Branch Of Left Colic Artery Research Articles

Surgical Significance of Variant Anatomy of Inferior Mesenteric Artery and Left Colic Artery: A Computed Tomography Angiographic Study

Introduction: A variation in vessel morphology determines flow dynamics and vascular disease pathogenesis. Definite information on the distinctive anatomical variations of the mesenteric vessels is extremely important for laparoscopic surgical procedures and interventional radiological procedures in the abdominal region. Three-dimensional-computed tomography angiography (3D-CTA) is a less invasive method to evaluate vascular anatomy using a visual tracking method on high-definition images, contrast-enhanced inferior mesenteric artery (IMA) can be traced to its terminal branches beside the colon wall. Subjects and Methods: Abdominal contrast-enhanced computed tomography scan data from 180 patients was retrospectively collected, reconstructed, and analyzed. The origin, length of IMA from origin to the first branch, branching patterns of IMA, and tracking patterns of the ascending branch of left colic artery (LCA), were examined, and their associations with clinical features were analyzed. Results: IMA displayed variations in the level of origin ranging from upper 1/3 of L3 to upper 1/3 of L4, mean length from origin to the first branch was 27.4 ± 7.8 mm. Observed branching patterns of IMA were grouped according to Yada classification: Type 1 (52.2%), Type 2 (15.5%), Type 3 (14.4%), and Type 4 (17.7%). Tracking of the ascending branch of LCA before anastomosis with marginal artery revealed four patterns: Type A LCA pattern in 43.9%; Type B LCA anatomy pattern was (19.4%); Type C LCA anatomy pattern was (20.0%); and Type D LCA anatomy pattern was observed (16.7%). Conclusion: Preoperative understanding of the vascular variations of IMA and LCA can be obtained by 3D-CTA. This may be helpful to surgeons in planning preoperative strategies to prevent iatrogenic injuries.

Imaging-Guided Percutaneous Puncture and Embolization of Visceral Pseudoaneurysms: Feasibility and Outcomes.

Visceral artery pseudoaneurysms (VAPAs) are the most frequently diagnosed pseudoaneurysms (PSAs). PSAs can be asymptomatic or symptomatic. The aim of our study was to evaluate the safety and effectiveness of percutaneous embolization of VAPAs performed on patients with an unfeasible trans-arterial approach. Fifteen patients with fifteen visceral PSAs, with a median dimension of 21 mm (IQR 20–24 mm), were retrospectively analyzed. No patients were suitable for trans-arterial catheterization and therefore a percutaneous approach was chosen. During percutaneous treatments, two embolic agents were used, either N-butyl cyanoacrylate (NBCA) (Glubran II, GEM Milan, Italy) mixed with Lipiodol (Lipiodol, Guerbet, France) or thrombin. The outcomes of this study were technical success, primary clinical success, and secondary clinical success. In our population the 15 PSA were located as follows: 2 in the left gastric artery, 1 in the right gastric artery, 3 in the right hepatic artery, 2 in a jejunal artery, 1 in left colic artery branch, 1 in a right colic artery branch, 1 in the gastroepiploic artery, 1 in the dorsal pancreatic artery, 1 in an ileocolic artery branch, 1 in an iliac artery branch, and 1 in a sigmoid artery branch. 80% of PSAs (12/15) were treated with a NBCA:lipiodol mixture and 20% of PSAs (3/15) were treated with thrombin. Technical, primary, and secondary clinical successes were obtained in 100% of the cases. No harmful or life-threatening complications were observed. Minor complications were registered in 26.6% (4/15) of the patients. Percutaneous embolization of visceral PSA is a safe and effective treatment and should be considered as an option when the endovascular approach is unsuccessful or unfeasible.

Level of inferior mesenteric artery ligation does not affect rectal cancer treatment outcomes despite better cancer-specific survival after low ligation-randomized trial results.

In rectal cancer surgery, the problem about which of the mesenteric artery ligation variants (high or low) is more beneficial to the patient remains unsolved. Recent meta-analyses suggest that the risk of surgical complications is similar for both ligation variants. The main objective was to compare the survival time in both groups with a minimum 48months' follow-up. Secondary objectives were comparison of the number of harvested lymph nodes, the complication rate and other selected data related to the surgery. This was a randomized, single-centre, unblinded clinical trial of adult patients (n=130) with cT1-3M0/ycT0-3M0 rectal and rectosigmoid junction adenocarcinoma undergoing radical open surgery. The intervention level was inferior mesenteric artery ligation. The mean and median survival in the whole group was 45months, while in the survivor group it was 83 and 82months. The survival for 1-5years, overall survival and disease-free survival were similar in both groups. The cancer-specific survival time was longer in the low inferior mesenteric artery ligation group (P=0.005 for all and P=0.02 for pTNM Stage III patients) There were no differences in the incidence of anastomotic leakage and overall morbidity. The median number of lymph nodes located at the root of the inferior mesenteric artery was 1; the mean was 1.7. They were not metastatic in any case. The median total number of harvested nodes was similar in both groups. In radically treated adenocarcinoma of the rectum and the rectosigmoid junction, the level of inferior mesenteric artery ligation below the left colic artery branch provides similar treatment results to inferior mesenteric artery ligation just below its branching from the aorta in relation to overall and disease-free survival, and the risk of complications. Low inferior mesenteric artery ligation results in better cancer-specific survival. The risk of metastases at the mesenteric nodes is negligible.

The New Concept of Physiological "Riolan's Arch" and the Reconstruction Mechanism of Pathological Riolan's Arch After High Ligation of the Inferior Mesenteric Artery by CT Angiography-Based Small Vessel Imaging.

BackgroundDue to the complexity of anatomical relationship between superior mesenteric artery (SMA) and left colic artery (LCA), there is no unified anatomical concept of “Riolan’s arch.” There is no consensus as to tie off the inferior mesenteric artery (IMA) at its origin or just below the origin of the left colic artery during radical surgery of sigmoid colon and rectal cancers. The aim of the study is to investigate the anatomy of shortcut anastomotic branches (adjacent branches) of SMA at splenic flexure and to explore how the shortcut pathway (Riolan’s arch) was formed, as the compensation of anastomotic branches between MCA and LCA under pathological conditions and the reconstruction and the mechanism of pathological Riolan’s arch after high ligation of the inferior mesenteric artery.MethodsBetween January 2018 and May 2020, patients with colorectal cancer who underwent CTA before surgery were enrolled in the study. The anatomy of shortcut anastomotic branch of SMA and LCA was investigated by volume rendering technique (VR) and maximum-intensity projection (MIP). GE’s small vessel extraction technology (selected VR) was used to directly display these shortcut anastomotic branches on a map and to establish their three-dimensional anatomical classification. Then, we used the axonometric drawing to make the model more exact. Next, combining with some cases of pathological Riolan’s arch and basing on hydrodynamic principle, we speculate the mechanism of collateral circulation. Finally, based on the retrospective study of high ligation cases and combined principles of fluid mechanics, we show how these shortcut anastomotic branches evolved into Riolan’s arch.ResultsWe report the classification of the ascending branch of LCA (which approaches the splenic flexure) and the left branch of MCA, display these shortcut anastomotic branches on a map, and establish their three-dimensional anatomical classification. We found that Riolan’s arch is a shortcut pathway for the compensation of anastomotic branches, between MCA and LCA under pathological conditions, and that the formation mechanism of shortcut path accords with the principle of hydrodynamics.ConclusionsOur results show the mechanism of pathological Riolan’s arch formation and provide new anatomic thinking for the battle between high and low ligation of IMA in colorectal cancer surgery.

Lengthening of left colon after rectal resection: What all is adequate? A prospective cohort study

BackgroundAdequate mobilization of colon is essential to achieve tension free anastomosis after sphinchter saving surgeries. Methods26 patients undergoing of recto-sigmoid resection underwent low tie of inferior mesenteric artery (IMA), splenic flexure mobilization and descending branch of left colic artery (LCA) ligation in that order. One point at proximal 1/3rd of sigmoid colon (point of partial sigmoid resection) and another at descending-sigmoid colon junction (point of total sigmoid resection) were used for measurements and the distance was measured from pubic symphysis. Mobilization was considered adequate if colon could reach 2 cm beyond the upper border of pubic symphysis. ResultsThe length gained after each maneuver was 4.2 + 3.6 cm (low tie), 5.8 + 3.7 cm (splenic flexure mobilization) and 4.7 + 4.2 cm (descending branch of LCA ligation). Mobilization was adequate in 19% and 0% (low tie), 56% and 20% (low tie with splenic flexure mobilization) and 100% and 86% (all three manoeuvres) with partial and complete sigmoid resection respectively. In 13 patients undergoing low anterior resection, adequate mobilization for anastomosis was attainable in 15.3% and 0% (low tie), 50% and 0% (low tie with splenic flexure mobilization) and 100% and 83.3% (all three manoeuvres) with partial and complete sigmoid resection respectively. 15.3% had anastomotic leak, however none of the patients undergoing descending branch of LCA ligation had anastomotic insufficiency. ConclusionsLow tie of IMA, with splenic flexure mobilization as required results in sufficient mobilization only in 50% patients with partial sigmoid resection. Ligation of descending branch of LCA is feasible, safe and enables a tension free anastomosis and is especially beneficial when sigmoid colon is resected completely.

Middle mesenteric artery arising from an inflammatory infrarenal aortic aneurysm

We report of a patient with an inflammatory infrarenal aortic aneurysm with a diameter of 6.5 cm, a middle mesenteric artery (MMA) arising from the aneurysm, and a review of the literature. The patient underwent successful surgical treatment by using an interposition tube graft (Dacron graft, 18 mm) with replantation of the MMA. Reports about a MMA arising separately from the aorta are extremely rare, especially in combination with an infrarenal aortic aneurysm. In our case, it arose from the anterior aspect of the abdominal aorta, 6 cm below the superior mesenteric artery (SMA) and 1.2 cm above the inferior mesenteric artery (IMA). The MMA gave branches to the ileum and distal jejunum and supplied the iliocolic and middle colic artery branch as well as the left colic artery branch. It is of extreme clinical importance for the surgical procedure to have a detailed knowledge of the different anatomical variations and anomalies.

Acute Lower Gastrointestinal Hemorrhage: Minimally Invasive Management with Microcatheter Embolization

To evaluate the efficacy of superselective embolization therapy in the management of acute lower gastrointestinal (LGI) hemorrhage, including any bleeding distal to the ligament of Treitz. Between June and August 2007, 20 patients with acute LGI bleeding underwent superselective transcatheter arterial embolization (TAE) at the authors' institution. The bleeding had different causes. All patients were treated with use of microcatheters. The following embolic agents were used: microcoils (n = 16), polyvinyl alcohol (PVA) particles (n = 2), and a combination of microcoils and PVA particles (n = 2). Outcome measures included technical success (complete cessation of bleeding as documented at completion angiography), clinical success (resolution of signs or symptoms of LGI bleeding within 30 days after TAE), and the rate of major and minor complications. The identified bleeding sources were as follows: jejunal branch, branch of middle colic artery, branch of ileocolic artery, ileal branch, branch of left colic artery, branch of sigmoid artery, branch of the superior rectal artery, and branch of the middle rectal artery. Technical success with effective control of active bleeding was achieved in all patients (100%). Clinical success attributed to TAE was documented in 18 of the 20 patients (90%). Major complications included death due to pulmonary embolism, heart infarction, and multiorgan failure in the 3rd week after TAE; a procedure-related colonic infarction occurred in one patient. A minor complication occurred in one patient who developed a groin hematoma. Superselective embolization may be used for effective, minimally invasive control of acute LGI bleeding.

Esophagocoloplasty for congenital, benign and malignant diseases. Surgical and long-term functional results.

Aim of this report is to evaluate the results of 100 consecutive esophagocoloplasties performed for congenital, benign and malignant diseases. From 1982 until 1993 one hundred consecutive esophagocoloplasties were performed. Fifty eight for benign diseases: 22 congenital atresias (group A), 36 acquired benign lesions (group B), and 42 for malignancy (group C). As 72% of the patients had undergone previous gastric or esophageal surgery, coloplasty had to be performed in 48 patients by necessity. In 85 patients the colon graft was vascularized by the ascending branch of left colic artery and in 95 the reconstruction was fashioned in isoperistaltic way. Fifty one complications occurred in 42 patients resulting in a hospital mortality of 8%. However, for all benign diseases (group A + B) mortality rate was 0, being 19% in malignancy (group C). Morbidity was significantly higher in group A + C as compared to group B (p < 0.0009). Anastomotic leak was the most frequent complication occurring in 13 patients however healing spontaneously in 11 patients (84.6%). Early revisional surgery was performed in 11 patients. Functional results were evaluated according to a new grading system, including the four main symptoms (dysphagia, pain, regurgitations, diarrhoea) and weight status, the latter for adult patients. Fifty one patients from group A and B were followed for at least one year and evaluated. The were divided in two groups: 25 pediatrics (0.18 years). Anastomotic stenosis occurred in 19 patients but resolved after one or more dilatations in 16 at final follow-up. Dysphagia decreased from 43.1% 3 months postoperatively to 17.6% at last follow-up (p < 0.01). In adult patients there was a strong correlation between dysphagia and weight loss (p < 0.02). This correlation was not found in children. No differences were detectable when comparing preoperative mean weight of adult patients with mean weight of adult patients with mean weight at last follow-up. Of all 51 patients, 82.3% had an excellent (grade 1) or very good (grade 2) result at final evaluation versus 49% at 3 months follow-up (p < 0.0001). Only one patient had an unsatisfactory final result. Esophagocoloplasty is a valuable and for some patients an essential technique in reconstruction of esophageal continuity. Mortality can be kept very low, especially in benign diseases, guaranteeing satisfactory results in the majority of patients, despite an initial substantial perioperative morbidity.