Abstract
The superior mesenteric artery (SMA) supplies irrigation to the small intestine, ascending and a variable area of the transverse colon. Although medical imaging and surgical procedures have been widely developed in the last decades, the anatomy of the SMA using advanced imaging technology remains to be elucidated. Previous studies have used small sample sizes of cadaveric or radiological samples to propose a number of classifications for the SMA. In this study, we aimed to provide a more detailed description and useful classification of the SMA and its main branches [middle colic artery (MCA), right colic artery (RCA), and ileocolic artery (ICA)]. Samples (n = 50, 28 males and 22 females) were obtained from the repository of human cadavers located at the Department of Human Anatomy and Embryology, Complutense University of Madrid. This sample was dissected by preclinical medical students and completed by two of the authors (Gamo and Jiménez). A second set of samples was obtained from a bank of computerized tomography (CT) (560 CTs, 399 males and 161 females) collected by the Radiology Department at the Clínico San Carlos Hospital, Spain. Based on the results obtained from these studies, we propose a new classification of four patterns for the SMA anatomy. Pattern I as the independent origin of the three main branches of the SMA (cadaveric 40 %; CT 73.69 %); Pattern II is subdivided in three sub-patterns based on the common trunks of origin: Pattern IIa, common trunk between RCA and MCA (cadaveric 20 %, CT 4.28 %); Pattern IIb, common trunk between RCA and ICA (cadaveric 32 %, CT 15 %); Pattern IIc, common trunk for the three main branches (cadaveric 0 %, CT 0.35 %); Pattern III, as the absence of RCA (cadaveric 8 %; CT 2.32 %) and Pattern IV, based on presence of accessory arteries (not found in any of the samples). Although the independent origin of the three colic arteries have been classically described as the most frequent, the right colic artery is responsible of major variations.
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References
Adachi B (1928) Das Arteriensystem der Japaner Band II. Verlag der Kaiserlich-Japanischen Universität zu Kyoto. Kyoto, pp 18–64
Anson BJ (1936) The topographical positions and the mutual relations of the visceral branches of the abdominal aorta. A study of 100 consecutive cadavers. Anat Rec 67(1):7–15
Barbin JY, Visset J, Kerninon R, Fauvy A, Leborgne J, Pannier M (1972) Variations anatomiques de l’artère colique supèrieure droite. Arch Anat Path 20(4):373–376
Basmajian JV (1954) The marginal anastomoses of the arteries to the large intestine. Surg Gynecol Obstet 99(5):614–616
Beaton LE, Anson BJ (1942) The arterial supply of the small intestine. Q Bull Northwest Univ Med Sch 16(2):114–122
Benton RS, Cotter WB (1963) A hitherto undocumented variation of the inferior mesenteric artery in man. Anat Rec 145:171–173
Bergman JF, Verlag München (1984) Catalog of Human Anatomy. Urban & Schwarzenberg, Baltimore, p 117–119
Cabanié MM, Soutoul (1954) L’arcade arteriélle intermésentérique (á propos de 8 cas)CR Assoc. Anatomistes 40:937–950.
Chen JK, Johnson PT, Horton KM, Fishman EK (2007) Unsuspected mesenteric arterial abnormality: comparison of MDCT axial sections to interactive 3D rendering. AJR Am J Roentgenol 189(4):807–813
Chevrel JP, Guèraud JP (1978) Arteries of the terminal ileum: diaphanization study and surgical applications. Anat Clin 1:95–108
Chung WS, Jun SY (1998) Anatomic variations of the right colic artery. Korean J Surg Soc 54 (Suppl):991–995
Cokkinis AJ (1930) Observations on the mesenteric circulation. J Anat 64(Pt 2):200–205
Doran FS (1950) The intramural blood supply of the upper jejunum in man. J Anat 84(3):283–286
Douard R, Chevallier JM, Delmas V, Cugnenc PH (2006) Clinical interest of digestive arterial trunk anastomoses. Surg Radiol Anat 3:219–227
Eisberg HB (1924) Intestinal arteries. The anatomical record 28(4):227–242 (first published online 2 Feb 2005)
Ferrari R De, Cecco CN, Iafrate F, Paolantonio P, Rengo M, Laghi A (2007) Anatomical variations of the coeliac trunk and the mesenteric arteries evaluated with 64-row CT angiography. Radiol med 112:988–998
Fleischmann D (2003) Multiple detector-row CT angiography of the renal and mesenteric vessels. Eur J Radiol 45(Suppl 1):S79–S87
Godlewski G, Dussaud J, Giraudon M (1979) Arterial vascularization of the left colon in the fetus. Bull Assoc Anat (Nancy) 63(181):207–216
Heiss SG, Li KC (1998) Magnetic resonance angiography of mesenteric arteries. A review. Invest Radiol 33(9):670–681
Hollinshead WH (1956) Anatomy for Surgeons, Vol 2. pp 469–526
Horton KM, Fishman EK (2002) Volume-rendered 3D CT of the mesenteric vasculature: normal Anatomy, anatomic variants, and pathologic conditions. RadioGraphics 22(1):161–172
Kachlik D, Baca V (2006) Macroscopic and microscopic intermesenteric communications. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 150(1):121–124
Keese M, Schmitz-Rixen T, Schmandra T (2013) Chronic mesenteric ischemia: time to remember open revascularization. World J Gastroenterol 19(9):1333–1337
Kornafel O, Baran B, Pawlikowska I, Laszczyński P, Guziński M, Sąsiadek M (2010) Analysis of anatomical variations of the main arteries branching from the abdominal aorta, with 64-detector computed tomography. Pol J Radiol 75(2):38–45
LeQuire MH, Sorge DG, Brantley SD (1991) The middle mesenteric artery: an unusual source for colonic hemorrhage. J Vasc Interv Radiol 2(1):141–145
Lin P, Chaikof E (2000) Embryology, anatomy, and surgical exposure of the great abdominal vessels. Surg Clin North Am 80(1):417–433
Lippert H, Pabst R (1985) Arterial Variations in man. Classification in frequency. JF Bergmann-Verlag, Munich, Germany p 48–53
Michels MA. Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. Lippincott Company, Philadelphia, p 280–291
Moskowitz M, Zimmerman H, Felson B (1964) The meandering mesenteric artery of the colon. Am J Roentgenol Radium Ther Nucl Med 92:1088–1099
NelsonTM Pollak R, JonassonO Abcarian H (1988) Anatomic variants of the celiac, superior mesenteric, and inferior mesenteric arteries and their clinical relevance. Clin Anat 1:75–91
Perko MJ, Nielsen HB, Skak C, Clemmesen JO, Schroeder TV, Secher NH (1998) Mesenteric, coeliac and splanchnic blood flow in humans during exercise. J Physiol 513(Pt 3):907–913
Pillet J, Reigner B, Jhoste PH, Mercier PH, Cronier P (1993) Considérations sur la vascularisation artérielle des colons. L’artere mésenterique moyenne. Bulletin de 1’Association des Anatomistes no 238:27–30
Quenu L, Chavrol J, Herlemont P (1954) Le colon, ses variations, ses arteres. Comptes rendus de l’Association des Anatomistes 86:760–769
Raikos A, Paraskevas GK, Natsis K, Tzikas A, Njau SN (2010) Multiple variations in the branching pattern of the abdominal aorta. Rom J Morphol Embryol 51(3):585–587
Rösch J, Keller F, Kaufman J (2003) The birth, early years, and future of interventional radiology. J Vasc Interv Radiol 14(7):841–853
Rosenblum J, Boyle CM, Schwartz LB (1997) The mesenteric circulation anatomy and physiology. Surg Clin N Am 77(2):289–306
Ross J (1952) The vascular patterns of small and large intestine compared. Br J Surg 39(156):330–333
Steward JA, Rankin FW (1933) Blood supply of the large intestine. Its surgical considerations. Arch Surg 26:843–891
Sonneland J (1958) Surgical anatomy of the arterial supply to the colon from the superior mesenteric artery based upon a study of 600 specimens. Surg Gynecol Obstet 106(4):38–98
Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, Saglam M, Karademir I (2010) Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol 83(992):661–667
Vandamme JPJ, Bonte J (1982) A new look at the blood supply of the ileocolic angle. Acta Anat 113:1–14
Villemin F (1920) Sur l’existence d’une anastomose entre les deux artères mésentériques. Hypothèse Embryologique 83:439–440
Walker TG (2009) Mesenteric vasculature and collateral pathways. Semin Interv Radiol 3:167–174
Wu Y, Peng W, Wu H, Chen G, Zhu J, Xing C (2014) Absence of the superior mesenteric artery in an adult and a new classification method for superior–inferior mesenteric arterial variations. Surg Radiol Anat 5:511–515
Yoshida T, Suzuki S, Sato T (1993) Middle mesenteric artery: an anomalous origin of a middle colic artery. Surg Radiol Anat 15:361–363
Zeitler E (1995) History of interventional radiology. Radiologe 5:325–336
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Both authors E. Gamo and C. Jiménez have equally participated in the design and development of the present study.
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E. Gamo and C. Jiménez have equally participated in the design and development of this study.
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Gamo, E., Jiménez, C., Pallares, E. et al. The superior mesenteric artery and the variations of the colic patterns. A new anatomical and radiological classification of the colic arteries. Surg Radiol Anat 38, 519–527 (2016). https://doi.org/10.1007/s00276-015-1608-3
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DOI: https://doi.org/10.1007/s00276-015-1608-3