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Khirurgiia 2022We report surgical treatment of 4 patients with superior mesenteric artery aneurysm. A comprehensive examination including Doppler ultrasound and CT angiography of...
We report surgical treatment of 4 patients with superior mesenteric artery aneurysm. A comprehensive examination including Doppler ultrasound and CT angiography of visceral arteries made it possible to assess the features of vascular anatomy. In accordance with the peculiarities of upper mesenteric artery angioarchitectonics, open and endovascular methods were used. A differentiated approach made it possible to treat patients without any complications.
Topics: Aneurysm; Computed Tomography Angiography; Endovascular Procedures; Gastrointestinal Diseases; Humans; Mesenteric Artery, Superior
PubMed: 36073591
DOI: 10.17116/hirurgia2022091105 -
Langenbeck's Archives of Surgery Dec 2021Pancreatoduodenectomy is the only treatment with a promise of cure for patients with pancreatic head adenocarcinoma, and a negative resection margin is an important... (Review)
Review
BACKGROUND
Pancreatoduodenectomy is the only treatment with a promise of cure for patients with pancreatic head adenocarcinoma, and a negative resection margin is an important factor related to overall survival. Complete clearance of the medial margin with removal of the so-called mesopancreas may decrease the recurrence rate after pancreatic resection. Here, we present some important information about the mesopancreas, total mesopancreas excision, and technical aspects to achieve negative resection margins. The area named mesopancreas is defined as the tissue located between the head of the pancreas and the superior mesenteric vessels and the celiac axis and consists of the nerve plexus, lymphatic tissue, and connective tissue. The superior mesenteric and celiac arteries define the border of the mesopancreas. En bloc resection of anterior and posterior pancreatoduodenal nodes, hepatoduodenal nodes, along the superior mesenteric artery nodes, pyloric nodes, and nodes along the common hepatic artery is necessary.
CONCLUSIONS
Improved knowledge of the surgical anatomy of the region and technical refinements of excision of the mesopancreas along with standardized pathological examination are important to increase and to determine radical resection of pancreatic head cancer.
Topics: Humans; Mesenteric Artery, Superior; Pancreas; Pancreatic Neoplasms; Pancreaticoduodenectomy; Surgeons
PubMed: 34117891
DOI: 10.1007/s00423-021-02211-y -
Surgical and Radiologic Anatomy : SRA May 2022The literature reports the presence of the intermesenteric artery (IA), an anastomosis connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery...
PURPOSE
The literature reports the presence of the intermesenteric artery (IA), an anastomosis connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA) in 9-18% of human cadaver dissections. This is the first study describing the morphological and demographic characteristics of the IA based on in vivo imaging.
METHODS
A total of 150 consecutive abdominal computed tomography (CT) angiographies of adult patients identified by sex and age were analyzed. The IA was assessed for its presence, point of origin, pathway, point of insertion, and diameter at its origin. The diameters of the SMA, IMA, and other arteries from which the IA originated and into which it inserted were measured by CT angiography using Radiant™ and Osirix MD™ software.
RESULTS
The IA was found in 17 (51.5%) of the females and 60 (51.3%) of the males. The diameters of the SMA and IMA were larger in the males than in the females, but there was no sex difference in the diameter of the IA. The diameter of the SMA was larger than that of the IMA, and the diameter of the IA was smaller than that of the other arteries evaluated. An IA connecting the SMA and IMA trunks was found in 25.9% of the cases, while other connections between the branches of those trunks through an IA occurred less frequently.
CONCLUSIONS
The intermesenteric artery is more frequently found than the literature refers and in most of cases directly connects the upper and lower arterial mesenteric circulations.
Topics: Abdomen; Adult; Angiography; Female; Humans; Male; Mesenteric Artery, Inferior; Mesenteric Artery, Superior; Tomography, X-Ray Computed
PubMed: 35543749
DOI: 10.1007/s00276-022-02956-1 -
Anatomia, Histologia, Embryologia Sep 2021Rats are often used as animal models in studies such as on intestinal transplantation and anastomosis healing, which require colectomy. Although detailed information...
Rats are often used as animal models in studies such as on intestinal transplantation and anastomosis healing, which require colectomy. Although detailed information regarding arterial supply is important to establish accurate and reproducible experimental procedures, this has not been studied in the rat colon. Therefore, we analysed the detailed arterial distribution pattern and its individual variations in the colon of 34 rats. The rat colon received colic branches of the ileocolic artery, and the right, middle and left colic arteries. The single left colic artery constantly arose from the caudal mesenteric artery and was distributed to the descending colon, whereas the others showed variations in number and distribution. The ileocolic artery gave rise to one (12%) or two (88%) colic branches supplying the proximal ascending colon, and these branches formed rich, mesh-like anastomoses along the initial portion of the ascending colon. One (74%) or two (26%) right colic arteries originated from the cranial mesenteric artery and supplied the ascending colon and right colic flexure. Moreover, one (38%), two (56%) or three (6%) middle colic arteries emerged from the cranial mesenteric artery and were distributed to the transverse colon, left colic flexure and proximal descending colon. In total, we categorized the individual variations in arterial branching and anastomosis into 11 patterns. Arterial supply to the rat colon showed a specific pattern and frequent individual variations. These findings thus provide essential information for establishing reproducible models of rat colic surgery.
Topics: Animals; Colon; Intestines; Mesenteric Arteries; Rats
PubMed: 34414598
DOI: 10.1111/ahe.12730 -
Annals of Vascular Surgery May 2021The celiac trunk (CT) commonly trifurcates into the left gastric artery, common hepatic artery (CHA), and splenic artery (SA). The CHA then sends off the proper hepatic...
BACKGROUND
The celiac trunk (CT) commonly trifurcates into the left gastric artery, common hepatic artery (CHA), and splenic artery (SA). The CHA then sends off the proper hepatic artery and gastroduodenal artery (GDA). The arcades of the head of the pancreas are celiacomesenteric anastomoses between branches of the GDA and the superior mesenteric artery. A quadrifurcation of the CT commonly occurs when a different branch is added to the 3 normal ones. An uncommon quadrifurcation of the CT occurs when only one or 2 of the normal branches of the CT participate.
METHODS
The CT quadrifurcations were documented on 112 computed tomography angiograms.
RESULTS
Five different types of CT quadrifurcation-3 uncommon (types 1-3) and 2 common (types 4-5)-were found in 15/112 cases (13.39%). A marginal significant association was found between the presence of quadrifurcations and male gender (P = 0.05; Fisher's exact test). Type 1 showed a hepatogastric trunk+SA + right hepatic artery+GDA pattern, type 2 had an HGT + right inferior phrenic artery + CHA + SA pattern, type 3 had a gastrophrenic trunk + left inferior phrenic artery+CHA + SA pattern, type 4 showed an left gastric artery + CHA + SA + left inferior phrenic artery combination, and type 5 had an additional common inferior phrenic trunk. One of the type 4 cases showed a buildup of a mesentericomesenteric anastomotic pancreatic arcade between the inferior pancreaticoduodenal arteries, rather than a celiacomesenteric one.
CONCLUSIONS
Anatomic variation of the celiacomesenteric axis is important during hepatobiliary and duodenopancreatic approaches. Therefore, preoperative evaluation is essential because theoretical anatomic possibilities could be real arterial variants.
Topics: Celiac Artery; Computed Tomography Angiography; Female; Gastric Artery; Hepatic Artery; Humans; Male; Mesenteric Artery, Superior; Predictive Value of Tests; Retrospective Studies; Risk Factors; Sex Factors; Splenic Artery; Vascular Malformations
PubMed: 33359689
DOI: 10.1016/j.avsg.2020.11.016 -
Anatomical Science International Jun 2021Awareness of the anatomical variations in abdominal surface anatomy with emphasis on relation to the abdominal planes may facilitate anatomical education and physical...
Awareness of the anatomical variations in abdominal surface anatomy with emphasis on relation to the abdominal planes may facilitate anatomical education and physical examination and inconvenience surgical intervention by giving surgeons more insight in surgical planning and training. This study was designed to verify whether the anatomical planes promote to the comprehension of surface anatomy and how the lumbar lordosis angle affects the vertebral level of the bifurcation of great vessels. This retrospective study was performed using computed tomography angiography images of 155 patients ranging from 18 up to 82 years. The vertebral levels of the celiac truncus, superior mesenteric artery, portal vein confluence, right and left renal arteries were within the transpyloric plane in 60%, 70%, 56.1% and 48.3-36.2% of patients, respectively. The inferior mesenteric artery was below the subcostal plane in 58% of patients. The aortic bifurcation (AB) was mostly corresponded to the level of L4 and was located within the umbilical plane in 73.1% of patients. The level of the inferior vena cava (IVC) confluence was within the supracristal plane in 54% of patients. We measured the mean value of the AB, IVC and lumbar lordosis angles as 39.54°, 58.05° and 54.26°, respectively. The AB and IVC levels showed a downward shift with decreasing lumbar lordosis angle. Precise knowledge of these relationships is crucial in clinical practice and surgical approaches to the anterior lumbosacral spine for safer and effective surgery.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Computed Tomography Angiography; Female; Humans; Lordosis; Lumbar Vertebrae; Male; Mesenteric Arteries; Middle Aged; Retrospective Studies; Young Adult
PubMed: 33453038
DOI: 10.1007/s12565-021-00602-1 -
Automated Detection and Diameter Estimation for Mouse Mesenteric Artery Using Semantic Segmentation.Journal of Vascular Research 2021Pressurized myography is useful for the assessment of small artery structures and function. However, this procedure requires technical expertise for sample preparation...
BACKGROUND
Pressurized myography is useful for the assessment of small artery structures and function. However, this procedure requires technical expertise for sample preparation and effort to choose an appropriate sized artery. In this study, we developed an automatic artery/vein differentiation and a size measurement system utilizing machine learning algorithms.
METHODS AND RESULTS
We used 654 independent mouse mesenteric artery images for model training. The model yielded an Intersection-over-Union of 0.744 ± 0.031 and a Dice coefficient of 0.881 ± 0.016. The vessel size and lumen size calculated from the predicted vessel contours demonstrated a strong linear correlation with manually determined vessel sizes (R = 0.722 ± 0.048, p < 0.001 for vessel size and R = 0.908 ± 0.027, p < 0.001 for lumen size). Last, we assessed the relation between the vessel size before and after dissection using a pressurized myography system. We observed a strong positive correlation between the wall/lumen ratio before dissection and the lumen expansion ratio (R = 0.832, p < 0.01). Using multivariate binary logistic regression, 2 models estimating whether the vessel met the size criteria (lumen size of 160-240 μm) were generated with an area under the receiver operating characteristic curve of 0.761 for the upper limit and 0.747 for the lower limit.
CONCLUSION
The U-Net-based image analysis method could streamline the experimental approach.
Topics: Animals; Arterial Pressure; Automation; Female; Genotype; Image Interpretation, Computer-Assisted; Machine Learning; Male; Mesenteric Arteries; Mesenteric Veins; Mice, Inbred C57BL; Mice, Transgenic; Microscopy; Myography; Neural Networks, Computer; Phenotype; Predictive Value of Tests; Mice
PubMed: 34182554
DOI: 10.1159/000516842 -
Asian Cardiovascular & Thoracic Annals May 2023Spontaneous isolated mesenteric arterial dissection (SIMAD) is an uncommon subset of non-traumatic dissection of the mesenteric arteries without concurrent aortic... (Review)
Review
Spontaneous isolated mesenteric arterial dissection (SIMAD) is an uncommon subset of non-traumatic dissection of the mesenteric arteries without concurrent aortic dissection. Due to the widespread use of computer tomography angiography, SIMAD cases have been increasingly reported in the past 20 years. Common risk factors associated with SIMAD include male gender, age 50-60 years, hypertension and smoking. This review summarises the diagnostic pathway and management of SIMAD based on contemporary literature and proposes a treatment algorithm for SIMAD. The presentation of SIMAD can be divided into symptomatic and asymptomatic cases. Symptomatic patients should be carefully assessed to detect the development of complications, particularly bowel ischemia or vessel rupture. Although these complications are rare, they necessitate urgent surgical management. The vast majority of symptomatic SIMAD cases are uncomplicated and can be managed safely with conservative treatment that includes antihypertensive therapy, bowel rest, with or without antithrombotic therapy. For asymptomatic SIMAD cases, expectant management with outpatient surveillance imaging appears to be a safe strategy.
Topics: Humans; Male; Middle Aged; Mesenteric Artery, Superior; Mesenteric Arteries; Mesenteric Ischemia; Computed Tomography Angiography; Aortic Dissection; Treatment Outcome; Retrospective Studies
PubMed: 37005792
DOI: 10.1177/02184923231166338 -
Pancreatology : Official Journal of the... Mar 2022The dorsal pancreatic artery is the main artery of the body and tail of the pancreas. Its origin and branching is highly variable. The aim of this study was to perform a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/OBJECTIVES
The dorsal pancreatic artery is the main artery of the body and tail of the pancreas. Its origin and branching is highly variable. The aim of this study was to perform a meta-analysis to generate pooled prevalence data on the presence and origin of the dorsal pancreatic artery. Clinically important aspects of the dorsal pancreatic artery were summarised during the literature review.
METHODS
Major medical databases were searched. Data on the presence and point of origin of the dorsal pancreatic artery were extracted and quantitatively synthesised. The obtained data of anatomical based studies and computed tomography based studies were statistically analysed.
RESULTS
In total, 30 studies, comprising 2322 anatomical and computed tomography based cases were included. The dorsal pancreatic artery was present in 95.8% of cases. It originated from the splenic artery in 37.6% of cases, common hepatic artery in 18.3% of cases, coeliac trunk in 11.9% of cases and the superior mesenteric artery in 23.9% of cases. Other rare origins were present in 2.77% of cases. Multiple dorsal pancreatic arteries were found in 1,7% of cases. There was no significant difference in the presence or origin of the dorsal pancreatic artery between anatomical and computed tomography based studies.
CONCLUSION
The dorsal pancreatic artery is present in the vast majority of cases. Its origin and branching are highly variable. Multiplicity of the dorsal pancreatic artery is infrequent.
Topics: Celiac Artery; Humans; Mesenteric Artery, Superior; Pancreas; Splenic Artery; Tomography, X-Ray Computed
PubMed: 35177332
DOI: 10.1016/j.pan.2022.02.002 -
Journal of Visualized Experiments : JoVE Jul 2023Early diagnosis of mesenteric ischemia remains challenging because mesenteric ischemia presents with no key symptoms or physical findings, and no laboratory data...
Early diagnosis of mesenteric ischemia remains challenging because mesenteric ischemia presents with no key symptoms or physical findings, and no laboratory data specifically indicates intestinal tissue ischemic status before necrosis develops. While computed tomography is the standard for diagnostic imaging, there are several limitations: (1) repeated assessments are associated with increased radiation exposure and risk of renal damage; (2) the computed tomography findings can be misleading because necrosis occasionally occurs despite opacified mesenteric arteries; and (3) computed tomography is not necessarily available within the golden time of salvaging the intestines for those patients in the operating room or at a place far from the hospital. This article describes a challenge to overcome such limitations using ultrasonography and near-infrared light, including clinical studies. The former is capable of providing not only morphologic and kinetic information of the intestines but also perfusion of the mesenteric vessels in real-time without transferring the patient or exposing them to radiation. Transesophageal echocardiography enables precise assessment of mesenteric perfusion in the OR, ER, or ICU. Representative findings of mesenteric ischemia in seven aortic dissection cases are presented. Near-infrared imaging with indocyanine green helps visualize the perfusion of vessels and intestinal tissues although this application requires laparotomy. Findings in two cases (aortic aneurysm) are shown. Near-infrared spectroscopy demonstrates oxygen debt in the intestinal tissue as digital data and can be a candidate for early detection of mesenteric ischemia without laparotomy. The accuracy of these assessments has been confirmed by intraoperative inspections and postoperative course (prognosis).
Topics: Humans; Mesenteric Ischemia; Multimodal Imaging; Mesenteric Arteries; Mesentery; Perfusion
PubMed: 37590532
DOI: 10.3791/65095