One visceral artery is enough. Pancreatectomy in a patient with total occlusion of the celiac and superior mesenteric arteries
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Keywords:
Celiac artery
Common hepatic artery
Inferior mesenteric artery
Collateral circulation
Mesenteric arteries
Objective To investigate the evaluation of collateral circulation after the inferior mesenteric artery stenosis/occlusion by multi-slice CT angiography(MSCTA).Methods Review the materials of 50 patients of abdominal aorta examined by MSCTA,13 patients were found inferior mesenteric artery(IMA) stenosis or occlusion.Revascularization of the vessel by volume rendering(VR) technology to add blood vessels(AV) to measure the formation of collateral circulation after IMA stenosis or occlusion.Results All the 13 patients with IMA stenosis or occlusion were found Riolan.Conclusion MSCTA can evaluate perfectly formation of collateral circulation of inferior mesenteric artery(IMA) stenosis or occlusion,which is useful to diagnosis and treatment of this disease.
Inferior mesenteric artery
Collateral circulation
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A pancreatic adenocarcinoma involving both the celiac artery and the gastroduodenal artery is often considered to be unresectable because the simultaneous division of both arteries may result in an acute severe ischemia of the liver and the stomach. We report here a case of total pancreatectomy with en bloc celiac axis resection for a 61-year-old female with a pancreatic adenocarcinoma involving both the celiac artery and the gastroduodenal artery. The patient had a replaced right hepatic artery from the superior mesenteric artery and a replaced left hepatic artery from the left gastric artery, which was directly arising from the aorta. Preserving these collateral arteries, neither hepatic artery reconstruction nor total gastrectomy was needed after resection. The reported incidence of similar arterial anatomy was only 0.2% but the precise evaluation of arterial anatomy is important to offer a chance of curative resection for patients with usually unresectable locally advanced pancreatic cancer.
Gastroduodenal artery
Celiac artery
Common hepatic artery
Left gastric artery
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A 56-year-old man with thoracoabdominal aortic aneurysm combined with inferior mesenteric artery aneurysm and occlusion of celiac and superior mesenteric arteries is presented. Contrast-enhanced computed tomography (CT) and aortography revealed thoracoabdominal aortic aneurysm of 6 cm in diameter, accompanied by inferior mesenteric aneurysm of 3 cm in diameter. Severe calcification of the abdominal aorta and occlusion of the celiac and the superior mesenteric arteries were also noted, whose territories were perfused by collateral circulation of the inferior mesenteric artery. At the operation, orifice of the left renal artery was stenosed by severe calcification, which was resected. Because of severe adhesion around the origins of celiac and superior mesenteric arteries, they were left unrevascularized. The thoracoabdominal aortic aneurysm was replaced with an Dacron tube graft, whose side branch was anastomosed to the inferior mesenteric artery after resection of its aneurysm. The postoperative course was uneventful, and no symptoms of intestinal ischemia were noted. As blood supply to the abdominal viscera mostly depends on the inferior mesenteric artery, careful follow-up is necessary.
Inferior mesenteric artery
Celiac artery
Mesenteric arteries
Aortography
Collateral circulation
Abdominal aorta
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Inferior mesenteric artery
Celiac artery
Collateral circulation
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Three cases of hypernephroma in which the tumor blood supply was obtained from the inferior or superior mesenteric artery are presented. In each case, the origin of the blood supply was demonstrated by selective arteriography. Correlation of arteriographic and surgical findings indicates that the demonstration of parasitic blood supply from the mesenteric arteries is a reliable sign that the hypernephroma has extended beyond the renal capsules and has invaded the mesentery of the colon.
Inferior mesenteric artery
Blood supply
Mesenteric arteries
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The investigation was based on the results of roentgen-anatomical study of 155 digestive tract complexes obtained from 155 cadavers of humans of both genders aged 17-90 years. It was established that in 91% (in 141 of 155) of the cases the trunk of the inferior mesenteric vein (IMV) was accompanied by the arteries only in the lower part (by inferior mesenteric artery) and in the middle part (by the left colic artery). The terminal part of IMV was separated from the artery. In 9% of (in 14 of 155) cases the trunk of the IMV is accompanied along the whole extent by different arteries (from down upwards): by inferior mesenteric artery and left colic artery from inferior mesenteric artery, and in its terminal part either by an additional anastomosis between the superior and inferior mesenteric arteries (in 5 of 14 cases), or by an additional anastomosis between superior and inferior mesenteric arteries and the branch or trunk of the proximal colic artery from the superior mesenteric artery (in 9 of 14 cases).
Inferior mesenteric artery
Mesenteric arteries
Inferior mesenteric vein
Left gastric artery
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Inferior mesenteric artery
Mesenteric arteries
Mesenteric Ischemia
Bowel infarction
Ischemic Colitis
Perforation
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A 42-year-old man had intestinal ischemia 7 weeks after endovascular abdominal aortic aneurysm repair due to sacrifice of the inferior mesenteric artery, which had compensated for the intestinal blood supply because of the total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). He was diagnosed in the active phase of Takayasu arteritis, and an emergency endovascular treatment was performed. After the SMA failed to be recanalized, a stent was successfully placed into the CA; this choice was made based on the preexisting collaterals between them. The symptoms were relieved shortly after the operation. The Kirk arcade, the Barkow arcade, and the enlarged pancreaticoduodenal arcade were visualized on the follow-up computed tomography angiography. Based on this case, a short review of celiomesenteric and intermesenteric collateral circulations is presented.
Inferior mesenteric artery
Celiac artery
Mesenteric Ischemia
Computed Tomography Angiography
Collateral circulation
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Collateral circulation
Celiac artery
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Angiography was performed in a 70-year-old man because of a recurrence of massive hemochezia. The angiogram demonstrated a third mesenteric artery, arising from the aorta between the superior and inferior mesenteric arteries and supplying the splenic flexure. Although many variations of colonic arterial supply have been described, those involving vessels originating from the aorta separate from the celiac, superior mesenteric, or inferior mesenteric arteries are extremely rate.
Inferior mesenteric artery
Mesenteric arteries
Abdominal aorta
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