Inter-mesenteric connections between the superior and inferior mesenteric arteries for left colonic vascularization: implications for colorectal surgery
- 49 Downloads
There is confusion regarding the names, the number, and the exact location of the colonic arterial arches which provide connections between the superior and inferior (IMA) mesenteric arteries at the level of the left colic angle. The aim of this review was to delineate the “true” colic arches arising in the meso of the left colic angle and to describe their surgical implications.
A systematic review of the literature was performed using the MEDLINE database. The search included only human studies between 1913 and 2018. All dissection, angiographic, arterial cast and corrosion studies were analyzed.
The terms “Riolan arch”, “marginal artery of Drummond”, “meandering mesenteric artery” and “Villemin’s arch” must no longer be used in the scientific literature. Three arterial arches were found at the level of the left colic angle, permitting the communication between the two arterial mesenteric systems: (1) the Marginal Artery (the most peripheral, found in 100% of cases); (2) the “V” termination of the ascending branch of the left colic artery (LCA), existing in more than 2/3 of cases; and (3) the inter-mesenteric trunk, found more centrally located and existing in less than 1/3 of cases.
Three arterial arches exist at the level of the left colic angle: (1) the Marginal Artery, (2) the “V” termination of the ascending branch of the LCA, and (3) the inter-mesenteric trunk. The knowledge of this anatomy is essential for performing colorectal surgeries involving ligation of the IMA.
KeywordsColic vascularization Colic arches Riolans’s arch Marginal artery Left colic angle
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Research involving human participants and/or animals
All applicable institutional and/or national guidelines were followed.
Informed consent does not apply.
- 1.Bertelli L, Lorenzini L, Bertelli E (1996) The arterial vascularisation of the large intestine. Anatomical and radiological study. Surg Radiol Anat 18(Suppl 1):A1–A6 (S1–59) Google Scholar
- 8.Gallot D (2006) Anatomie chirurgicale du côlon. EMC Tech Chir Appar Dig 1:1–8Google Scholar
- 10.Griffiths JD (1956) Surgical anatomy of the blood supply of the distal colon. Ann R Coll Surg Eng 19:241–256Google Scholar
- 13.Michels NA, Siddharth P, Kornblith PL et al (1963) The variant blood supply to the small and large intestines: its import in regional resections. J Int Coll Surg 39:127–170Google Scholar
- 15.Mosckowicz M, Zimmerman H, Felson B (1964) The meandering mesenteric artery of the colon. Am J Roentgenol 92:1088–1099Google Scholar