A new classification for the branching pattern of the left colic artery and the sigmoid arteries from the inferior mesenteric artery
EAES Academy. Kazaryan A. 07/05/22; 362998; P041
Dr. Airazat M. Kazaryan
Contributions
Contributions
Abstract
AIMS
The splenic flexure is situated in-between two vascular areas irrigated from the middle colic artery (MCA) and from the inferior mesenteric artery (IMA). The aim of this study is to explore the impact of the MCA bifurcation, the presence of the accessory middle colic artery (aMCA), the 3-dimensional relationship between the two vascular areas and the pattern of the inferior mesenteric vein (IMV) confluence.
Methods:
The vascular anatomy was studied using 32 preoperative high-resolution CT scans. The CT scans were manually 3D reconstructed using Osirix MD, Mimics Medical and 3-matic Medical Datasets, and exported for further investigations as PDF files, video clips, stills and STL files for 3D printing.
Results:
The most common position (53.1%) for the MCA bifurcation was in front of the superior mesenteric vein (SMV), followed by right to SMV (34,4%) and left to SMV (12.1%). The median distance from the MCA origin to the MCA bifurcation was 3.21 cm.
The aMCA was found in 31.3% of the patients. All aMCA trajected towards the splenic flexure. 50% directly through the transverse colon mesentery, and 50% following the lower pancreatic border before turning towards the flexure.
The origin of MCA could be found both cranial (87.5%) and caudal (9.4%) to the origin of IMA. 3.1% of the patients lacked proper MCA. We found an anatomical triangle between the MCA origin, the aorta, and the IMA origin. This triangle represents the mesenteric inter-arterial step.
The IMV has two main confluence patterns, to the SMV, either through a jejunal vein or directly (65.6%) or to the splenic vein (34.4%). Either way, the path of the IMV could be infrapancreatic (53.1%), infrapancreatic with a retropancreatic arch (21.9%) or true retropancreatic (25%).
Conclusion:
Today the surgeon could be aided by many techniques giving the possibility to personalise surgery according to patient specific anatomy. The different anatomical variants might represent different possible lymphatic pathways which must be considered. To negotiate the mesenteric inter-arterial step, the surgeon could follow the IMV.
The splenic flexure is situated in-between two vascular areas irrigated from the middle colic artery (MCA) and from the inferior mesenteric artery (IMA). The aim of this study is to explore the impact of the MCA bifurcation, the presence of the accessory middle colic artery (aMCA), the 3-dimensional relationship between the two vascular areas and the pattern of the inferior mesenteric vein (IMV) confluence.
Methods:
The vascular anatomy was studied using 32 preoperative high-resolution CT scans. The CT scans were manually 3D reconstructed using Osirix MD, Mimics Medical and 3-matic Medical Datasets, and exported for further investigations as PDF files, video clips, stills and STL files for 3D printing.
Results:
The most common position (53.1%) for the MCA bifurcation was in front of the superior mesenteric vein (SMV), followed by right to SMV (34,4%) and left to SMV (12.1%). The median distance from the MCA origin to the MCA bifurcation was 3.21 cm.
The aMCA was found in 31.3% of the patients. All aMCA trajected towards the splenic flexure. 50% directly through the transverse colon mesentery, and 50% following the lower pancreatic border before turning towards the flexure.
The origin of MCA could be found both cranial (87.5%) and caudal (9.4%) to the origin of IMA. 3.1% of the patients lacked proper MCA. We found an anatomical triangle between the MCA origin, the aorta, and the IMA origin. This triangle represents the mesenteric inter-arterial step.
The IMV has two main confluence patterns, to the SMV, either through a jejunal vein or directly (65.6%) or to the splenic vein (34.4%). Either way, the path of the IMV could be infrapancreatic (53.1%), infrapancreatic with a retropancreatic arch (21.9%) or true retropancreatic (25%).
Conclusion:
Today the surgeon could be aided by many techniques giving the possibility to personalise surgery according to patient specific anatomy. The different anatomical variants might represent different possible lymphatic pathways which must be considered. To negotiate the mesenteric inter-arterial step, the surgeon could follow the IMV.
AIMS
The splenic flexure is situated in-between two vascular areas irrigated from the middle colic artery (MCA) and from the inferior mesenteric artery (IMA). The aim of this study is to explore the impact of the MCA bifurcation, the presence of the accessory middle colic artery (aMCA), the 3-dimensional relationship between the two vascular areas and the pattern of the inferior mesenteric vein (IMV) confluence.
Methods:
The vascular anatomy was studied using 32 preoperative high-resolution CT scans. The CT scans were manually 3D reconstructed using Osirix MD, Mimics Medical and 3-matic Medical Datasets, and exported for further investigations as PDF files, video clips, stills and STL files for 3D printing.
Results:
The most common position (53.1%) for the MCA bifurcation was in front of the superior mesenteric vein (SMV), followed by right to SMV (34,4%) and left to SMV (12.1%). The median distance from the MCA origin to the MCA bifurcation was 3.21 cm.
The aMCA was found in 31.3% of the patients. All aMCA trajected towards the splenic flexure. 50% directly through the transverse colon mesentery, and 50% following the lower pancreatic border before turning towards the flexure.
The origin of MCA could be found both cranial (87.5%) and caudal (9.4%) to the origin of IMA. 3.1% of the patients lacked proper MCA. We found an anatomical triangle between the MCA origin, the aorta, and the IMA origin. This triangle represents the mesenteric inter-arterial step.
The IMV has two main confluence patterns, to the SMV, either through a jejunal vein or directly (65.6%) or to the splenic vein (34.4%). Either way, the path of the IMV could be infrapancreatic (53.1%), infrapancreatic with a retropancreatic arch (21.9%) or true retropancreatic (25%).
Conclusion:
Today the surgeon could be aided by many techniques giving the possibility to personalise surgery according to patient specific anatomy. The different anatomical variants might represent different possible lymphatic pathways which must be considered. To negotiate the mesenteric inter-arterial step, the surgeon could follow the IMV.
The splenic flexure is situated in-between two vascular areas irrigated from the middle colic artery (MCA) and from the inferior mesenteric artery (IMA). The aim of this study is to explore the impact of the MCA bifurcation, the presence of the accessory middle colic artery (aMCA), the 3-dimensional relationship between the two vascular areas and the pattern of the inferior mesenteric vein (IMV) confluence.
Methods:
The vascular anatomy was studied using 32 preoperative high-resolution CT scans. The CT scans were manually 3D reconstructed using Osirix MD, Mimics Medical and 3-matic Medical Datasets, and exported for further investigations as PDF files, video clips, stills and STL files for 3D printing.
Results:
The most common position (53.1%) for the MCA bifurcation was in front of the superior mesenteric vein (SMV), followed by right to SMV (34,4%) and left to SMV (12.1%). The median distance from the MCA origin to the MCA bifurcation was 3.21 cm.
The aMCA was found in 31.3% of the patients. All aMCA trajected towards the splenic flexure. 50% directly through the transverse colon mesentery, and 50% following the lower pancreatic border before turning towards the flexure.
The origin of MCA could be found both cranial (87.5%) and caudal (9.4%) to the origin of IMA. 3.1% of the patients lacked proper MCA. We found an anatomical triangle between the MCA origin, the aorta, and the IMA origin. This triangle represents the mesenteric inter-arterial step.
The IMV has two main confluence patterns, to the SMV, either through a jejunal vein or directly (65.6%) or to the splenic vein (34.4%). Either way, the path of the IMV could be infrapancreatic (53.1%), infrapancreatic with a retropancreatic arch (21.9%) or true retropancreatic (25%).
Conclusion:
Today the surgeon could be aided by many techniques giving the possibility to personalise surgery according to patient specific anatomy. The different anatomical variants might represent different possible lymphatic pathways which must be considered. To negotiate the mesenteric inter-arterial step, the surgeon could follow the IMV.
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