Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: Insights into rectal cancer surgery – A retrospective observational study

Ke, Jia; Cai, Jiawei; Wen, Xiaofeng; Wu, Xianrui; He, Zhen; Zou, Yifeng; Qiu, Jianping; He, Xiaowen; He, Xiaosheng; Lian, Lei; Wu, Xiaojian; Zhou, Zhiyang; Lan, Ping

doi:10.1016/j.ijsu.2017.03.012

Cited by 62 publications

(58 citation statements)

References 13 publications

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“…The most common configuration they found was LCA arising independently from the IMA (46.4%), followed by LCA, SA and SRA branching simultaneously (30%) and LCA and SA branching from a common trunk of the IMA (23.6%). Similar findings were observed by Ke et al [13] with 47.3% of LCA arising independently from the IMA, whilst 27.1% of LCA arose at the root of the sigmoid artery and 20.7% shared a common trunk with the sigmoid artery.…”

Section: Branching Patterns Of the Inferior Mesenteric Arterysupporting

confidence: 87%

“…Another large review of angiographic data by Kahn and Abrams [26] reported 66% of patients with an IMA arising at the level of L3, and 87% with an IMA arising between L2 and L4 levels, with L3 commonly used as a landmark for the IMA during angiography. Ke et al [13], in their angiographic study involving 188 subjects (124 male and 64 female), found that the most common location of the IMA was at the level of L3 in 64%, also commenting that it was 4.21 cm from the aortic iliac bifurcation.…”

Section: Origin Of Inferior Mesenteric Arterymentioning

confidence: 99%

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A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

McSweeney¹,

Kotakadeniya

Dissabandara

2020

SN Compr. Clin. Med.

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The objective of this review is to describe the normal and variant anatomy of the inferior mesenteric artery (IMA), including a brief overview of the relevant embryology, as well as proposing a classification system of the IMA vasculature, and clinical significance. A systematic review of articles published in Google Scholar and PubMed database using search terms: inferior mesenteric artery anatomy, inferior mesenteric artery variation, inferior mesenteric artery development, mesenteric circulation anatomy and variation, inferior mesenteric artery angiography. This was followed by review of the reference list of relevant publications to reveal publications missed during the initial search. Several standard anatomy and surgery text books were also referred for normal anatomy. The anatomy of the inferior mesenteric system is highly variant, with only a small proportion of anatomical, angiographic or surgical studies providing support for what is traditionally taught to be normal anatomy. Whilst the origin of the inferior mesenteric artery is less variant, the branching into left colic, sigmoidal and superior rectal arteries is variable between individuals in terms of origin of branches, number of branches and the presence or absence of certain branches. Whilst there did not appear to be a common classification system, similarities included three main variants of branching with a colosigmoid trunk, recto-sigmoid trunk or common trifurcation. There is a disparity between what is described in anatomical texts as the 'normal' IMA, and what is seen in anatomical, radiological and surgical research studies. The variable anatomy of the inferior mesenteric artery and its branches is significant in radiological interpretation and colorectal surgery from both an oncological perspective when considering resection, as well as in colonic ischaemia. A classification system has been introduced with a stepwise approach to the assessment of the IMA anatomy to avoid misleading nomenclature and provide a framework for surgeons to assess the vasculature.

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Section: Branching Patterns Of the Inferior Mesenteric Arterysupporting

confidence: 87%

Section: Origin Of Inferior Mesenteric Arterymentioning

confidence: 99%

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

McSweeney¹,

Kotakadeniya

Dissabandara

2020

SN Compr. Clin. Med.

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“…The colorectal anastomosis should be tension‐free, well vascularized and appropriately orientated in order to have the greatest chance of healing . The arterial blood supply of the sigmoid colon comes from the inferior mesenteric artery (IMA), which originates from the aorta and divides into the left colic artery and two to six sigmoid arteries, which enter the sigmoid mesocolon . The terminal branch of the IMA is the superior rectal artery .…”

Section: Introductionmentioning

confidence: 99%

Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

et al. 2019

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Aim In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, ligation of the IMA is not mandatory during treatment of diverticular disease. The object of this meta‐analysis was to assess if preservation of the IMA reduces the risk of anastomotic leakage. Method A search was performed up to August 2018 using the following electronic databases: MEDLINE/PubMed, ISI Web of Knowledge and Scopus. The measures of treatment effect utilized risk ratios for dichotomous variables with calculation of the 95% CI. Data analysis was performed using the meta‐analysis software Review Manager 5.3. Results Eight studies met the inclusion criteria and were included in the meta‐analysis: two randomized controlled trials (RCTs) and six non‐RCTs with 2190 patients (IMA preservation 1353, ligation 837). The rate of anastomotic leakage was higher in the IMA ligation group (6%) than the IMA preservation group (2.4%), but this difference was not statistically significant [risk ratio (RR) 0.59, 95% CI 0.26–1.33, I2 = 55%]. The conversion to laparotomy was significantly lower in the IMA ligation group (5.1%) than in the IMA preservation group (9%) (RR 1.74, 95% CI 1.14–2.65, I2 = 0%). Regarding the other outcomes (anastomotic bleeding, bowel injury and splenic damage), no significant differences between the two techniques were observed. Conclusion This meta‐analysis failed to demonstrate a statistically significant difference in the anastomotic leakage rate when comparing IMA preservation with IMA ligation. Thus, to date there is insufficient evidence to recommend the IMA‐preserving technique as mandatory in resection for left‐sided colonic diverticular disease.

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“…The preservation of LCA during anterior resection for rectal cancer requires exposing IMA and LCA, which if of technical difficulties. Thus, preoperative evaluation of the IMA type based on three-dimensional CT reconstruction results is beneficial [15,37]. In this study, the IMA of 108 patients was divided into four types according to the three-dimensional CT reconstruction image.…”

Section: Discussionmentioning

confidence: 99%

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

Zheng

Tian

et al. 2020

Preprint

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Background Whether or not to preserving left colic artery(LCA) in anterior resection for rectal cancer and its effect on anastomotic leakage are remains controversial. The aim of this study was to investigate the clinical outcomes of preserving the LCA during anterior resection for rectal cancer. We further explored branching types of the inferior mesenteric artery(IMA) based on the three-dimensional computed tomography reconstruction images. Methods Between January 2017 and October 2019, patients who underwent anterior resection for rectal cancer were allocated to preservation LCA or non-preservation LCA. Evaluation parameters including intraoperative conditions, pathological outcomes, postoperative complications, and short-term results. Furthermore, preoperative three-dimensional computer tomography reconstruction were performed to assess types of IMA. Results 160 patients with rectal cancer were enrolled in this study, 56 were arranged to preservation LCA and 104 to non-preservation LCA. The incidence of anastomotic leakage and overall early complications were significantly(P<0.05) decreased in the preservation LCA group. The reoperation rate of the preservation LCA group (1.8%) was lower than that of the non-preservation LCA group (10.6%), but the difference was not statistically significant (P>0.05). The two groups did not significantly(P>0.05) differ in blood loss, intraoperative complications, total number of harvested lymph nodes, and number of positive lymph nodes. The three-dimensional computer tomography reconstruction images of 108 patients with rectal cancer were evaluated, the IMA was divided into four types, of which 53(49.1%) were type I, 24 (22.2%) were type II, 18 (16.7%) were type III, and 13 (12%) were type IV. Conclusions The preservation of LCA in anterior resection for rectal cancer could help reducing the incidence of anastomotic leakage, overall early complications and without increasing other known risks. The three-dimensional computer tomography reconstruction technique was useful for evaluating the IMA types to facilitate make intraoperative surgical decisions and preservation of LCA during rectal cancer surgery.

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Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: Insights into rectal cancer surgery – A retrospective observational study

Abstract: Preoperative understanding of the vascular variations and the mutual relationship among LCA, IMA and IMV could be obtained by 3D-CTA, which would further help surgeons to set detailed plans for laparoscopic rectal cancer surgery.

Cited by 62 publications

References 13 publications

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

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