of Arts & Science, University of Toronto, Toronto, CAN
| | - Harun S Bola
- Faculty of Medicine, Department of Surgery, Division of Anatomy, University of Toronto, Toronto, CAN
| | - Danielle C Bentley
- Faculty of Medicine, Department of Surgery, Division of Anatomy, University of Toronto, Toronto, CAN
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Saldarriaga B, Larrotta O, Ballesteros L. Morphological characteristics of the left gastric, common hepatic and splenic arteries. A descriptive study in human cadaveric specimens. Rev Col Bras Cir 2023; 50:e20233403. [PMID: 36790227 PMCID: PMC10519692 DOI: 10.1590/0100-6991e-20233403-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/16/2022] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE to evaluate the morphology of the branches of celiac trunk (CT), left gastric (LGA), common hepatic (CHA), and splenic (SA) arteries in cadaveric specimens from a sample of a Colombian population. METHODS descriptive cross-sectional study of 26 blocks from the abdominal upper segment of human cadavers who underwent forensic autopsies at the Instituto de Medicina Legal at Bucaramanga, Colombia. The vascular beds of the celiac trunk were, subsequently, perfused with a semi-synthetic resin. RESULTS the diameters of LGA, CHA, and SA were 3.6±0.8mm, 5,2±1.2mm, and 5.9±1.0mm, respectively. Statistically, LGA and SA were different (p=<0.001). SA followed a linear trajectory in 8 (31%) samples, slightly tortuous in 4 (15%), and tortuous in 14 (54%). The tortuosity index was 1.25±0.18. Of the branches of CHA, the proper hepatic artery (PHA) had 4.8±1.2mm in diameter and 18.8±9.1mm in length, whereas the gastroduodenal artery (GDdA) had 4.1±0.8mm. In 2 cases (7.7%), an accessory hepatic artery from the LGA was found to supply perfusion to the left hepatic lobe. Finally, in 2 cases (7.7%) the SA came independently from the abdominal aorta. CONCLUSION the observed emergence incidence of the CT branches from the same level as reported in the literature is lower. The characterization, along with their variants, of LGA, CHA, and SA must be considered in surgical procedures in the upper abdominal segment, to avoid iatrogenic complications.
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Affiliation(s)
- Bladimir Saldarriaga
- - Universidad Autónoma de Bucaramanga, Basic Science - Bucaramanga - Santander - Colômbia
- - Universidad Industrial de Santander, Basic Science - Bucaramanga - Santander - Colômbia
| | - Oscar Larrotta
- - Universidad Autónoma de Bucaramanga, Basic Science - Bucaramanga - Santander - Colômbia
- - Universidad Industrial de Santander, Basic Science - Bucaramanga - Santander - Colômbia
| | - Luis Ballesteros
- - Universidad Autónoma de Bucaramanga, Basic Science - Bucaramanga - Santander - Colômbia
- - Universidad Industrial de Santander, Basic Science - Bucaramanga - Santander - Colômbia
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Covantsev S, Alieva F, Mulaeva K, Mazuruc N, Belic O. Morphological Evaluation of the Splenic Artery, Its Anatomical Variations and Irrigation Territory. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010195. [PMID: 36676143 PMCID: PMC9861032 DOI: 10.3390/life13010195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Precise knowledge of the topographic features of the splenic artery and its branches in the hilum region is of practical interest due to the various interventions on the vessels of the spleen. MATERIALS AND METHODS The anatomy of the spleen was studied by means of macroscopic dissection on 330 organ complexes, which were carefully documented and analyzed statistically. RESULTS The analysis of the splenic artery trajectory led to identification of four types: straight (43.03%), sinusoidal (27.58%), serpentine (20.91%) and alternating (8.48%). To assess the relation between the trajectory of the splenic artery and its branches we performed a chi square test. Sinuous or serpentine trajectory was associated with the presence of long splenic artery branches (dorsal pancreatic artery or the great pancreatic artery), X2 (2, N = 330) = 12.85, p = 0.001. The artery was located suprapancreatic in 70.30% of cases, anteropancreatic in 4.55%, the vessel had an intrapancreatic course in 14.85% and in 10.00% of cases the artery was located retropancreatic. The presence of inferior polar arteries was associated with a longer pancreas (Spearman's correlation; r = 0.37; p = 0.037). In a multiple regression analysis, inferior polar arteries predicted the length of the pancreas although only a small number of cases could be explained by this model (R2 = 0.127, Adjusted R2 = 0.098; Betta = 0.357; t(330) = 2.091; p = 0.045). There were 30 (9.09%) cases of accessory spleens. CONCLUSIONS The arterial supply of the spleen is highly variable in its trajectory, terminal branches, and relation to other organs. The splenic artery tends to be sinuous or serpentine in zones when a large artery branches off (e.g., the dorsal pancreatic or greater pancreatic artery). Multiple short branches tend to stabilize the trajectory of the splenic artery. Inferior polar arteries and accessory spleens contribute to the length of the pancreas, most likely due to increased vascular supply to the tail of the gland.
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Affiliation(s)
- Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, 125284 Moscow, Russia
- Correspondence:
| | - Fariza Alieva
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, 125993 Moscow, Russia
| | - Karina Mulaeva
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, 125993 Moscow, Russia
| | - Natalia Mazuruc
- Department of Human Anatomy, State University of Medicine and Pharmacy “N. Testemitanu”, 2004 Chisinau, Moldova
| | - Olga Belic
- Department of Human Anatomy, State University of Medicine and Pharmacy “N. Testemitanu”, 2004 Chisinau, Moldova
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SALDARRIAGA BLADIMIR, LARROTTA OSCAR, BALLESTEROS LUIS. Características morfológicas das artérias gástricas esquerda, hepática comum e esplênica. Um estudo descritivo em espécimes cadavéricos humanos. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
RESUMO Objetivo: avaliar a morfologia dos ramos das artérias do tronco celíaco (CT), gástrica esquerda (LGA), hepática comum (HC) e esplênica (SA) em espécimes cadavéricos de uma amostra de uma população colombiana. Métodos: estudo transversal descritivo de 26 blocos do segmento superior abdominal de cadáveres humanos submetidos a necropsias forenses no Instituto de Medicina Legal de Bucaramanga, Colômbia. Os leitos vasculares do tronco celíaco foram, posteriormente, perfundidos com resina semissintética. Resultados: os diâmetros de LGA, CHA e SA foram 3,6±0,8mm, 5,2±1,2mm e 5,9±1,0mm, respectivamente. Estatisticamente, LGA e SA foram diferentes (p=<0,001). A SA seguiu uma trajetória linear em 8 (31%) amostras, levemente tortuosa em 4 (15%) e tortuosa em 14 (54%). O índice de tortuosidade foi de 1,25±0,18. Dos ramos do ACS, a artéria hepática própria (APH) tinha 4,8±1,2mm de diâmetro e 18,8±9,1mm de comprimento, enquanto a artéria gastroduodenal (GDdA) tinha 4,1±0,8mm. Em 2 casos (7,7%), uma artéria hepática acessória do GIG foi encontrada para fornecer perfusão ao lobo hepático esquerdo. Finalmente, em 2 casos (7,7%) a SA veio independentemente da aorta abdominal. Conclusão: a incidência observada de emergência dos ramos de TC do mesmo nível relatado na literatura é menor. A caracterização, juntamente com suas variantes, de LGA, CHA e SA deve ser considerada em procedimentos cirúrgicos no segmento abdominal superior, para evitar complicações iatrogênicas.
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Affiliation(s)
- BLADIMIR SALDARRIAGA
- Universidad Autónoma de Bucaramanga, Colombia; Universidad Industrial de Santander, Colombia
| | - OSCAR LARROTTA
- Universidad Autónoma de Bucaramanga, Colombia; Universidad Industrial de Santander, Colombia
| | - LUIS BALLESTEROS
- Universidad Autónoma de Bucaramanga, Colombia; Universidad Industrial de Santander, Colombia
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Wang X, He C, Li H, Huang J, Ge N, Yang Y. Endovascular treatment for delayed post-pancreaticoduodenectomy hemorrhage of unusual origin (splenic artery branch). J Vasc Surg Cases Innov Tech 2022; 8:865-871. [PMID: 36568956 PMCID: PMC9768243 DOI: 10.1016/j.jvscit.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022] Open
Abstract
Objective The objective of this study was to investigate the method, efficacy, and safety of endovascular treatment (EVT) of delayed splenic artery branch (SAB) hemorrhage after pancreaticoduodenectomy. Methods From March 2019 to January 2022, all patients underwent EVT of SAB for delayed post-pancreaticoduodenectomy hemorrhage were included. Demographic, laboratory, angiographic, and clinical follow-up data were collected and analyzed. Results A total of eight patients were enrolled. In two patients, celiac axis angiography alone failed, but selective splenic artery (SA) angiography demonstrated the SAB bleeding; SAB erosions in four patients with recurrent bleeding were successfully detected by a second angiography; four patients underwent balloon catheter placement at the SA for temporary hemostasis and to further confirm the SAB bleeding before the subsequent EVT. Superselective embolization was performed in only one patient (12.5%; 1/8); covered stent implantation at the SA was performed in two patients (25%; 2/8); Embolization of the SA was performed in the remaining five patients (62.5%; 5/8). The technical success rate, clinical success rate, and in-hospital mortality were 100.0%, 87.5%, and 25%, respectively. No severe complications related to EVT occurred. Conclusions EVT of SAB for delayed post-pancreaticoduodenectomy hemorrhage is effective and safe. An awareness of the SAB as a potential bleeding source, together with appropriate endovascular procedures including selective SA angiography, repeat angiography, balloon catheter placement at the SA, and applicable hemostasis protocol, could achieve a high success rate of managing SAB hemorrhage.
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Affiliation(s)
| | | | | | | | - Naijian Ge
- Correspondence: Naijian Ge, MD, Department of Interventional Radiology, 700 Moyu North Road, Shanghai, 200438, China
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Boscà-Ramon A, Ratnam L, Cavenagh T, Chun JY, Morgan R, Gonsalves M, Das R, Ameli-Renani S, Pavlidis V, Hawthorn B, Ntagiantas N, Mailli L. Impact of site of occlusion in proximal splenic artery embolisation for blunt splenic trauma. CVIR Endovasc 2022; 5:43. [PMID: 35986797 PMCID: PMC9391208 DOI: 10.1186/s42155-022-00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Proximal splenic artery embolisation (PSAE) can be performed in stable patients with Association for the Surgery of Trauma (AAST) grade III-V splenic injury. PSAE reduces splenic perfusion but maintains viability of the spleen and pancreas via the collateral circulation. The hypothesized ideal location is between the dorsal pancreatic artery (DPA) and great pancreatic artery (GPA). This study compares the outcomes resulting from PSAE embolisation in different locations along the splenic artery. Materials and methods Retrospective review was performed of PSAE for blunt splenic trauma (2015–2020). Embolisation locations were divided into: Type I, proximal to DPA; Type II, DPA-GPA; Type III, distal to GPA. Fifty-eight patients underwent 59 PSAE: Type I (7); Type II (27); Type III (25). Data was collected on technical and clinical success, post-embolisation pancreatitis and splenic perfusion. Statistical significance was assessed using a chi-squared test. Results Technical success was achieved in 100% of cases. Clinical success was 100% for Type I/II embolisation and 88% for Type III: one patient underwent reintervention and two had splenectomies for ongoing instability. Clinical success was significantly higher in Type II embolisation compared to Type III (p = 0.02). No episodes of pancreatitis occurred post-embolisation. Where post-procedural imaging was obtained, splenic perfusion remained 100% in Type I and II embolisation and 94% in Type III. Splenic perfusion was significantly higher in the theorized ideal Type II group compared to Type I and III combined (p = 0.01). Conclusion The results support the proposed optimal embolisation location as being between the DPA and GPA.
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Pateman Aciu S, Petrochko J, Bassik N, Fisher J. Spontaneous isolated celiac and splenic artery dissection with splenic infarction. Radiol Case Rep 2022; 17:2085-2091. [PMID: 35464790 PMCID: PMC9018800 DOI: 10.1016/j.radcr.2022.03.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
Spontaneous isolated celiac artery dissection is considered an uncommon clinical condition. Rarer still is spontaneous isolated celiac and splenic artery dissection, with a total of 42 reported cases. There is no known definitive cause of visceral artery dissections, but risk factors include male sex, age in 5th or 6th decade, hypertension, and connective tissue disorders. The presentation varies, diagnosis is principally radiographic, and the mainstay of treatment is anticoagulation or antiplatelet therapy. Splenic infarction is a common finding with splenic artery dissection, although the strength of this association has not previously been reported. Herein we present a case of spontaneous isolated celiac and splenic artery dissection with splenic infarction that was successfully managed with blood pressure control and antiplatelet therapy. We review previous literature, principles of diagnosis and management, and incidence and outcomes of splenic infarction as it related to splenic artery dissection.
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Zhang ZG, Li Z, Yang Y, Cheng B, Yan W, Yuan Y, Chen M, Hou W, Yang M, Chen Q. Hemodynamic effect through a novel endoscopic intervention in management of varices and hypersplenism (with video). Gastrointest Endosc 2022; 95:172-183.e2. [PMID: 34224735 DOI: 10.1016/j.gie.2021.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We previously reported a new and combined EUS-guided intervention in a patient with portal hypertension, consisting of obliteration of varices and partial splenic embolization (PSE). Performing PSE is known to diminish the increase in portal venous pressure after endoscopic intervention for varices. The aim of this study was to use multidetector CT portal venography to evaluate the anatomy of esophagogastric varices (EGV) and the impact on hemodynamics of portosystemic collaterals shortly after the concomitant procedures. METHODS From October 2019 to December 2020, 5 patients with cirrhosis and with clinically significant portal hypertension who had variceal bleeding history and hypersplenism were treated with combined endoscopic obliteration for varices and EUS-guided PSE. Multidetector CT portal venography was applied to assess the anatomic drainage patterns of the EGV, diameters of feeders and drainage vessels, and splenic embolization rate. RESULTS Within 5 days after concomitant endoscopic interventions, we observed decreased mean diameters of the left gastric vein, short gastric vein, and azygos vein as .3 mm, 1.0 mm, and 5.2 mm compared with 3.11 mm, 7.1 mm, and 5.4 mm before the procedures, respectively. Patients showed increased white blood cells (mean count of 2.7 × 109/L before vs 5.8 × 109/L after) and platelets (mean count of 52.8 × 109/L before vs 95.8 × 109/L after). The mean splenic embolization rate was 64.5% (range, 28.8%-84.6%). CONCLUSIONS Our experience may illustrate an alternative technique of combining EUS-guided PSE with endoscopic therapy of varices to treat patients with portal hypertension.
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Affiliation(s)
- Zhen-Gang Zhang
- The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Zhen Li
- Department of Radiology at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Yang Yang
- Department of Radiology at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Bin Cheng
- The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Wei Yan
- The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Yue Yuan
- The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China; Hubei Key Laboratory of Hepato-Pancreato-Biliary Disease, at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST) Wuhan, China
| | - Min Chen
- The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China; Hubei Key Laboratory of Hepato-Pancreato-Biliary Disease, at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST) Wuhan, China
| | - Wei Hou
- The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Min Yang
- The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Qian Chen
- The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China; Hubei Key Laboratory of Hepato-Pancreato-Biliary Disease, at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST) Wuhan, China
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Nishino H, Zimmitti G, Ohtsuka T, Abu Hilal M, Goh BKP, Kooby DA, Nakamura Y, Shrikhande SV, Yoon YS, Ban D, Nagakawa Y, Nakata K, Endo I, Tsuchida A, Nakamura M. Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:136-150. [PMID: 33527704 DOI: 10.1002/jhbp.903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/23/2020] [Accepted: 01/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimally invasive distal pancreatectomy (MIDP) is increasingly performed worldwide; however, the surgical anatomy required to safely perform MIDP has not yet been fully considered. This review evaluated the literature concerning peripancreatic vascular anatomy, which is considered important to conduct safe MIDP. METHODS A database search of PubMed and Ichushi (Japanese) was conducted. Qualified studies investigating the anatomical variations of peripancreatic vessels related to MIDP were evaluated using SIGN methodology. RESULTS Of 701 articles yielded by our search strategy, 76 articles were assessed in this systematic review. The important vascular anatomy required to recognize MIDP included the pancreatic parenchymal coverage on the root and the running course of the splenic artery, branching patterns of the splenic artery, confluence positions of the left gastric vein and the inferior mesenteric vein, forms of pancreatic veins including the centro-inferior pancreatic vein, characteristics of the left renal vein, and collateral routes perfusing the spleen following Warshaw's technique. Very few articles evaluating the relationship between the anatomical variations and surgical outcomes of MIDP were found. CONCLUSIONS The precise knowledge of peripancreatic vessels is important to adequately complete MIDP. More detailed anatomic analyses and descriptions will benefit surgeons and their patients who are facing these operations.
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Affiliation(s)
- Hitoe Nishino
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Giuseppe Zimmitti
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Takao Ohtsuka
- First Department of Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Mohammed Abu Hilal
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore City, Singapore
| | - David A Kooby
- Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | | | - Shailesh V Shrikhande
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University, Seoul, Korea
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Manatakis DK, Piagkou M, Loukas M, Tsiaoussis J, Delis SG, Antonopoulos I, Chytas D, Natsis K. A systematic review of splenic artery variants based on cadaveric studies. Surg Radiol Anat 2021; 43:1337-1347. [PMID: 33481130 DOI: 10.1007/s00276-020-02675-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The splenic artery (SA) is the largest and most tortuous branch of the celiac trunk with a wide spectrum of variants, particularly in its terminal branches. METHODS The current study presents a systematic review of the English literature on the SA variations, with emphasis on its terminal branching patterns. RESULTS Thirty cadaveric studies (3132 specimens) were included in the analysis. The SA originated from the celiac trunk in 97.2%, from the abdominal aorta in 2.1% and from the superior mesenteric or the common hepatic artery in 0.7% of cases. A suprapancreatic course was observed in 77.4%, retropancreatic course in 17.8%, anteropancreatic course in 3.4% and intrapancreatic course in 1.3%. In the majority of cases, the SA bifurcated into superior and inferior lobar arteries (83.4%), with trifurcation and quadrifurcation in 11.3% and 2.7%, respectively. Five or more lobar branches (1.4%) and a single lobar artery (1.2%) were rarely identified. The distributed branching pattern was found in 72.7%, whereas the magistral pattern in 26.9%. The inferior and superior polar arteries (IPA and SPA) were found in 47.7% and 41.7% of cases, respectively, while polar artery agenesis was recorded in 28.2%. The SPA usually originated from the SA main trunk (53.6%) or from the superior lobar artery (33.1%). The IPA emanated mainly from the left gastroepiploic artery (53%), from the SA (23.5%) or the inferior lobar artery (21.9%). Intersegmental anastomoses between adjacent arterial segments were identified in 14.2%. CONCLUSION Knowledge of the SA aberrations is important for surgeons and radiologists involved in angiographic interventions.
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Affiliation(s)
- Dimitrios K Manatakis
- Department of Surgery, Athens Naval and Veterans Hospital, 70 Deinokratous Str., 11521, Athens, Greece.
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - John Tsiaoussis
- Laboratory of Anatomy, School of Medicine, University of Crete, Heraklion, Greece
| | - Spiridon G Delis
- Department of Surgery, Konstantopouleio General Hospital, Nea Ionia, Athens, Greece
| | - Ioannis Antonopoulos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloníki, Greece
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14
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Morphometric analysis of the splenic artery using contrast-enhanced computed tomography (CT). Surg Radiol Anat 2020; 43:377-384. [PMID: 33104863 PMCID: PMC7897610 DOI: 10.1007/s00276-020-02598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/10/2020] [Indexed: 10/30/2022]
Abstract
PURPOSE To evaluate the morphology and course of the splenic artery, which might impact the surgical implantation of systems that stimulate the nerves surrounding the splenic artery. Experimental studies indicate that these nerves play an important part in immune modulation, and might be a potential target in the treatment of autoimmune diseases. METHODS This retrospective cohort study made use of contrast-enhanced CT images from 40 male and 40 female patients (age 30-69) that underwent a CT examination of the aorta, kidneys or pancreas. Anatomic features were described including total splenic artery length, calibers, tortuosity, the presence of arterial loops and the branching pattern of the splenic artery. RESULTS No age-gender-related differences could be found related to tortuosity or branching pattern. The length of splenic artery in contact with pancreatic tissue decreased with increasing age, but was not different between genders. Artery diameters were wider in male compared to female subjects. Loops of variable directions, that represent a part of the artery that curls out of the pancreatic tissue, were identified in each age-gender category and were present in nearly all subjects (86%). CONCLUSION This study suggests that although some anatomic features of the splenic artery are subject to factors as age and gender, the tortuosity of the splenic artery is not age dependent. Most subjects had one or multiple loops, which can serve as a target for neuromodulatory devices. Future studies should investigate whether splenic nerve stimulation is safe and feasible.
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15
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Cleypool CGJ, Lotgerink Bruinenberg D, Roeling T, Irwin E, Bleys RLAW. Splenic artery loops: Potential splenic plexus stimulation sites for neuroimmunomodulatory-based anti-inflammatory therapy? Clin Anat 2020; 34:371-380. [PMID: 32583891 PMCID: PMC7984037 DOI: 10.1002/ca.23643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The splenic plexus might represent a novel neuroimmunomodulatory therapeutic target as electrical stimulation of this tissue has been shown to have beneficial anti-inflammatory effects. Tortuous splenic artery segments (splenic artery loops), including their surrounding nerve plexus, have been evaluated as potential stimulation sites in humans. At present, however, our understanding of these loops and their surrounding nerve plexus is incomplete. This study aims to characterize the dimensions of these loops and their surrounding nerve tissue. MATERIALS AND METHODS Six formaldehyde fixed human cadavers were dissected and qualitative and quantitative macro- and microscopic data on splenic artery loops and their surrounding nerve plexus were collected. RESULTS One or multiple loops were observed in 83% of the studied specimens. These loops, including their surrounding nerve plexus could be easily dissected free circumferentially thereby providing sufficient space for further surgical intervention. The splenic plexus surrounding the loops contained a significant amount of nerves that contained predominantly sympathetic fibers. CONCLUSION The results of this study support that splenic artery loops could represent suitable electrical splenic plexus stimulation sites in humans. Dimensions with respect to loop height and width, provide sufficient space for introduction of surgical instruments and electrode implantation, and, the dissected neurovascular bundles contain a substantial amount of sympathetic nerve tissue. This knowledge may contribute to further development of surgical techniques and neuroelectrode interface design.
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Affiliation(s)
- Cindy G J Cleypool
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Dyonne Lotgerink Bruinenberg
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Tom Roeling
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Eric Irwin
- Galvani Bioelectronics, Stevenage, UK.,Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Ronald L A W Bleys
- Department of Anatomy, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, The Netherlands
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Başara Akın I, Altay C, Bengi G, Tarhan O, Seçil M. Extremely rare cause of extrinsic compression of the stomach during esophagogastroduodenoscopy. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:1064-1065. [PMID: 31854313 DOI: 10.5152/tjg.2019.19046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Işıl Başara Akın
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Göksel Bengi
- Division of Gastroenterology, Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Oktay Tarhan
- Division of Oncology, Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mustafa Seçil
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
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17
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Hemamalini. Variations in the branching pattern of the celiac trunk and its clinical significance. Anat Cell Biol 2018; 51:143-149. [PMID: 30310705 PMCID: PMC6172596 DOI: 10.5115/acb.2018.51.3.143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 12/15/2022] Open
Abstract
Celiac trunk is the artery of foregut, arising from the abdominal aorta at the level of T12/L1 vertebral body. It extends approximately 1.5 to 2 cm horizontally forwards before dividing into three branches: left gastric, common hepatic, and splenic arteries. Out of the three ventral branches of abdominal aorta, celiac trunk is more prone to have variations. During routine dissection of abdomen for undergraduate students we found some rare variations in the branching pattern of the celiac trunk. Absence of celiac trunk with hepatomesenteric trunk, quadrifurcation with dorsal pancreatic artery arising from it, quadrifurcation with middle colic artery arising from it, left inferior phrenic artery arising from celiac trunk, highly tortuous splenic artery supplying distal 1/3rd of transverse colon and hepatosplenic trunk. Knowledge of such variations is essential for liver and pancreas transplantations, pancreaticoduodenectomy, radiological abdominal interventions, laproscopic surgeries, and in trauma of the abdomen.
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Affiliation(s)
- Hemamalini
- Department of Anatomy, Jagadguru Sri Shivarathreeshwara Medical College, Mysore, India
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18
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Grippi FJ, Yu H. Acute upper gastrointestinal hemorrhage from a pseudoaneurysm of an unusual superior polar artery of the spleen. Radiol Case Rep 2018; 13:797-800. [PMID: 30002784 PMCID: PMC6041380 DOI: 10.1016/j.radcr.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/01/2018] [Accepted: 05/05/2018] [Indexed: 12/20/2022] Open
Abstract
Splenic artery (SA) aneurysm and pseudoaneurysm are rare pathologies and uncommon causes of massive upper gastrointestinal (GI) bleeding. They represent the third most common intra-abdominal aneurysms. Variations in the origin of SA are relatively common and asymptomatic. However, the presence of an accessory SA that is symptomatic is quite atypical. In this report, we describe the case of a 73-year-old female who presented with massive upper GI bleeding caused by a pseudoaneurysm of a superior polar artery with an unusual anatomic origin. The patient was successfully treated endovascularly with transarterial coil embolization. Early diagnosis and interventional management are crucial for patient's survival; hence, it must be kept in mind as possible etiology of life-threatening GI bleeding to reduce morbidity and mortality.
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Affiliation(s)
- Francisco Javier Grippi
- Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine at Chapel Hill, 2006 Old Clinic CB# 7510, Chapel Hill, NC 27599, USA
| | - Hyeon Yu
- Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine at Chapel Hill, 2006 Old Clinic CB# 7510, Chapel Hill, NC 27599, USA
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19
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Lymph nodes around the posterior gastric artery: their existence, frequency, and clinical implications. Surg Today 2018; 48:916-920. [PMID: 29869067 DOI: 10.1007/s00595-018-1677-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/27/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The lymphatic flow along the posterior gastric artery (PGA) is considered of possible clinical importance in terms of lymphatic metastasis; however, little is known about the lymph nodes (LNs) around this artery. The purpose of this study was to establish if LNs exist around the PGA and to evaluate their clinical implications. METHODS We examined the tissues surrounding the PGA from 21 cadavers to search for LNs. We also investigated the patterns of lymphatic metastases in patients who underwent surgery for gastric neoplasms at our institute to detect their presence along the PGA. RESULTS The PGA was identified in 11 cadavers, and LNs around the PGA were detected microscopically in 2 of these. Lymphatic metastasis directly to the LNs at the splenic artery without any metastases was regarded as skip metastasis along the PGA. Skip metastasis was found in two of ten patients who underwent surgery for remnant gastric cancer. CONCLUSIONS The existence of LNs around the PGA was confirmed, and based on our findings, lymphatic metastasis through the PGA is possible in patients with remnant gastric cancer.
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20
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Nayak SB, Shetty P, R D, Sirasanagandla SR, Shetty SD. A lobulated spleen with multiple fissures and hila. J Clin Diagn Res 2014; 8:AD01-2. [PMID: 25386417 DOI: 10.7860/jcdr/2014/8996.4774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/28/2014] [Indexed: 11/24/2022]
Abstract
During our dissection classes, we observed a lobulated spleen with multiple hila and fissures. The spleen presented 4 hila and 5 deep fissures. The hila were seen on the visceral surface. The fissures extended into the substance of the spleen from superior border, inferior border and the visceral surface. Because of these fissures, the spleen appeared to be lobulated, having seven distinct lobes/lobules. Knowledge of this variation could be useful to the radiologists and surgeons.
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Affiliation(s)
- Satheesha B Nayak
- Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) , Manipal University, Karnataka, India
| | - Prakashchandra Shetty
- Associate Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) , Manipal University, Karnataka, India
| | - Deepthinath R
- Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) , Manipal University, Karnataka, India
| | - Srinivasa Rao Sirasanagandla
- Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) , Manipal University, Karnataka, India
| | - Surekha D Shetty
- Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) , Manipal University, Karnataka, India
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Coils versus Gelatin Particles with or without Intraarterial Antibiotics for Partial Splenic Embolization: A Comparative Evaluation. J Vasc Interv Radiol 2014; 25:852-8. [DOI: 10.1016/j.jvir.2013.12.563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/21/2013] [Accepted: 12/21/2013] [Indexed: 02/05/2023] Open
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Proximal splenic arterial embolization may also result in pancreatic necrosis. ACTA ACUST UNITED AC 2011; 71:268-9. [PMID: 21818047 DOI: 10.1097/ta.0b013e318222327f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Chemoembolization Via Branches from the Splenic Artery in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2011; 35:90-6. [DOI: 10.1007/s00270-011-0109-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/12/2011] [Indexed: 11/25/2022]
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24
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Golder WA. [Tortuosity and calcification of the splenic artery. More than an additional finding]. Radiologe 2009; 48:1066-7, 1069-74. [PMID: 18317717 DOI: 10.1007/s00117-008-1631-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Tortuosity of the splenic artery and calcification of the vessel wall are typical additional findings on plain abdominal x-ray. The combination of both anomalies is common in elderly persons presenting without symptoms of splenic ischemia. Its pathogenesis is thought to be multifactorial. In infancy and childhood, the splenic artery is stretched in its entire course. A growing difference between the length of the vessel and the distance between its origin and the splenic hilum gives rise to tortuosity. The artery's proximal segment is involved more frequently and more severely than the distal one. The tortuous route of the vessel is accentuated by the direction of its major branches, which is roughly perpendicular to the main trajectory. Neither tortuosity nor calcification should be taken to be risk factors for the comparatively common splenic artery aneurysm. Calcific deposits are not confined to the media but are also detected in the intima of the vascular wall. Critical narrowings of the lumen arising on the calcium deposits are not observed. Calcifying atherosclerosis of the splenic artery is comparable to medial sclerosis of the peripheral arteries frequently noticed in diabetics and dialysis patients. Only the less important calcification of the intima may be attributed to mechanisms of the hydrohemodynamic theory of atherosclerosis. The spleen's blood storage capacity may contribute to the characteristic age-dependent alterations of the shape and course of the splenic artery.
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Affiliation(s)
- W A Golder
- SELARL Association d'Imagerie Médicale, 65, rue Raymond-Poincaré, 100000 Troyes, France.
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25
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Hamers RL, Van Den Berg FG, Groeneveld ABJ. Acute necrotizing pancreatitis following inadvertent extensive splenic artery embolisation for trauma. Br J Radiol 2009; 82:e11-4. [PMID: 19095808 DOI: 10.1259/bjr/92246530] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a case of splenic artery embolisation (SAE) after traumatic splenic injury that was complicated by acute necrotizing pancreatitis, caused by inadvertently extensive embolisation of the splenic artery. Although SAE is increasingly used for splenic preservation in trauma, there is insufficient knowledge on its efficacy and pitfalls. This report aims to draw attention to a rare but potentially serious complication of SAE.
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Affiliation(s)
- R L Hamers
- Department of Intensive Care, VU University Medical Center (VUMC), Amsterdam, The Netherlands
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26
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Vanhoenacker FM, Op de Beeck B, De Schepper AM, Salgado R, Snoeckx A, Parizel PM. Vascular disease of the spleen. Semin Ultrasound CT MR 2007; 28:35-51. [PMID: 17366707 DOI: 10.1053/j.sult.2006.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A wide range of vascular disorders can affect the spleen. Although clinical presentation is often nonspecific, early diagnosis and treatment are mandatory in most conditions. Noninvasive imaging techniques are well suited to meet these objectives. Familiarity with normal macroscopic and microscopic vascular anatomy is a prerequisite to understand the pathophysiology of vascular disorders of the spleen. This article deals with diseases of the splenic vasculature (aneurysms, arteriovenous fistula, splenic vein thrombosis, collateral circulation in portal hypertension) as well as vascular disorders affecting the splenic parenchyma (splenic infarct, Gamna-Gandy bodies). Primary vascular tumors and tumor-like conditions of the spleen will be discussed very briefly.
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Affiliation(s)
- F M Vanhoenacker
- Department of Radiology, University Hospital Antwerp, Wilrijkstraat, 10, B-2650 Edegem, Belgium.
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Loukas M, Wartmann CT, Louis RG, Tubbs RS, Ona M, Curry B, Jordan R, Colborn GL. The clinical anatomy of the posterior gastric artery revisited. Surg Radiol Anat 2007; 29:361-6. [PMID: 17563830 DOI: 10.1007/s00276-007-0222-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 05/24/2007] [Indexed: 11/29/2022]
Abstract
A consensus concerning the incidence, course and distribution of the posterior gastric artery (PGA) has yet to be reached. Recent literature has explored and subsequently demonstrated the importance of the identification of this vessel in surgical procedures such as subtotal gastrectomy, splenectomy and pancreatic transplantation. The gross anatomy of the PGA was examined in 120 adult human cadavers. The PGA was identified as that artery which provided the predominant arterial supply to the posterior wall of the superior portion of the gastric body near the cardiac region and fundus. A PGA was identified in 81.6% of specimens. The most common origin of the PGA was from the left gastric artery (type I), occurring in 41.8% of specimens. In decreasing order of prevalence, were origins from the splenic artery (Type II), occurring in 25.5%; from both the left gastric and splenic arteries as double PGAs (Type III) in 22.4%; and from the celiac trunk (Type IV) occurring in 10.2%. The importance of accurate delineation of the PGA is crucial for pancreatic transplantation and gastric tumor removal. In addition, knowledge of variations in this vessel's origin could prove useful in transcatheter arterial embolization for the treatment of chronic bleeding from gastric ulcers. Furthermore, ligation of this vessel during partial gastrectomy, pancreaticoduodenectomy, and parietal cell vagotomy may result in gastric wall necrosis and gastric stump leak.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, St George's University, School of Medicine, Grenada, West Indies.
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