Differential growth patterns of the abdominal aorta and vertebrae during childhood

Relationship of the lumbar Lordotic angle to the abdominal aortic deviation and abdominal aortic diameter

In anterior approaches during lumbar disc surgery, knowledge of abdominal aorta (AA) deviation and the lumbar lordotic angle (LLA) may provide surgeons with greater foresight in surgical planning and assist in preventing complications. This study aimed to determine the effect of AA deviation on AA morphometry and the effect of the LLA on both AA deviation and AA morphometry. A total of 499 individuals (259 females, 240 males) with a mean age of 50.60 ± 17.96 years were included in this retrospective study. On 2D computed tomography angiography (CTA) images, LLA and AA diameters were measured at 3 different vertebral levels. The vertebral levels of AA deviation were determined on 3D images. While the AA diameter values were greater in individuals with AA deviation (p < 0.001), it was observed that the level of deviation did not affect AA morphometry (p > 0.05). AA deviation was most frequently observed at the L2-L3 level in females, while the mid-L3 level was the most common site of AA deviation in males (p = 0.019). LLA was significantly greater in females compared to males (p = 0.015), but it was not affected by the presence of AA deviation (p = 0.373). The data from this study could provide guidance for endovascular interventions and anterior lumbosacral surgical procedures and could make a valuable contribution to the existing literature.

Variations in origin level of superior mesenteric artery, inferior mesenteric artery, and coeliac trunk in Indian population

OBJECTIVE

The abdominal aorta is a continuation of the thoracic aorta and gives off the coeliac trunk, superior mesenteric artery, and inferior mesenteric artery. The focus of our study is to evaluate variations in the origin level in the coeliac trunk, superior mesenteric artery, inferior mesenteric artery, and aortic bifurcation in the Indian population and compare with various demographics.

METHODS

The study was retrospective and the local ethics committee approval was taken before starting it. Three hundred patients who were more than 18 years of age and required contrast-enhanced CT studies were included in this. The vertebral origin level of the arteries from the abdominal aorta and aortic bifurcation level was analysed.

RESULTS

The most common origin level of the coeliac trunk for both males and females was T12-L1 disc level. The most common origin level of the superior mesenteric artery was L1 upper level. The most common origin level of the inferior mesenteric artery was L3 upper level. The most common level of aortic bifurcation was L4 middle level. There was no statistical difference between the origin of any arteries in males and females in the Indian population.

CONCLUSION

As per our study of the Indian population and the published literature, it is realized that there are significant variations in the origins of the coeliac trunk, superior mesenteric artery, inferior mesenteric artery, and abdominal aorta bifurcation in different populations.

ADVANCES IN KNOWLEDGE

This study elaborates on potential anatomical variations in the Indian population, particularly the Mumbai city population. Also, our study compares it to different countries' data and their results in variations found in abdominal aorta branches.

Evaluation of the celiac trunk and its branching pattern by magnetic resonance angiography

OBJECTIVE

The study aimed to examine the celiac trunk (CT) in detail by magnetic resonance angiography, to determine the locations, positions and variations of the CT, to provide detailed information for surgeons and interventional radiologists, and to reduce the time spent in the catheter angiography.

MATERIAL AND METHODS

MR angiography images of 185 patients with abdominal imaging in PACS (Picture Archiving Communication Systems) were retrospectively analyzed. The level of origin of CT, according to the vertebral column, angle of origin, distance between CT and branches of the abdominal aorta (AA), and the branching pattern of CT were evaluated. Parameters were evaluated according to gender and age.

RESULTS

The most common origin site for CT, according to the vertebral column, was found to be at T12-L1 in both genders. There was a low, positive correlation between age and CT-Sagittal angle (SA) in the whole study group (p<0.05). The most common CT branching pattern was the hepatogastrosplenic trunk in both genders, according to Adachi and Uflkacker's classification. The distance between CT and the inferior mesenteric artery (IMA) and CT and the aortic bifurcation (AB) of males was greater than in females, and the differences were statistically significant (p<0.05).

CONCLUSION

Knowledge of the locations, positions, and variations of CT is essential in the diagnosis, differential diagnosis and decision-making mechanisms regarding the type of intervention to be performed for this vessel and related structures. In addition, the fact that data on these vessels can be obtained by MR angiography due to the improved image quality will prevent patients and physicians from the problems caused by the ionizing radiation of computed tomography. The data presented will constitute a basis for detailed and individualized interpretation and evaluation of each patient, as they provide important details about the configuration of the CT concerning gender and age using MRA.

Superior mesenteric artery revisited using magnetic resonance angiography

PURPOSE

We aimed to examine the superior mesenteric artery in detail by magnetic resonance angiography to provide an alternative to other imaging methods, to reduce the exposure time of patients and physicians to X-rays and the time spent in catheter angiography, to determine the variations, positions, and locations of the celiac trunk, and to provide detailed information for surgeons and interventional radiologists using this method.

METHODS

The procedures were approved by the Kocaeli University Medical School Non-Interventional Clinical Research Ethics Committee (10.04.2023, approval number: 2021/51). MR angiography images of 185 patients with abdominal imaging in PACS (Picture Archiving Communication Systems) were retrospectively registered. The level of origin of the superior mesenteric artery according to the vertebral column, angle of origin, distance between the superior mesenteric artery and branches of the abdominal aorta, and branching pattern of the superior mesenteric artery were evaluated. Parameters were evaluated according to gender and age using SPSS version 25.

RESULTS

The distance between superior mesenteric artery-inferior mesenteric artery and superior mesenteric artery-aortic bifurcation in males was higher than in females, and the difference was statistically significant. In females and the whole study group, a low, positive and significant relationship was found between age and superior mesenteric artery-sagittal angle. The most common origin site for the superior mesenteric artery, according to the vertebral column was found to be at L1 middle for males and L1 upper for females. The most common superior mesenteric artery branching pattern was classical type in both genders.

CONCLUSION

Individual evaluation of the superior mesenteric artery could reduce the risks during surgical interventions, considering the relationship of the superior mesenteric artery, especially with distally located vessels, and the gender differences for the angle of origin. Furthermore, considering that interventional radiologists choose the catheter according to the angle of origin of the artery during catheter angiography procedures, individual evaluation of patients taking into account gender and age is of utmost importance.

A reappraisal of pediatric abdominal surface anatomy

Surface anatomy is fundamental to clinical and surgical practices. As the surface anatomy varies with age, the purpose of this study is to provide age-standardized surface markings for the abdomen in children. A total of 155 abdominal computed tomography scans of healthy children aged 0-18 years were categorized into six groups, and the surface anatomy of the major vascular structures, solid viscera, and anatomical planes in the abdomen was analyzed. The vertebral levels of the celiac trunk, superior mesenteric artery, and hepatic portal vein formation were higher in the youngest age group, whereas the levels of the inferior mesenteric artery, formation of the inferior vena cava, and renal arteries did not differ with age. The right kidney lay between T12 and L3 and the left at T11-L3; however, both kidneys were in lower positions in younger children. The spleen was most commonly located between the 8th and 11th ribs except in toddlers. In all age groups, the hepatic portal vein formation was within the transpyloric plane and the aortic bifurcation was above the supracristal plane. In vivo reassessment of the surface anatomy enables the substantial variability of surface landmarks to be highlighted. This study demonstrates that taking account of age-related variations will increase the accuracy and therefore the clinical relevance of surface anatomy.

Aortic Origins of the Celiac Trunk and Superior Mesenteric Artery

(1) Background. The vertebral level of origin (VLO) of the celiac trunk (CT) and superior mesenteric artery (SMA) has been scarcely investigated. (2) Method. This study used 107 computed tomography angiograms and an eleven type grading system to classify the VLO of the CT and SMA. Each of the T12–L2 vertebra were divided in three horizontal levels. The intervertebral discs were considered distinct levels. (3) Results. The VLO of the CT ranged from the upper third of the T12 vertebra to the lower third of the L1 vertebra. The VLO of the SMA ranged from the lower third of the T12 vertebra to the upper third of the L2 vertebra. There was a highly significant association between the VLO of the CT and SMA (Chi2 = 201, p < 0.001), usually respecting a “plus two” rule. The mean CT–SMA distance was 1.82 +/− 0.66 cm in males and 1.55 +/− 0.411 cm in females, the difference being statistically significant. The mean CT–SMA distance tended to decrease with increasing CT–SMA types, the differences being statistically significant. (4) Conclusions. These characteristics of CT and SMA origins and their relations should be known by surgeons, as they could impact operative management and should be evaluated on a case-by-case basis.