A three-dimensional computed tomography angiography study of the anatomy of the accessory middle colic artery and implications for colorectal cancer surgery

Abstract

Purpose In the present study, we focused on the accessory middle colic artery and aimed to increase the safety and curative value of colorectal cancer surgery by investigating the artery course and branching patterns. Methods We included 143 cases (mean age, 70.4 ± 11.2 years; 86 males) that had undergone surgery for neoplastic large intestinal lesions at the First Department of Surgery at Yamagata University Hospital between August 2015 and July 2018. We constructed three-dimensional (3D) computed tomography (CT) angiograms and fused them with reconstructions of the large intestines. We investigated the prevalence of the accessory middle colic artery, the variability of its origin, and the prevalence and anatomy of the arteries accompanying the inferior mesenteric vein at the same level as the origin of the inferior mesenteric artery. Results Accessory middle colic artery was observed in 48.9% (70/143) cases. This arose from the superior mesenteric artery in 47, from the inferior mesenteric artery in 21, and from the celiac artery in two cases. In 78.2% (112/143) cases, an artery accompanying the inferior mesenteric vein was present at the same level as the origin of the inferior mesenteric artery; this artery was the left colic artery in 92, the accessory middle colic artery in 11, and it divided and became the left colic artery and the accessory middle colic artery in 10 cases. Conclusion 3D CT angiograms are useful for preoperative evaluation. Accessory middle colic arteries exist and were observed in 14.9% of cases.

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer

“…The frequency of the aMCA presence reported in the literature is highly variable. It ranges from 4.1% [ 13 ] to 49.2% [ 16 ]. It seems that the reported incidence of finding this vessel has increased during the last three decades [ 14 ], reflecting the rising interest in this vessel.…”

“…Further, when preoperative examinations suggest aMCA following IMV, one should anticipate a vessel in close proximity to the inferior border of the pancreas which has a high probability of being accompanied by lymphatic drainage from the splenic flexure. In addition, it is necessary to mention when the aMCA is in concern that considerable confusion can arise due the different nomenclature deployed in the literature for a vessel with a similar origin and trajectory, the superior left colic artery [ 42 ], the left accessory aberrant colic artery [ 32 , 43 ], accessory left colic artery [ 13 , 44 ] or most recently the transverse colon splenic flexure artery [ 16 ].…”

“…The aMCA was defined as a vessel originating from SMA cranial to the "regular" MCA origin, entering the mesocolon and running towards the splenic flexure [13][14][15][16].…”

Surgical anatomy of the accessory middle colic artery: a meta‐analysis with implications for splenic flexure cancer surgery

“…A total of 16 studies (n = 2203 patients) were included [3,7,8,[14][15][16][17][18][19][20][21][22][23][24][25][26]. Most of the studies were performed in Asia (12 studies, 1923 patients) while the rest were from North America (2 studies, 240 patients); Europe (1 study, 13 patients) and the Middle East (1 study, 27 patients).…”

The vessels around the transverse colon mesentery – An investigation using 44 cadaver specimens and 505 cases in which dynamic computed tomography angiography was performed

“…The analysis of the frequency of the AMCA has been reported. (13)(14)(15)(16)) Some studies focused on the splenic exure and its relationship to the left colic artery. (34,35) The analytical methods have been reported, with some studies using CT angiography and others using cadavers; the AMCA was reported to be present in 6.8-49.2%.…”