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Yaman V, Ardali Duzgun S, Hazirolan T. A blind-ending branch of celiac artery: a persistent embryologic vascular remnant? Indian J Thorac Cardiovasc Surg 2024; 40:96-98. [PMID: 38125318 PMCID: PMC10728382 DOI: 10.1007/s12055-023-01614-4] [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: 07/26/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023] Open
Abstract
The celiac artery classically divides into three major branches, but it may have variations in branching pattern. Here we report a case of celiac artery having a blind-ending branch in a 54-year-old man who underwent computed tomography of the abdomen before the kidney transplantation surgery. Preprocedural assessment of celiac artery variations is critical for surgical and angiographic procedures involving the upper abdomen.
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Affiliation(s)
- Vedat Yaman
- Department of Radiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Selin Ardali Duzgun
- Department of Radiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Tuncay Hazirolan
- Department of Radiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
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2
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Desai G, Wagle PK. First jejunal vein, jejunal trunk, and pancreatico-duodenectomy: resolving the literature conundrum. Langenbecks Arch Surg 2023; 408:104. [PMID: 36826524 DOI: 10.1007/s00423-023-02849-w] [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: 05/04/2022] [Accepted: 02/18/2023] [Indexed: 02/25/2023]
Abstract
A detailed knowledge of the surgical anatomy of tributaries of the superior mesenteric vein, especially proximal jejunal venous anatomy (first jejunal vein and jejunal trunk), is a key prerequisite for performing a safe pancreatico-duodenectomy. However, the available literature on the anatomical course and surgical relevance of these vessels is scarce, the nomenclature across the articles is heterogeneous, and the resulting evidence is confusing to interpret. Standardized terminology and an in-depth review of these vessels with regard to their course, termination, vascular relations, and variations will help the surgeons in planning and performing this complex surgery safely, especially when a venous resection and reconstruction is planned in cases of borderline resectable pancreatic cancer. A uniform nomenclature and a unifying classification are proposed in this review for these two tributaries to help resolve the literature conundrum. This standardized terminology and anatomical description will assist the radiologists in reporting pancreatic protocol-computed tomography scans and surgeons in selecting the appropriate steps for the different anatomical orientations of these tributaries for the performance of safe pancreatic surgery. This will also help future researchers communicate in well-defined terms in reference to these tributaries so as to avoid confusion in future studies.
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Affiliation(s)
- Gunjan Desai
- Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, 400050, India.
| | - Prasad K Wagle
- Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, 400050, India
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3
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Kachlík D, Naňka O, Blanková A, Turyna R, Csöbönyeiová M, Varga I. A unique anatomical variation of the vascular supply of the ovary, uterine tube, and uterus from the greater omentum – an anatomical case study. Physiol Res 2022. [DOI: 10.33549/physiolres.935034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
It is well known that the blood supply of the greater omentum and female internal genital organs are not physiologically connected. There is also no mention of such anatomical variation in anatomical, radiological, or surgical textbooks. Here we present a very rare case report of atypical double arterial anastomosis (the first and second variant artery) between the right limb of the omental arcade of Barkow, uterus, and right ovary, which was found during a routine student anatomical dissection course. It is very challenging to find a proper explanation for the presence of the described anatomical variation; however, we hypothesized that it is based on their common embryonic origin - the mesentery. The first and second variant arteries could be remnants of transient anastomoses or collateral circulation, which were present during embryonic development and persisted until adulthood. Moreover, during our literature review, we noticed that the general description of omental blood supply and its possible variations is relatively poor; therefore, we emphasize the need for more precise knowledge regarding these anatomical parts, which could help surgeons who are performing abdominal or pelvic surgeries in preventing avoidable bleeding.
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Affiliation(s)
- D Kachlík
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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4
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Mann MR, Kawzowicz M, Komosa AJ, Sherer YM, Łazarz DP, Loukas M, Tubbs RS, Pasternak A. The marginal artery of Drummond revisited: A systematic review. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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5
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Kuzu MA, Güner MA, Kocaay AF, İsmail E, Arslan MN, Tekdemir İ, Açar Hİ. Redefining the collateral system between the superior mesenteric artery and inferior mesenteric artery: a novel classification. Colorectal Dis 2021; 23:1317-1325. [PMID: 33382167 DOI: 10.1111/codi.15510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 12/28/2022]
Abstract
AIM The aim of this study was to evaluate the arterial collateral vasculature between the superior mesenteric artery and the inferior mesenteric artery (IMA) from a surgical perspective. METHOD A total of 107 fresh adult cadavers (94 male) were studied with emphasis on the vascular anatomy of the left colon. Dissections were carried out mimicking the anterior resection technique. The vasculature of the left mesocolon and the collaterals between the superior mesenteric artery and the IMA with respect to their relationship to the inferior mesenteric vein (IMV) were assessed and classified. Collaterals were classified into three different groups: marginal anastomoses (via the marginal = pericolic artery), intermediate mesocolic anastomoses (parallel to the marginal artery but neither adjacent to the IMV nor close to the duodenum) and central mesocolic anastomoses (next to the IMV at the level of the duodenojejunal junction and the lower border of the pancreas). RESULTS All patients had a marginal anastomosis. However, the marginal anastomosis, as the only anastomosis between the superior and inferior mesenteric arteries at the splenic flexure, was observed in 41 cases (38%). In addition to the marginal artery, intermediate mesocolic anastomoses were found in 49 (46%) and a central mesocolic anastomosis was observed in 17 (16%) of the 107 cases in the splenic flexure mesocolon. It is in this latter variant that collateral vessels can be compromised during ligation/transection of the IMV. CONCLUSION This new classification can contribute to a precise mesocolic dissection technique and splenic flexure mobilization and help prevent ischaemic damage to the descending colon.
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Affiliation(s)
- Mehmet Ayhan Kuzu
- General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mehmet Ali Güner
- Department of Anatomy, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Akın Fırat Kocaay
- General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Erkin İsmail
- General Surgery, Acibadem Hospital, Ankara, Turkey
| | | | - İbrahim Tekdemir
- Department of Anatomy, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Halil İbrahim Açar
- Department of Anatomy, Faculty of Medicine, Ankara University, Ankara, Turkey
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6
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Ho A, Slagle J, Vellody R, Meagher E, Sharma K, Yadav B. Aortic quadfurcation with persistent left sciatic artery: an extremely rare anatomic variant in a 3-year-old boy. J Vasc Surg Cases Innov Tech 2021; 7:262-265. [PMID: 33997568 PMCID: PMC8095045 DOI: 10.1016/j.jvscit.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/23/2020] [Indexed: 10/27/2022] Open
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7
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Revzin MV, Pellerito JS, Nezami N, Moshiri M. The radiologist's guide to duplex ultrasound assessment of chronic mesenteric ischemia. Abdom Radiol (NY) 2020; 45:2960-2979. [PMID: 31410506 DOI: 10.1007/s00261-019-02165-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This article reviews the relevant anatomy and physiology of the mesenteric vasculature, familiarizes the radiologist with the accepted diagnostic criteria for mesenteric artery stenosis and its role in the diagnosis of chronic mesenteric ischemia, describes Doppler imaging techniques, and provides protocols for the assessment and surveillance of the mesenteric vasculature before and after revascularization. It also discusses expected changes following revascularization and reviews common post-procedural complications. RESULTS Duplex sonography plays an important role in the diagnosis and management of chronic mesenteric ischemia (CMI). Establishing a successful diagnosis is dependent upon knowledge of mesenteric arterial anatomy and physiology as well as sufficient expertise in image optimization and scanning techniques. Although there has been a trend toward utilization of other noninvasive [computed tomographic angiography (CTA), magnetic resonance angiography (MRA), and invasive (digital subtraction angiography (DSA)] imaging modalities for assessment of the mesenteric vasculature, a new era of "imaging wisely" raises legitimate concerns about the effects of ionizing radiation as well as potential effects of CT and MR contrast agents. These concerns are obviated by the use of ultrasound, and recently developed techniques, such as contrast-enhanced ultrasound and vascular applications focused on the evaluation of slow flow, have revealed the vast potential of vascular ultrasound in the evaluation of chronic mesenteric ischemia. CONCLUSION Duplex sonography is a cost-effective and powerful tool that can be utilized for the accurate assessment of mesenteric vascular pathology, specifically mesenteric arterial stenosis, and for the evaluation of mesenteric arterial system post revascularization.
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Landen C, Dreu M, Weiglein A. The sigmoidea ima artery: A player in colonic ischemia? Clin Anat 2020; 33:850-859. [PMID: 31883167 PMCID: PMC7496534 DOI: 10.1002/ca.23552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/23/2019] [Accepted: 12/17/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The sigmoidea ima artery is defined as the lowest sigmoid artery, which forms the distal end of the marginal artery by linking with the superior rectal artery. It supplies the rectosigmoid junction, which is a critical area for ischemia. The aim of the present study was to delineate the area supplied by the inferior mesenteric artery with special consideration of the sigmoidea ima artery. MATERIALS AND METHODS The inferior mesenteric artery was dissected from its origin to the bifurcation of the superior rectal artery in 30 cadavers (15 male, 15 female). Vessel length and distance to the promontory were measured for each branch. RESULTS There were two manifestations of the sigmoidea ima artery, irrespective of the branching pattern of the inferior mesenteric artery. It originated below the promontory in 25 cases (83.3%) and above it in three (10%). It did not derive from the superior rectal artery in two cases (6.7%). In these 16.7%, the marginal artery was absent near the rectosigmoid junction. CONCLUSIONS We suggest the terms "arteria sigmoidea ima pelvina" and "arteria sigmoidea ima abdominalis" for the two variants. The terms "arteria marginalis pelvina" and "arteria marginalis abdominalis" could be applied in clinical practice. An abdominal marginal artery could be considered a risk factor for colonic ischemia in colorectal resections and abdominal aortic aneurysm repair. Both variants should be considered when pre- and intra-operative perfusion measurements are interpreted.
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Affiliation(s)
- Christoph Landen
- Department of Macroscopic and Clinical AnatomyMedical University of GrazGrazAustria
| | - Manuel Dreu
- Department of Macroscopic and Clinical AnatomyMedical University of GrazGrazAustria
| | - Andreas Weiglein
- Department of Macroscopic and Clinical AnatomyMedical University of GrazGrazAustria
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Degheili JA, Malhas H, Yoo TK, Dergham MYR. A Very Low-Positioned Aortic Bifurcation. Vasc Specialist Int 2020; 36:112-115. [PMID: 32415814 PMCID: PMC7333085 DOI: 10.5758/vsi.200009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/20/2022] Open
Abstract
Anomalies of the aortoiliac arteries are rarely reported and are generally discovered incidentally on imaging performed mostly for investigation of other medical concerns. While aortic bifurcation is typically reported at the fourth lumbar vertebra, variations are possible. We present a case with very low aortic bifurcation, almost at the level of S2, with various other anomalies including a corkscrew left common iliac artery passing just anterior to the bladder dome with pulsation noted during cystoscopy. An ectopic right kidney was also noted. To our knowledge, these vascular anomalies have not been reported previously.
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Affiliation(s)
- Jad A Degheili
- Division of Urology, Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Haya Malhas
- Department of Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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10
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Zhang C, Li A, Luo T, Li Y, Li F, Li J. Evaluation of characteristics of left-sided colorectal perfusion in elderly patients by angiography. World J Gastroenterol 2020; 26:3484-3494. [PMID: 32655271 PMCID: PMC7327791 DOI: 10.3748/wjg.v26.i24.3484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Handling of the inferior mesenteric artery (IMA) and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer. However, the branching of this artery and the drainage patterns of this vein vary among individuals, and the characteristics and perfusion region of this artery in elderly patients remain unclear.
AIM To evaluate the characteristics and perfusion region of the IMA in elderly patients using angiography.
METHODS We enrolled 154 patients (> 65 years old) who underwent digital subtraction angiography of the IMA. The characteristics, bifurcation, and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined using digital subtraction angiography. Collateral arterial arches and the IMA hemoperfusion region were also recorded. Perfusion regions were cross-referenced with clinical and anatomical features by the univariate analysis.
RESULTS Of 154 patients, 25 (16.2%) had IMA lesions. The left colic artery arose independently from the IMA in 44.2% of patients, shared a trunk with the sigmoid artery in 35.1%, shared an opening with the sigmoid and superior rectal arteries in 16.9%, and was absent in 5.1%. The IMA perfusion region stopped at the splenic flexure in 50 (32.5%) patients. The collateral circulation existed in the colonic perfusion region, including the marginal artery (Drummond’s artery), the ascending branch of the left colonic artery to supply the transverse colon, and the arc of Riolan with a frequency of 100%, 22.7%, and 1.9%, respectively. The IMA perfusion region was independently associated with the comorbidity of atherosclerosis, IMA atherosclerotic lesion, branching pattern, collateral circulation, and marginal artery integrity.
CONCLUSION The IMA and its branches are prone to arteriosclerosis, and IMA perfusion may be interrupted at the splenic flexure in elderly patients. The applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion patterns could facilitate geriatric laparoscopic left-sided colorectal cancer surgery with suspicion of poor IMA perfusion.
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Affiliation(s)
- Chao Zhang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Tao Luo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Yu Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Jia Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
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11
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Dill Extract Induces Elastic Fiber Neosynthesis and Functional Improvement in the Ascending Aorta of Aged Mice with Reversal of Age-Dependent Cardiac Hypertrophy and Involvement of Lysyl Oxidase-Like-1. Biomolecules 2020; 10:biom10020173. [PMID: 31979322 PMCID: PMC7072659 DOI: 10.3390/biom10020173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/16/2023] Open
Abstract
Elastic fibers (90% elastin, 10% fibrillin-rich microfibrils) are synthesized only in early life and adolescence mainly by the vascular smooth muscle cells through the cross-linking of its soluble precursor, tropoelastin. Elastic fibers endow the large elastic arteries with resilience and elasticity. Normal vascular aging is associated with arterial remodeling and stiffening, especially due to the end of production and degradation of elastic fibers, leading to altered cardiovascular function. Several pharmacological treatments stimulate the production of elastin and elastic fibers. In particular, dill extract (DE) has been demonstrated to stimulate elastin production in vitro in dermal equivalent models and in skin fibroblasts to increase lysyl oxidase–like-1 (LOXL-1) gene expression, an enzyme contributing to tropoelastin crosslinking and elastin formation. Here, we have investigated the effects of a chronic treatment (three months) of aged male mice with DE (5% or 10% v/v, in drinking water) on the structure and function of the ascending aorta. DE treatment, especially at 10%, of aged mice protected pre-existing elastic lamellae, reactivated tropoelastin and LOXL-1 expressions, induced elastic fiber neo-synthesis, and decreased the stiffness of the aging aortic wall, probably explaining the reversal of the age-related cardiac hypertrophy also observed following the treatment. DE could thus be considered as an anti-aging product for the cardiovascular system.
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12
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Maithel S, Grigorian A, Fujitani RM, Kabutey NK, Sheehan BM, Gambhir S, Chen SL, Nahmias J. Incidence, morbidity, and mortality of traumatic superior mesenteric artery injuries compared to other visceral arteries. Vascular 2019; 28:142-151. [DOI: 10.1177/1708538119893827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ObjectivesCeliac artery, superior mesenteric artery, and inferior mesenteric artery injuries are often grouped together as major visceral artery injuries with an incidence of <1%. The mortality rates range from 38–75% for celiac artery injuries and 25–68% for superior mesenteric artery injuries. No large series have investigated the mortality rate of inferior mesenteric artery injuries. We hypothesize that from all the major visceral artery injuries, superior mesenteric artery injury leads to the highest risk of mortality in adult trauma patients.MethodsThe Trauma Quality Improvement Program (2010–2016) was queried for patients with injury to the celiac artery, superior mesenteric artery, or inferior mesenteric artery. A multivariable logistic regression model was used for analysis. Separate subset analyses using blunt trauma patients and penetrating trauma patients were performed.ResultsFrom 1,403,466 patients, 1730 had single visceral artery injuries with 699 (40.4%) involving the celiac artery, 889 (51.4%) involving the superior mesenteric artery, and 142 (8.2%) involving the inferior mesenteric artery. The majority of patients were male (79.2%) with a median age of 39 years old, and median injury severity score of 22. Compared to celiac artery and inferior mesenteric artery injuries, superior mesenteric artery injuries had a higher rate of severe (grade >3) abbreviated injury scale for the abdomen (57.5% vs. 42.5%, p < 0.001). The overall mortality for patients with a single visceral artery injury was 20%. Patients with superior mesenteric artery injury had higher mortality compared to those with celiac artery and inferior mesenteric artery injuries (23.7% vs. 16.3%, p < 0.001). After controlling for covariates, traumatic superior mesenteric artery injury increased risk of mortality (OR = 1.72, CI = 1.24–2.37, p < 0.01) in adult trauma patients, while celiac artery ( p = 0.59) and inferior mesenteric artery ( p = 0.31) injury did not. After stratifying by mechanism, superior mesenteric artery injury increased risk of mortality (OR = 3.65, CI = 2.01–6.45, p < 0.001) in adult trauma patients with penetrating mechanism of injury but not in those with blunt force mechanism (OR = 1.22, CI = 0.81–1.85, p = 0.34).ConclusionsCompared to injuries of the celiac artery and inferior mesenteric artery, traumatic superior mesenteric artery injury is associated with a higher mortality. Moreover, while superior mesenteric artery injury does not act as an independent risk factor for mortality in adult patients with blunt force trauma, it nearly quadruples the risk of mortality in adult trauma patients with penetrating mechanism of injury. Future prospective research is needed to confirm these findings and evaluate factors to improve survival following major visceral artery injury.
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Affiliation(s)
- Shelley Maithel
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Areg Grigorian
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Roy M Fujitani
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Nii-Kabu Kabutey
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Brian M Sheehan
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Sahil Gambhir
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Samuel L Chen
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Jeffry Nahmias
- Irvine Department of General Surgery, University of California, Orange, CA, USA
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13
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Bruzzi M, M'harzi L, Poghosyan T, Ben Abdallah I, Papadimitriou A, Ragot E, El Batti S, Balaya V, Taieb J, Chevallier JM, Douard R. Arterial vascularization of the right colon with implications for surgery. Surg Radiol Anat 2019; 42:429-435. [PMID: 31637473 DOI: 10.1007/s00276-019-02359-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/04/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE During right-sided colectomies, surgeons encounter major anatomical variations at the level of the right colon, leading to morbidity. Due to the confusion surrounding the colonic arterial vessels emerging from the superior mesenteric artery (SMA) to vascularize the right part of the colon, this review aimed to describe the arterial vessels found in the mesocolic structures of the ascending colon, the hepatic flexure and the right transverse colon. METHODS A review of the literature was performed using the MEDLINE database. Only human studies were included. All dissection, angiographic, arterial cast and corrosion studies were analyzed. RESULTS This review demonstrates that the right colon, the hepatic flexure and the right transverse colon are vascularized by three significant arteries emerging from the SMA and forming one peripheral paracolic arc: (1) the ileocolic artery (ICA), the most constant vessel (99.8%) with low variability; (2) the right colic artery (RCA), the most inconstant vessel (2/3 of cases) with high variability in its origin; and (3) the middle colic artery (MCA), a constant vessel (95%) with variation in its origin and its number. The marginal artery is almost constant (100%) and represents the only peripheral arterial arc at the level of the right side of the colon. CONCLUSIONS Three arteries emerging from the superior mesenteric artery exist: the ICA, the RCA and the MCA. The ICA and the MCA are the most constant. Knowledge of this vascular anatomy is essential for performing right-sided colectomies.
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Affiliation(s)
- Matthieu Bruzzi
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France. .,Paris Descartes Faculty of Medicine, Paris, France. .,INSERM 970, Équipe 2, PARCC, HEGP, Paris, France. .,Service de Chirurgie générale et digestive, Hôpital européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - Leila M'harzi
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France.,Paris Descartes Faculty of Medicine, Paris, France.,INSERM 970, Équipe 2, PARCC, HEGP, Paris, France
| | - Tigran Poghosyan
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France.,Paris Descartes Faculty of Medicine, Paris, France.,INSERM 970, Équipe 2, PARCC, HEGP, Paris, France
| | | | - Argyri Papadimitriou
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France
| | - Emilia Ragot
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France
| | | | | | - Julien Taieb
- Paris Descartes Faculty of Medicine, Paris, France.,Digestive Oncology Unit, Georges Pompidou AP-HP University Hospital, Paris, France
| | - Jean-Marc Chevallier
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France.,Paris Descartes Faculty of Medicine, Paris, France
| | - Richard Douard
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France.,Paris Descartes Faculty of Medicine, Paris, France
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14
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Desai GS, Pande PM. Gastroduodenal artery: single key for many locks. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:281-291. [PMID: 31099488 DOI: 10.1002/jhbp.636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastroduodenal artery (GDA) commonly arises from common hepatic artery, a branch of celiac axis. It holds a unique anatomical position that connects the foregut and midgut due to its intimate communications with foregut and midgut arterial supply. Its numerous anatomical variations have a significant impact on planning and performance of hepatopancreaticobiliary (HPB) surgery. Its close relation to the first part of duodenum, common bile duct and head of pancreas makes it susceptible for inadvertent bleeding during or after surgery, or due to various HPB pathologies. Also, a large number of vascular interventions rely on GDA and its branches. Careful preoperative planning is the key and a detailed knowledge and awareness of its variant anatomy is of paramount importance, be it liver resections, liver transplant, biliary and pancreatic resections and pancreatic transplant or transarterial procedures involving these arteries. GDA can also be a cause of gastrointestinal hemorrhage due to true or pseudoaneurysms and anatomy has significant implications on its management. The article provides a succinct review on relevance of GDA anatomy and variations and highlights that preoperative planning and intraoperative awareness of variations is the key to performance of safe HPB surgery and interventions.
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Affiliation(s)
- Gunjan S Desai
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India
| | - Prasad M Pande
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India
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Jojima K, Nogami E, Shimauchi K, Kuwano A, Kitsuka T, Mukae Y, Furutachi A, Takamatsu M, Itou M, Yunoki J, Tanaka A, Nishida T. Acute Dissection of the Middle Colic Artery Immediately after Endovascular Abdominal Aortic Aneurysm Repair: A Case Report. Ann Vasc Surg 2019; 58:382.e11-382.e14. [PMID: 30802565 DOI: 10.1016/j.avsg.2018.12.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/07/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
A 78-year-old man underwent endovascular abdominal aortic aneurysm repair (EVAR) for a true aortic aneurysm. He developed sudden abdominal pain 4 hr after EVAR. Angiography revealed a dissected aneurysm of the middle colic artery (MCA). Despite conservative treatment, follow-up computed tomography revealed an expanded aneurysm of the MCA. We therefore performed coil embolization of the dissected MCA to prevent a rupture of the aneurysm. There has never been a reported case of acute dissection of the MCA immediately after EVAR that was not caused by catheters. In this report, we discuss the possible underlying mechanisms and the optimal therapeutic strategy for this rare complication.
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Affiliation(s)
- Kota Jojima
- Center for Graduate Medical Education Development and Research, Faculty of Medicine, Saga University Hospital, Saga, Japan.
| | - Eijiro Nogami
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kota Shimauchi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Akito Kuwano
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takahiro Kitsuka
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yousuke Mukae
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Akira Furutachi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masanori Takamatsu
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Manabu Itou
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Junji Yunoki
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Atsuhisa Tanaka
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takahiro Nishida
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Kuyumcu G, Latich I, Hardman RL, Fine GC, Oklu R, Quencer KB. Gastrodoudenal Embolization: Indications, Technical Pearls, and Outcomes. J Clin Med 2018; 7:jcm7050101. [PMID: 29724061 PMCID: PMC5977140 DOI: 10.3390/jcm7050101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 01/06/2023] Open
Abstract
The gastroduodenal artery (GDA) is frequently embolized in cases of upper GI bleed that has failed endoscopic therapy. Additionally, it may be done for GDA pseudoaneurysms or as an adjunctive procedure prior to Yttrim-90 (Y90) treatment of hepatic tumors. This clinical review will summarize anatomy and embryology of the GDA, indications, outcomes and complications of GDA embolization.
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Affiliation(s)
- Gokhan Kuyumcu
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale University School of Medicine, New Haven, CT 06519, USA.
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale University School of Medicine, New Haven, CT 06519, USA.
| | - Rulon L Hardman
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT 84108, USA.
| | - Gabriel C Fine
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT 84108, USA.
| | - Rahmi Oklu
- Department of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA.
| | - Keith B Quencer
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT 84108, USA.
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17
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Fukuoka A, Sasaki T, Tsukikawa S, Miyajima N, Ostubo T. Evaluating distribution of the left branch of the middle colic artery and the left colic artery by CT angiography and colonography to classify blood supply to the splenic flexure. Asian J Endosc Surg 2017; 10:148-153. [PMID: 28008722 DOI: 10.1111/ases.12349] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 09/30/2016] [Accepted: 10/16/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION CT angiography has gained widespread acceptance for preoperative evaluation of blood supply in patients with colorectal cancer. However, there have been few reports that pertain to the splenic flexure, for which surgery is technically difficult. We used preoperative CT angiography and CT colonography to evaluate blood supply to the splenic flexure. METHODS We defined the splenic flexure as the junction of the distal third of the transverse colon and the proximal third of the descending colon. We reviewed 191 cases and considered the descending colon as divided into the proximal third and the distal two-thirds; we then determined which part of the descending colon the left colic artery (LCA) entered. We also considered the transverse colon as divided into the proximal two-thirds and the distal third, and evaluated which part of the transverse colon the left branch of the middle colic artery entered. RESULT We classified blood supply to the splenic flexure into six types, described by the feeder vessels: type 1, the LCA (39.7%); type 2, the left branch of the middle colic artery (17.8%); type 3, the LCA and the left branch of the middle colic artery (9.9%); type 4, the accessory left colic artery (4.1%); type 5, the LCA and the accessory left colic artery (2.6%); and type 6, the marginal artery (25.6%). CONCLUSION We classified blood supply to the splenic flexure into more complex types than previous reports had. Because we dissect the lymph nodes according to the type of blood supply, knowing the type before splenic flexure surgery is crucial.
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Affiliation(s)
- Asako Fukuoka
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Gastroenterological Surgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Takahiro Sasaki
- Department of Gastroenterological Surgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Satoshi Tsukikawa
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nobuyoshi Miyajima
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takehito Ostubo
- Department of Gastroenterological Surgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan
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18
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Gamo E, Jiménez C, Pallares E, Simón C, Valderrama F, Sañudo JR, Arrazola J. The superior mesenteric artery and the variations of the colic patterns. A new anatomical and radiological classification of the colic arteries. Surg Radiol Anat 2016; 38:519-27. [PMID: 26728989 DOI: 10.1007/s00276-015-1608-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/08/2015] [Indexed: 11/25/2022]
Abstract
The superior mesenteric artery (SMA) supplies irrigation to the small intestine, ascending and a variable area of the transverse colon. Although medical imaging and surgical procedures have been widely developed in the last decades, the anatomy of the SMA using advanced imaging technology remains to be elucidated. Previous studies have used small sample sizes of cadaveric or radiological samples to propose a number of classifications for the SMA. In this study, we aimed to provide a more detailed description and useful classification of the SMA and its main branches [middle colic artery (MCA), right colic artery (RCA), and ileocolic artery (ICA)]. Samples (n = 50, 28 males and 22 females) were obtained from the repository of human cadavers located at the Department of Human Anatomy and Embryology, Complutense University of Madrid. This sample was dissected by preclinical medical students and completed by two of the authors (Gamo and Jiménez). A second set of samples was obtained from a bank of computerized tomography (CT) (560 CTs, 399 males and 161 females) collected by the Radiology Department at the Clínico San Carlos Hospital, Spain. Based on the results obtained from these studies, we propose a new classification of four patterns for the SMA anatomy. Pattern I as the independent origin of the three main branches of the SMA (cadaveric 40 %; CT 73.69 %); Pattern II is subdivided in three sub-patterns based on the common trunks of origin: Pattern IIa, common trunk between RCA and MCA (cadaveric 20 %, CT 4.28 %); Pattern IIb, common trunk between RCA and ICA (cadaveric 32 %, CT 15 %); Pattern IIc, common trunk for the three main branches (cadaveric 0 %, CT 0.35 %); Pattern III, as the absence of RCA (cadaveric 8 %; CT 2.32 %) and Pattern IV, based on presence of accessory arteries (not found in any of the samples). Although the independent origin of the three colic arteries have been classically described as the most frequent, the right colic artery is responsible of major variations.
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Affiliation(s)
- E Gamo
- Department of Human Anatomy and Embryology. School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - C Jiménez
- Department of Human Anatomy and Embryology. School of Medicine, Complutense University of Madrid, Madrid, Spain.
| | - E Pallares
- Radiology Department. Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - C Simón
- Computer Science and Statistics. Area: Statistics and Operations Research, Rey Juan Carlos University, Móstoles, Spain
| | - F Valderrama
- Department of Human Anatomy and Embryology. School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - J R Sañudo
- Department of Human Anatomy and Embryology. School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - J Arrazola
- Radiology Department. Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
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19
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Andall RG, Matusz P, du Plessis M, Ward R, Tubbs RS, Loukas M. The clinical anatomy of cystic artery variations: a review of over 9800 cases. Surg Radiol Anat 2015; 38:529-39. [PMID: 26698600 DOI: 10.1007/s00276-015-1600-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 11/30/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE While laparoscopic cholecystectomy can be a routine procedure when biliary anatomy is normally located, cystic artery variations can easily disorientate the inexperienced surgeon to the anatomy of the hepatobiliary triangle. This study presents the clinically important anatomical variations of the cystic artery. METHODS PubMed, Medline, Cochrane Database of Systematic Reviews, and Google Scholar databases were searched to conduct a review of the existing English literature on the clinically important cystic artery variations. An aberrant vessel was defined as a vessel that originated from an atypical source and/or one that was present in a specimen in addition to the normal vessel. RESULTS The cystic artery originated typically from the right hepatic artery (79.02 %) and was found in the hepatobiliary triangle in only 5427 of 6661 (81.5 %) cases. Clinically important cystic artery variations are (1) the cystic artery located anterior to the common hepatic duct or common bile duct found in 485 of 2704 (17.9 %) and 228 of 4202 (5.4 %) of cases, respectively, (2) the cystic artery located inferior to the cystic duct found in 38 of 770 (4.9 %) of cases, (3) short cystic arteries found in 98 of 1037 (9.5 %) cases and (4) multiple cystic arteries found in (8.9 %) of cases. CONCLUSION These variations are common in the general population and can lead to inadvertent ligation of biliary ducts or aberrant vessels. Therefore, it is important for the hepatobiliary surgeon to be aware of these vascular anomalies to avoid operative complications.
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Affiliation(s)
- R G Andall
- Department of Anatomical Sciences, St. George's University, School of Medicine, St. George's, Grenada, West Indies
| | - P Matusz
- Department of Anatomy, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - M du Plessis
- Department of Anatomical Sciences, St. George's University, School of Medicine, St. George's, Grenada, West Indies
| | - R Ward
- Department of Radiology, Tufts Medical School, Boston, MA, USA
| | - R S Tubbs
- Department of Anatomical Sciences, St. George's University, School of Medicine, St. George's, Grenada, West Indies.,Pediatric Neurosurgery, Children's Hospital, Birmingham, AL, USA
| | - M Loukas
- Department of Anatomical Sciences, St. George's University, School of Medicine, St. George's, Grenada, West Indies.
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20
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Yin T, Wan Z, Chen H, Mao X, Yi Y, Li D. Obstructive jaundice caused by pancreaticoduodenal artery aneurysms associated with celiac axis stenosis: case report and review of the literature. Ann Vasc Surg 2015; 29:1016.e1-6. [PMID: 25769284 DOI: 10.1016/j.avsg.2014.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 11/20/2014] [Accepted: 12/14/2014] [Indexed: 10/23/2022]
Abstract
Pancreaticoduodenal artery aneurysm (PDA) is quite rare, which accounts for only approximate 2% of all visceral aneurysms. Besides, PDA is usually related to celiac axis stenosis (CAS) and prone to rupture. Advanced imaging examination can facilitate the disclosure of such peripancreatic masses, but most of them were seldom diagnosed until they rupture because of the nonspecific symptoms. Secondary to PDA, obstructive jaundice is however an extremely rare manifestation. A case of an 84-year-old man is reported here, who suffered from severe jaundice caused by a ruptured PDA associated with CAS. In addition, this review collects and organizes PDAs with jaundice by applying a MEDLINE search and discusses the pathogenesis and therapeutic options of these aneurysms leading to external compression over the bile duct. Consequently, the formation of PDA with obstructive jaundice is based on the specific anatomy of pancreaticoduodenal arcades. When there is a retroperitoneal mass around the head of the pancreas associated with unexpected jaundice, PDA should be considered, for which early aggressive therapy is required. The case report and literature review suggest that PDA associated with obstructive jaundice may be treated successfully by single transcatheter arterial embolization (TAE) without auxiliary biliary drainage, whether it ruptures or not.
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Affiliation(s)
- Tiansheng Yin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhili Wan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongwei Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xixian Mao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yayang Yi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dewei Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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21
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Chakravarthi KK. Unilateral multiple variations of renal, phrenic, suprarenal, inferior mesenteric and gonadal arteries. J Nat Sci Biol Med 2014; 5:173-5. [PMID: 24678220 PMCID: PMC3961927 DOI: 10.4103/0976-9668.127320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Knowledge of the branching pattern of the abdominal aorta is clinically important for any abdominal surgeon operating on parts of the gut or neighboring structures. Variations of these vessels may influences urological, renal transplantation and laparoscopic surgeries. We present an unreported case of multiple variations of branching pattern of abdominal aorta. It includes double renal arteries for left kidney, a common trunk with right and left phrenic, right and left superior suprarenal and left middle supra renal arteries, and a common trunk originate 2.5 cm above the bifurcation of abdominal aorta gave off inferior mesenteric, accessory renal artery to the left kidney and left testicular arteries in the middle-aged normal male cadaver. The embryogenesis of such multiple variations of branches of abdominal aorta is not clear, but the anatomic consequences may have important clinical implications. Knowledge of these variations is important for urologists, radiologists and surgeons in general.
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Affiliation(s)
- Kosuri Kalyan Chakravarthi
- Department of Anatomy, Santhiram Medical College, NH-18, Nandyal, Kurnool District, Andhra Pradesh, India
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22
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Azeemuddin M, Naqi R, Sayani R. Therapeutic angiography and embolisation for bleeding aberrant duodenal artery arising from replaced hepatic artery. BMJ Case Rep 2013; 2013:bcr2013200214. [PMID: 24243501 PMCID: PMC3830185 DOI: 10.1136/bcr-2013-200214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a rare case of a 70-year-old man with a known case of hypertension and carcinoma larynx, he was admitted under ENT (ear, nose and throat) services for a laryngectomy. On admission, he started having severe per rectal bleeding. The patient underwent a number of radiological investigations to determine the origin of the bleed, including Tc 99 m labelled red blood cells tagged scan, a CT scan and two angiographies. The final angiogram showed an aberrant artery supplying the duodenum showing active extravasation. It was arising from the replaced right hepatic artery which itself arose from the superior mesenteric artery. Successful embolisation was performed using polyvinyl alcohol particles and microcoil. We present this rare case of an aberrant artery supplying the duodenum.
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23
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Al-Asari SF, Lim D, Min BS, Kim NK. The relation between inferior mesenteric vein ligation and collateral vessels to splenic flexure: anatomical landmarks, technical precautions and clinical significance. Yonsei Med J 2013; 54:1484-90. [PMID: 24142655 PMCID: PMC3809879 DOI: 10.3349/ymj.2013.54.6.1484] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Our aim to assess clinical significance of the relation between inferior mesenteric vein ligation and collateral blood supply (meandering mesenteric artery) to the splenic flexure with elaboration more in anatomical landmarks and technical tips. MATERIALS AND METHODS We review the literature regarding the significance of the collateral vessels around inferior mesenteric vein (IMV) root and provide our prospective operative findings, anatomical landmarks and technical tips. We analyzed the incidence and pattern of anatomic variation of collateral vessels around the IMV. RESULTS A total of 30 consecutive patients have been prospectively observed in a period between June 25-2012 and September 7-2012. Nineteen males and eleven females with mean age of 63 years. Major colorectal procedures were included. There were three anatomical types proposed, based on the relation between IMV and the collateral vessel. Type A and B in which either the collateral vessel crosses or runs close to the IMV with incidence of 43.3% and 13.3%, respectively, whereas type C is present in 43.3%. There was no definitive relation between the artery and vein. No intra or postoperative ischemic events were reported. CONCLUSION During IMV ligation, inadvertent ligation of Arc of Riolan or meandering mesenteric artery around the IMV root "in type A&B" might result in compromised blood supply to the left colon, congestion, ischemia and different level of colitis or anastomotic dehiscence. Therefore, careful dissection and skeletonization at the IMV root "before ligation if necessary" is mandatory to preserve the collateral vessel for the watershed area and to avoid further injury.
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Affiliation(s)
- Sami F. Al-Asari
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Daero Lim
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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24
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Kallamadi R, Demoya MA, Kalva SP. Inferior pancreaticoduodenal artery aneurysms in association with celiac stenosis/occlusion. Semin Intervent Radiol 2011; 26:215-23. [PMID: 21326566 DOI: 10.1055/s-0029-1225671] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Inferior pancreaticoduodenal artery aneurysms in association with celiac stenosis or occlusion are well described in the literature. These aneurysms are true aneurysms and develop as a result of increased flow through the pancreaticoduodenal arcades in the presence of hemodynamically significant stenosis of the celiac axis or common hepatic artery. Aneurysms may be multiple and rarely associated with aneurysms in other collateral pathways-such as the dorsal pancreatic artery or the arc of Buhler. These aneurysms may be incidentally detected or patients may present with abdominal pain or shock secondary to rupture of the aneurysms. Treatment options include surgical resection and transcatheter embolization; current literature favors the latter option. Treatment of celiac axis stenosis may be recommended in addition to treating the aneurysms; however, no formal guidelines exist on this recommendation.
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Affiliation(s)
- Rekha Kallamadi
- Department of Radiology (Division of Cardiovascular Imaging and Intervention), Harvard Medical School, Boston, Massachusetts
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25
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Abstract
The arterial and venous circulation of the bowel is complex and is characterized by marked redundancy of multiple interconnecting branches, which provides a rich blood supply to aid in the digestive process and also serves to protect the bowel from potential ischemia or infarction. As a result of this circulatory pattern, anatomic variants and extensive collateral pathways are common. A thorough knowledge of both the arterial and venous mesenteric circulation, including normal, variant, and collateral anatomy, is necessary for the appropriate evaluation and management of the various disease processes that may affect the vascular supply of the gastrointestinal system.
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Affiliation(s)
- T Gregory Walker
- Section of Cardiovascular Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts
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26
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Yen TH, Chang CT, Huang CC, Ng KK, Tsai SY. Bifurcated Abdominal Aorta, with a Coarctation over the Right Branch of the Bifurcated Abdominal Aorta and Aberrant Renal Arteries Originating from the Left Branch of the Bifurcated Abdominal Aorta. Ren Fail 2009; 26:83-7. [PMID: 15083928 DOI: 10.1081/jdi-120028560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This study describes an unusual case of secondary hypertension in a young female patient presenting with severe hypertension and abdominal bruits. Gadolinium-enhanced MRA revealed a clearly bifurcated abdominal aorta, with a coarctation over the right branch of the bifurcated abdominal aorta and aberrant renal arteries originated from the left branch of the bifurcated abdominal aorta. Of interest is conventional angiography had failed to reveal these vascular abnormalities. This study mentions both embryologic and clinical aspects of this developmentally abnormal bifurcated abdominal aorta, coarctation of abdominal aorta and aberrant renal arteries.
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Affiliation(s)
- Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
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27
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Kachlik D, Laco J, Turyna R, Baca V. A very rare variant in the colon supply--arteria mesenterica media. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 153:79-82. [PMID: 19365532 DOI: 10.5507/bp.2009.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS The arteria mesenterica media is a very rare variation of the mesenteric blood supply. It is a direct branch from the aorta abdominalis originating between the arteria mesenterica superior and inferior. This is not an aim. METHODS One hundred forty-nine large intestines from cadavers fixed with formaldehyde were dissected. RESULTS A case of the present arteria mesenterica media was discovered during the dissection of the large intestine blood supply. It originated from the anterior wall of the aorta abdominalis 2 cm above the arteria mesenterica inferior origin, having the diameter 0.9 mm. Then it ran horizontally to the left giving off branches to the colon descendens and flexura coli sinistra, in the extent of the normal arteria colica sinistra. DISCUSSION Seventeen cases of true arteria mesenterica media have been reported since 1952. CONCLUSION The term arteria mesenterica media must be reserved for the vessel stemming from the aorta abdominalis in the extent between the arteria mesenterica superior and inferior.
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Affiliation(s)
- David Kachlik
- Department of Anatomy, Third Faculty of Medicine, Charles University in Prague, Ruská 87, Praha 10, Czech Republic.
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28
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Stauffer JA, Bridges MD, Turan N, Nguyen JH, Martin JK. Aberrant right hepatic arterial anatomy and pancreaticoduodenectomy: recognition, prevalence and management. HPB (Oxford) 2009; 11:161-5. [PMID: 19590642 PMCID: PMC2697872 DOI: 10.1111/j.1477-2574.2009.00037.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 01/17/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Aberrant arterial anatomy is a common finding during foregut surgery. Anomalies to the right hepatic lobe are especially relevant during pancreaticoduodenectomy (PD) and their recognition serves to protect the blood supply to the liver and bile ducts. We report our experience with aberrant right hepatic arterial anatomy (ARHAA) found during PD. METHODS All patients who underwent PD between February 2003 and June 2007 were retrospectively reviewed and those with ARHAA were identified. Preoperative imaging studies were assessed by one radiologist, graded according to the presence of ARHAA and compared with the original interpretations. RESULTS We found ARHAA in 31 of 191 patients (16.2%). Operative management included dissection and preservation in 24, transection and reconstruction in four, and transection and primary anastomosis in three patients. Reconstruction of ARHAA was carried out through interposition grafts in two patients and implantation into the gastroduodenal stump in two patients. No cases of arterial thrombosis, liver infarction, abscess formation or biliary fistula were demonstrated in the immediate postoperative period. Review of preoperative imaging interpretations found that only nine of 23 reports indicated the presence of ARHAA; however, the retrospective review of the images found that ARHAA was readily apparent in 24 patients. DISCUSSION Recognition of aberrant vasculature to the liver before PD is important. Preoperative imaging studies will often be adequate to identify these anomalies, but interpreting radiologists may not be aware of its clinical significance. Surgeons performing PD must be adept at managing ARHAA safely.
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Affiliation(s)
- John A Stauffer
- Section of General Surgery, Mayo ClinicJacksonville, FL, USA
| | | | - Naciye Turan
- Section of General Surgery, Mayo ClinicJacksonville, FL, USA
| | - Justin H Nguyen
- Division of Transplant Surgery, Mayo ClinicJacksonville, FL, USA
| | - J Kirk Martin
- Section of General Surgery, Mayo ClinicJacksonville, FL, USA
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29
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Hager E, Isenberg G, Gonsalves C, Moudgill N, Dong S, DiMuzio P. A new anatomic variant of the aorta: a case report. J Vasc Surg 2008; 48:213-5. [PMID: 18589235 DOI: 10.1016/j.jvs.2008.02.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 02/13/2008] [Accepted: 02/14/2008] [Indexed: 11/29/2022]
Abstract
Anatomic anomalies of the infrarenal aorta and iliac arteries are rare. We report a 39-year-old man who presented with an ileo-cecal fistula secondary to Crohn disease. A computed tomography scan and subsequent arteriography noted his aorta bifurcated immediately inferior to the main renal arteries, at the level of the second lumbar vertebrae. Associated vascular anomalies included a common superior mesenteric artery/celiac axis plus multiple renal arteries. To our knowledge, this is the first report of this aortic anomaly in the literature.
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Affiliation(s)
- Eric Hager
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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30
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Yi SQ, Terayama H, Naito M, Hirai S, Alimujang S, Yi N, Tanaka S, Itoh M. Absence of the celiac trunk: case report and review of the literature. Clin Anat 2008; 21:283-6. [PMID: 18428985 DOI: 10.1002/ca.20627] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The authors report a rare variation of the absence of the celiac trunk in a Japanese cadaver, with the left gastric, splenic, common hepatic, and superior mesenteric arteries arising independently from the abdominal aorta in the routine dissection of a 95-year-old Japanese male cadaver. The incidence and developmental and clinical significance of this variation is discussed with a detailed review of the literature. Knowledge of such case has important clinical significance in an abdominal operation or invasive arterial procedure, that is, Appleby procedure and liver transplantation, laparoscopic surgery, and radiological procedures in the upper abdomen.
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Affiliation(s)
- Shuang-Qin Yi
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan.
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31
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Abdominal Aortic Aneurysms. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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32
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Sakorafas GH, Sarr MG, Peros G. Celiac artery stenosis: an underappreciated and unpleasant surprise in patients undergoing pancreaticoduodenectomy. J Am Coll Surg 2007; 206:349-56. [PMID: 18222391 DOI: 10.1016/j.jamcollsurg.2007.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Revised: 08/16/2007] [Accepted: 09/04/2007] [Indexed: 12/11/2022]
Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, Athens, Greece.
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33
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Sakorafas GH, Zouros E, Peros G. Applied vascular anatomy of the colon and rectum: clinical implications for the surgical oncologist. Surg Oncol 2007; 15:243-55. [PMID: 17531744 DOI: 10.1016/j.suronc.2007.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 02/23/2007] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
Surgery remains the most radical method of treatment of many solid tumors, including colorectal cancer; in these tumors, surgery is the only method that can offer the chance of cure. To avoid early postoperative morbidity (mainly, anastomotic leak) and to achieve good long-term results (low incidence of tumor recurrence, long overall and disease-free survival, and optimal quality of life), the surgeon should have an in-depth knowledge of vascular anatomy of the colon and rectum. This essential requirement is based on the fact that the actual course followed by lymph fluid drainage from any part of the colon/rectum is determined by its blood supply; therefore, the extent of resection for colorectal cancer follows the principles of blood supply and lymphatic drainage. Knowledge of the colorectal vascular anatomy and its variations is of vital importance in the planning of radical surgical treatment and in appropriately performing colorectal resections, particularly in the patient who underwent in the past colectomy or aortic surgery that has changed the usual pattern of collateral blood supply to the colon. This review summarizes currently available data regarding vascular anatomy of the colon and rectum, from a surgical perspective.
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Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, Athens, Greece.
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35
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Bilbao Jaureguízar JI, Vivas Pérez I, Cano Rafart D, Martínez de la Cuesta A. Imaging and Intervention in Gastrointestinal Hemorrhage and Ischemia. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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36
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Kalva SP, Athanasoulis CA, Greenfield AJ, Fan CM, Curvelo M, Waltman AC, Wicky S. Inferior pancreaticoduodenal artery aneurysms in association with celiac axis stenosis or occlusion. Eur J Vasc Endovasc Surg 2007; 33:670-5. [PMID: 17276102 DOI: 10.1016/j.ejvs.2006.12.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 12/18/2006] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe the pathophysiology, identification and management of inferior pancreaticoduodenal artery aneurysms in association with celiac axis stenosis or occlusion has been reported. REVIEW FINDINGS These aneurysms are thought to arise due to increased flow through the pancreaticoduodenal arcades. The arcades first enlarge, and then form focal aneurysms which may rupture. The aneurysms can be treated through endovascular techniques or by surgery, though the former is a preferred approach.
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Affiliation(s)
- S P Kalva
- Radiology, Massachusetts General Hospital, Boston, MA, USA.
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37
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Woodfield CA, Torigian DA. MDCT angiography of middle mesenteric artery with associated bowel nonrotation complicating management of abdominal aortic aneurysm. AJR Am J Roentgenol 2006; 187:W524-7. [PMID: 17056885 DOI: 10.2214/ajr.05.0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Courtney A Woodfield
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104-4283, USA
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38
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Kim HJ, Ko YT, Lim JW, Lee DH. Radiologic anatomy of the superior mesenteric vein and branching patterns of the first jejunal trunk: evaluation using multi-detector row CT venography. Surg Radiol Anat 2006; 29:67-75. [PMID: 17033735 DOI: 10.1007/s00276-006-0153-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 09/04/2006] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to describe radiologic anatomy of the superior mesenteric vein (SMV) and to evaluate branching patterns of the first jejunal trunk on axial CT images and multi-detector row CT (MDCT) venography in adults. Two hundred and twenty consecutive patients who underwent abdominal CT examinations were enrolled in this study. Appearance of the SMV, branching patterns of the first jejunal trunk, and drainage site of the inferior mesenteric vein (IMV) were assessed on axial CT images and MDCT venography. The SMV and first jejunal trunk were identified in all patients. A single trunk of the SMV was present in 95% (210/220) and absent in 5% (10/220). First jejunal trunk crossed dorsal to the superior mesenteric artery (SMA) towards the left abdomen in 64% (141/220) and first jejunal trunk crossed ventral to the SMA in 19% (41/220). First jejunal trunk crossed dorsal to the SMA and abruptly turned towards the right abdomen in 17% (38/220). Among these 38 patients, biliary-enteric bypass surgery (n = 9) and large hematoma in left abdomen (n = 1) were present. The IMV was identified in 213 patients and was observed to drain into splenic vein in 112 patients (53%), SMV in 67 (31%), splenoportal confluence in 26 (12%), and first jejunal trunk in 8 (4%). In conclusion, the first jejunal trunk, abruptly turning toward the right abdomen, may be an anatomic variant or indirect finding of biliary-enteric anastomosis. The IMV may drain into the first jejunal trunk as well as splenic vein, splenoportal confluence, and SMV.
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Affiliation(s)
- Hyoung Jung Kim
- Department of Diagnostic Radiology, Kyung Hee University Hospital, 1, Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, South Korea
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Trinidad-Hernandez M, Keith P, Habib I, White JV. Reversible Gastroparesis: Functional Documentation of Celiac Axis Compression Syndrome and Postoperative Improvement. Am Surg 2006. [DOI: 10.1177/000313480607200413] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Celiac axis compression syndrome has generated much controversy since its original description in 1963. The main symptoms are postprandial epigastric abdominal pain, regurgitation of undigested food, and weight loss, all of which are caused by gastric ischemia from impingement of the celiac axis by the median arcuate ligament of the diaphragm. These symptoms are seen in other common disorders such as chronic mesenteric ischemia and gastroparesis. This makes the diagnosis of celiac axis compression syndrome a true challenge for the clinician. We present data on three patients successfully treated. The pre- and postoperative studies clearly demonstrate a resolution of the condition. The duplex ultrasound images clearly show variable compression on the celiac axis. The angiogram presented shows a classic image of the disease. A review of the data has enabled us to develop an algorithm for the diagnosis of this disease.
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Affiliation(s)
- Magdiel Trinidad-Hernandez
- Department of Surgery, University of Illinois College of Medicine/Metropolitan Group Hospitals, Chicago, Illinois; and
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Phillip Keith
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Ibrahim Habib
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - John V. White
- Department of Surgery, University of Illinois College of Medicine/Metropolitan Group Hospitals, Chicago, Illinois; and
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois
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40
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Fujisawa Y, Morishita K, Fukada J, Hachiro Y, Kawaharada N, Abe T. Celiac Artery Compression Syndrome Due to Acute Type B Aortic Dissection. Ann Vasc Surg 2005; 19:553-6. [PMID: 15981118 DOI: 10.1007/s10016-005-5022-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute distal aortic dissection sometimes causes one or more visceral vessels to be stenosed by the thrombosed false lumen. Although stenosis of the only celiac artery (CA) usually does not cause ischemic symptoms because of the extensive collateral pathways of the mesenteric circulation, we experienced a rare case of CA compression syndrome which was caused by acute type B aortic dissection. The principal symptom was severe epigastric pain that was refractory to medicinal treatment. The angiogram showed absence of the anatomically well-developed collateral pathways between the CA and the superior mesenteric artery. We treated the patient with percutaneous transluminal angioplasty in the CA. This report indicates that attention should be given to the possibility of CA compression syndrome in the case of acute distal aortic dissection and that endovascular management can be successfully applied to control symptoms caused by the syndrome, which is otherwise extremely difficult to repair directly by surgery.
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Affiliation(s)
- Yasuaki Fujisawa
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
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Abstract
PURPOSE The aim of this study was to review the literature regarding collateral mesenteric circulation with emphasis on the mesenteric meandering artery (of Moskowitz). Standard vascular embryology and anatomy are described as are the collateral mesenteric vessels that can develop with arterial stenosis or occlusion. A discussion on the correct usage of terms for describing mesenteric collateral vessels follows. METHODS We undertook review of the historical literature to discuss the surgical implications of the meandering mesenteric artery. RESULTS Despite a long history of study by anatomists and surgeons, confusion still persists regarding both the number and correct descriptive terminology of the collateral mesenteric vessels. CONCLUSIONS The use of the vague historic term "arc of Riolan" should be discarded for the more precise term "meandering mesenteric artery." The meandering mesenteric artery should routinely be preserved in all surgical procedures, to include resection for cancer, given its critical function in providing collateral mesenteric circulation. Further evaluation in the asymptomatic patient, however, is unnecessary.
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Affiliation(s)
- Eric J Gourley
- Department of Surgery, General Surgery Service, William Beaumont Army Medical Center, El Paso, Texas 79920, USA.
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Obernosterer A, Aschauer M, Mitterhammer H, Lipp RW. Congenital familial vascular anomalies: a study of patients with an anomalous inferior vena cava, and of their first-degree relatives. Angiology 2004; 55:73-7. [PMID: 14759092 DOI: 10.1177/000331970405500110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With magnetic resonance angiography and computed tomography, congenital anomalies of the inferior vena cava are diagnosed more frequently than they used to be. Accessory renal arteries identified by magnetic resonance angiography in a patient with an anomalous inferior vena cava indicated a combination of arterial and venous abnormalities. The study was initiated to screen consecutive patients with an anomalous inferior vena cava for concomitant abdominal and pelvic arterial abnormalities, and their first-degree relatives for congenital vascular anomalies. Magnetic resonance angiography identified in 2 of 5 patients with an anomalous inferior vena cava concomitant accessory renal arteries and in 5 of 11 first-degree relatives major abdominal vascular anomalies including accessory renal arteries, accessory renal veins, and anomalies of the hepatic artery. None of the relatives showed abnormalities of the inferior vena cava. The familial occurrence of vascular anomalies strongly suggests an underlying pathogenetic component in affected family members. In patients with a congenital anomaly of the inferior vena cava, concomitant arterial abnormalities should be considered. First-degree relatives may be at risk for congenital vascular anomalies.
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Affiliation(s)
- Andrea Obernosterer
- Division of Angiology, Department of Internal Medicine, Karl-Franzens University Hospital, Graz, Austria, Europe.
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Abstract
Due to several distinct advantages over conventional angiography (including minimal invasiveness, lower cost, and lower ionizing radiation exposure for patients and staff), computed tomography (CT) angiography has replaced diagnostic conventional angiography in several clinical situations. The recent introduction of multislice CT (MSCT) scanners has significantly improved CT angiographic applications, especially in the evaluation of the mesenteric vasculature. Thin-slice collimation protocols associated with powerful postprocessing procedures allow the display of mesenteric circulation with excellent detail. The purposes of this presentation are (a) to illustrate the imaging technique that can be used to obtain state-of-the-art MSCT angiographic images of the mesenteric vasculature, (b) to review the normal anatomy and anatomic variants of mesenteric vessels, and (c) to illustrate some of the potential clinical applications of MSCT angiography of the mesenteric vessels.
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Affiliation(s)
- R Iannaccone
- Department of Radiological Sciences, University of Rome La Sapienza, Policlinico Umberto I, Via Arturo Graf, 40 00137 Rome, Italy.
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Horton KM, Fishman EK. Volume-rendered 3D CT of the mesenteric vasculature: normal anatomy, anatomic variants, and pathologic conditions. Radiographics 2002; 22:161-72. [PMID: 11796905 DOI: 10.1148/radiographics.22.1.g02ja30161] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Multi-detector row computed tomography (CT) offers important advantages over more conventional imaging methods in the evaluation of the mesenteric vasculature. It allows faster scanning, which practically eliminates motion and breathing artifacts, as well as thinner collimation. These advances, coupled with rapid intravenous administration of contrast material, allow excellent opacification of the mesenteric arteries and veins. This improves the quality of the three-dimensional (3D) data sets, which in turn leads to improved 3D vascular maps and more accurate assessment of various conditions such as arterial or venous encasement in patients with pancreatic cancer, mesenteric ischemia, or inflammatory bowel disease. Three-dimensional multi-detector row CT also allows better visualization of arterial and venous branching, thereby improving detection of more distal vascular involvement. In addition, 3D multi-detector row CT may help detect hemodynamic changes in patients with active inflammation and hyperemia of a bowel segment because it can be used to measure bowel wall enhancement over time. Carcinoid tumors that have infiltrated the mesentery have a characteristic CT appearance, and other conditions such as lymphoma or sclerosing mesenteritis can also manifest as an infiltrating mass that envelops mesenteric vessels. Three-dimensional multi-detector row CT represents a significant advance in CT technology and can help ensure prompt, accurate evaluation of the mesenteric vasculature.
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Affiliation(s)
- Karen M Horton
- Department of Radiology, Johns Hopkins Medical Institutions, 601 N Caroline St, Baltimore, MD 21287, USA
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