Variaciones anatómicas en la vascularización del colon derecho y su implicancia en la escisión completa del mesocolon con linfadenectomía D3. Estudio de corte transversal / Anatomical variations in right colon vascularization: its implication in complete mesocolic excision with D3 lymphadenectomy. A cross-sectional study

Introducción: La escisión completa del mesocolon con linfadenectomía D3 (CME-D3) mejora los resultados de los pacientes operados por cáncer del colon. Reconocer adecuadamente la anatomía vascular es fundamental para evitar complicaciones. Objetivo: El objetivo primario fue determinar la prevalencia de las variaciones anatómicas de la arteria mesentérica superior (AMS) y sus ramas en relación a la vena mesentérica superior (VMS). El objetivo secundario fue evaluar la asociación entre las distintas variantes anatómicas y el sexo y la etnia de lo pacientes. Diseño: Estudio de corte transversal. Material y métodos: Se incluyeron 225 pacientes con cáncer del colon derecho diagnosticados entre enero 2017 y diciembre de 2020. Dos radiólogos independientes describieron la anatomía vascular observada en las tomografías computadas. Según la relación de las ramas de la AMS con la VMS, la población fue dividida en 2 grupos y subdividida en 6 (1a-c, 2a-c). Resultados: La arteria ileocólica fue constante, transcurriendo en el 58,7% de los casos por la cara posterior de la VMS. La arteria cólica derecha, presente en el 39,6% de los pacientes, cruzó la VMS por su cara anterior en el 95,5% de los casos. La variante de subgrupo más frecuente fue la 2a seguida por la 1a (36,4 y 24%, respectivamente). No se encontró asociación entre las variantes anatómicas y el sexo u origen étnico. Conclusión: Las variaciones anatómicas de la AMS y sus ramas son frecuentes y no presentan un patrón predominante. No hubo asociación entre las mismas y el sexo u origen étnico en nuestra cohorte. El reconocimiento preoperatorio de estas variantes mediante angiotomografía resulta útil para evitar lesiones vasculares durante la CME-D3. (AU)

Background: Complete mesocolic excision with D3 lymphadenectomy (CME-D3) improves the outcomes of patients operated on for colon cancer. Proper recognition of vascular anatomy is essential to avoid complications. Aim: Primary outcome was to determine the prevalence of anatomical variations of the superior mesenteric artery (SMA) and its branches in relation to the superior mesenteric vein (SMV). Secondary outcome was to evaluate the association between these anatomical variations and sex and ethnicity of the patients. Design: Cross-sectional study. Material and methods: Two hundred twenty-fivepatients with right colon cancer diagnosed between January 2017 and December 2020 were included. Two independent radiologists described the vascular anatomy of computed tomography scans. The population was divided into 2 groups and subdivided into 6 groups (1a-c, 2a-c), according to the relationship of the SMA and its branches with the SMV. Results: The ileocolic artery was constant, crossing the SMV posteriorly in 58.7% of the cases. The right colic artery, present in 39.6% of the patients, crossed the SMV on its anterior aspect in 95.5% of the cases. The most frequent subgroup variant was 2a followed by 1a (36.4 and 24%, respectively). No association was found between anatomical variants and gender or ethnic origin. Conclusions: The anatomical variations of the SMA and its branches are common, with no predominant pattern. There was no association between anatomical variations and gender or ethnic origin in our cohort. Preoperative evaluation of these variations by computed tomography angi-ography is useful to avoid vascular injuries during CME-D3. (AU)

Evaluación angiográfica de la distribución anatómica de la irrigación sanguínea del ángulo esplénico del colon en población chilena

Objetivo: Identificar los patrones de distribución vascular del ángulo esplénico del colon (AEC) en la población chilena para su comparación con la literatura oriental (Fukuoka). Materiales y Métodos: Estudio descriptivo, transversal. Se caracterizó la irrigación del AEC de imágenes con protocolo Urotac realizadas en Clínica INDISA entre el año 2020 y 2021 (n = 127), clasificándolas dentro de 6 tipos descritos por Fukuoka. Se evaluaron características demográficas y comorbilidades. Las variables fueron analizadas utilizando estadística descriptiva y la significancia mediante la prueba Chi2. Resultados: Existen diferencias en los tipos irrigación del AEC entre la serie local y Fukuoka, la irrigación tipo 3 fue la que presentó mayor variación (p < 0,05). El tipo 1 es la más frecuente (34,7%), sin casos del Tipo 4. No se identificó diferencia entre los distintos tipos de irrigación con relación a las variables demográficas y comorbilidades. Discusión: Al comparar nuestra serie con la oriental se evidenció similar frecuencia en tipos 1 y 6, mayor en tipos 3 y 5, y tipos 2 y 4 con menor representación. Se identificó un mayor aporte en la irrigación del AEC por la arteria cólica izquierda (ACI) en la población estudiada (64,6%). Conclusión: Nuestra población tiene mayor participación de ACI en irrigación del AEC que orientales (64,6% vs 49,6%), los tipos más frecuentes son 1, 3 y 6, el Tipo 1 es la forma más frecuente de irrigación, similar a Fukuoka (34,7% vs 39,7%), Tipo 3 tiene mayor representación en nuestra población que en la oriental (29,9% vs 9,9%).

Objective: To identify the vascular distribution patterns of the splenic flexure of the colon (AEC) in the Chilean population for comparison with the oriental literature (Fukuoka). Methods: Descriptive, cross-sectional study. The irrigation of the AEC of images with the Urotac protocol performed at the INDISA Clinic between 2020 and 2021 (n = 127) was characterized, classifying them into 6 types described by Fukuoka. Demographic characteristics and comorbidities were evaluated. Variables were analyzed using descriptive statistics and significance using the Chi2 test. Results: There are differences in the types of irrigation of the AEC between the local series and Fukuoka, irrigation type 3 was the one that presented the greatest variation (p < 0.05). Type 1 is the most frequent (34.7%), with no cases of Type 4. No difference was identified between the different types of irrigation in relation to demographic variables and comorbidities. Discussion: When comparing our series with the eastern one, a similar frequency was found in types 1 and 6, higher in types 3 and 5, and types 2 and 4 with less representation. A greater contribution was identified in the irrigation of the AEC by the left colic artery (ICA) in the population studied (64.6%). Conclusion: Our population has a greater participation of ICA in AEC irrigation than Orientals (64.6% vs 49.6%), the most frequent types are 1, 3 and 6, Type 1 is the most frequent form of irrigation, similar to Fukuoka (34.7% vs 39.7%), Type 3 is more represented in our population than in the eastern one (29.9% vs 9.9%).

Vascular anatomy and clinical application of latissimus dorsi myocutaneous flap / 解剖学报

Objective To explore the relationship between latissimus dorsi myocutaneous flap and blood supply, so as to provide a scientific basis for the re-division, transposition and transplantation of latissimus dorsi myocutaneous flap. Methods The latissimus dorsi muscle of 48 cadavers were observed by anatomy and angiography. The clinical applications of latissimus dorsi myocutaneous flap in 31 cases were reviewed. Results The latissimus dorsi myocutaneous flap had many sources of blood supply. The main thoracodorsal artery was distributed in the upper and outer latissimus dorsi muscle. The medial and lateral branches were separated steadily with their respective distribution areas. The inner and lower parts of latissimus dorsi muscle were supplied by intercostal and lumbar arteries. The anastomosis between them and the branches of thoracodorsal artery was obvious according to X-ray angiography. The caliber was between 320-550 μm. The blood supply of the skin superficial to the latissimus dorsi muscle was from the myocutaneous artery. But the anastomosis between the perforating branches was sparse and the caliber was small near the inner and lower parts. Myocutaneous flaps were applied for wound repair, breast reconstruction and leg defect repair after mass excision in 31 cases. Thirty cases of myocutaneous flaps survived completely post-operation. One case of myocutaneous flap had early signs of partial blood flow disturbance. After treatment, blood flow gradually improved and wound healing delayed. Conclusion The latissimus dorsi myocutaneous flap can be divided into 3 parts according to their arterial branches and anastomotic characteristics, which can provide the vascular anatomical basis for whole or partial separation, transposition or transplantation and preservation of muscle function.

The applied anatomy of vascular variability of duplex kidney in children / 中华泌尿外科杂志

Objective To study the vascular anatomy of duplex kidney and to provide a scientific basis for surgical resection of the renal segment.Methods From February 2012 to April 2018,the clinical data of 84 children with renal duplex kidney disease admitted to our hospital,were reviewed and analyzed.Among them,75 cases (89.3％) were unilateral and 9 cases (10.7％) were bilateral.According to the preoperative CT + CTA and the duplicated renal morphology,size,location,and anatomical relationship of the kidney segment,combined with the branches and passage of the renal artery which supplies the upper moiety,it described the blood supply of the upper renal moiety.At the same time,it analyzed various types of embryological related factors and gender differences and summarized the tips for laparoscopic surgery.Results Of the 93 duplex kidneys,69 (74.2％) were supplied with 1 artery,and 25 (26.9％) were supplied with 2 or more arteries.Based on the shape and orifice of artery,they were divided into 3 types.The most common type was that the renal artery separated into two or more arteries near the renal parenchyma.The upper and lower renal poles were respectively supplied,which could be summarized as early branching,a total of 71 sides (76.3 ％).The second type was the arteries from abdominal aorta or its branches,directly flowing into the upper renal pole,which was classified into the sub-renal artery,a total of 18 sides (19.4％).The others (4 sides,3.3％) were less common,and most of them were a combination of the above-mentioned two types,and one of them whose upper pole was supplied by branches of adrenal artery.Based on the classification of vascular variability,no significant difference was found between males and fenmals,or left and right sides.Conclusions The upper renal moiety are mainly supplied by one branch of renal artery,and the most common type of this artery is prehilar branch,without gender difference.The determination of vascular variability before surgery can avoid bleeding during surgery and avoid accidental injury of normal blood vessels.

A rare double profunda femoris artery in a female cadaver / 대한해부학회지

The profunda femoris artery (PFA) represents the first and largest branch of the femoral artery in the thigh. A series of anatomical variations are reported, mostly concerning its point of origin and its altered trajectories within the lower limb. We present a rare case of a double PFA, where each separate branch followed the expected arterial pattern. Our case aim to alert surgeons and radiologists for the possibility to encounter an unexpected vascular alternation. Knowledge of topographical anatomy of the PFA and its variations is essential for possible complications after interventional procedures to be avoided.

Improvement to colon interposition after esophagectomy / 中华胸心血管外科杂志

Objective To explore the improving safety measures of colon interposition after esophagectomy .Methods From January 2003 to December 2014, 65 cases of colon interposition after esophagectomy were performed, and some improve-ments were made in the methods and procedures .Mainly including: Preoperative evaluation to first operation; Selection of co-lon segment; Simplify vascular anatomy;Cervical anastomosis was replaced by intrathoracic anastomosis;Modified anastomosis sequence; Strengthen preoperative preparation.Results There were no perioperative deaths.Only 2 patients with cervical fis-tula, due to malnutrition automatically discharged.The rate of anastomotic leakage on neck were 27.77%(10/36) and 6.89%(2/29) in the chest.2 cases were completed intestinal obstruction after jejunostomy , 1 cases of volvulus and 1 cases of intus-susception confirmed by reoperation.Conclusion Colon interposition after esophagectomy is a very important way of surgery. The operation process is complex, but as long as mastering the point of surgery, improving the surgical procedures, the good effect can be obtained and greatly improve the safety of the operation .

An Anatomical Study of Superficial Palmar Arch.

Background: The study of superficial palmar arch and its variations has been reported rarely. The purpose of the study is to provide assessment of anatomical variations in the formation of superficial palmar arch in hand. A classic superficial palmar arch is formed by direct communication between the superficial branch of the ulnar artery and superficial branch of radial artery. Materials and Methods: Twenty dissected upper limb specimens, out of which 16 males and 4 females aged between 18 – 75years were obtained from Department of Anatomy, Bangalore Medical College and Research Institute, Bangalore. The vascular pattern of superficial palmar arch was recorded. Results and Discussion: The complete and incomplete formation of the superficial palmar arch was found in 19 and 1 hands respectively. This indicates that the incidences of complete and incomplete formation of superficial palmar arch are 95% and 5% respectively. Conclusion: The findings suggest that the incomplete formation of superficial palmar arch will lead to ischemia or poor nourishment of intrinsic muscles of the hand.

Unusual branching pattern of external iliac artery: case report / Patrón inusual de ramificación de la arteria ilíaca externa: reporte de caso

During the routine dissection, a rare anomaly was observed in left lower limb of a female cadaver. The external iliac artery continued as femoral artery, branched on lateral side as the lateral circumflex femoral artery and on medial side as profunda femoris artery. On tracing the lateral circumflex femoral artery, the ascending branch towards the spinous anastomosis was very thin and coursed behind the rectus femoris muscle. The transverse and descending branches were not observed, however, the artery coursed along the vastus lateralis towards the knee. The femoral artery had its normal course and continued as popliteal artery. The profunda femoris artery originated from the medial side of the external iliac artery, initially superficial to the femoral vein, coursed downwards and posteriorly, relating posteromedial to femoral artery. The medial circumflex femoral artery originated as thin branch, which further divided into two divisions. The profunda femoris gave origin of 3 perforators and continued as 4th perforator. The unusual branching pattern was observed to be novel and not reported in the literature.

Durante una disección de rutina, se observó una rara anomalía en el miembro inferior izquierdo de un cadáver de sexo femenino. La arteria ilíaca externa dio origen en el lado lateral ala arteria circunfleja femoral lateral y en el lado medial a la arteria femoral profunda. En el recorrido de la arteria circunfleja femoral lateral, la rama ascendente era muy delgada y corría detrás del músculo recto femoral. No se observaron ramas transversales y descendente, sin embargo, la arteria descendió hacia la rodilla a lo largo del músculo vasto lateral. La arteria femoral tuvo su curso normal y continuó como arteria poplítea. La arteria femoral profunda, inicialmente superficial a la vena femoral, se dirigió inferior y posteriormente colocándose posteromedial a la arteria femoral. La arteria circunfleja femoral medial se originó como una rama delgada, que otorgó dos arterias. La arteria femoral profunda dio origen a tres ramas perforantes y continuó como cuarta perforante. Este patrón de ramificación inusual es una descripción nueva no reportada en la literatura.

An Anatomical study on Dorsalis Pedis Artery.

Background:The study of Dorsalis pedis artery and variations in its branching pattern has been reported sporadically. The purpose of this study was to evaluate the arterial supply on the dorsum of the foot. Materials and Methods: The study was carried out on forty two dissected limbs of unknown sex and age from the department of Anatomy,BMCRI,Bangalore. Results and Discussion:The incidence of classical text book description was found to be very less in the present study. In 16.67% of cases the arcuate artery was completely absent, which was compensated by two large lateral tarsal arteries that provided the dorsal metatarsal arteries. In 9.52% of cases the dorsalis pedis artery was absent. Conclusion:The findings suggest that the lateral aspect of the dorsum of the foot has a poor nourishment.

Laparoscopic spleen-preserving hilar lymph nodes dissection based on splenic hilar vascular anatomy / 中华消化外科杂志

ObjectiveTo investigate the efficacy of laparoscopic spleen-preserving hilar lymph nodes dissection based on splenic hilar vascular anatomy.MethodsFrom July 2010 to March 2011,the clinical data of 39 patients with advanced proximal gastric cancer who underwent laparoscopic spleen-preserving hilar lymph nodes dissection at the Union Hospital of Fujian Medical University were retrospectively analyzed.Different types of vascular anatomy were analyzed,and different methods of lymph node dissection in the splenic hilus were adopted accordingly.ResultsThe operation was successfully performed on all the patients,with no conversion to open surgery or splenectomy due to splenic vascular or parenchyma injury.There were 4 types of splenic artery running,including type Ⅰ (25 patients),type Ⅱ (8 patients),type Ⅲ (4 patients) and type Ⅳ (2 patients).There were 2 types of the end branches of splenic artery,including concentrated type (28 patients) and dispersion type (11 patients).The splenic lobial vessels of all the patients were anatomically classified and divided into 4 types,including a single branch of splenic lobial vessels in 3 patients,2 branches in 24 patients,3 branches in 11 patients and multibranches in 1 patient.The mean number of short gastric vessels was 3.2 ± 1.4 (range,2-6).The time for dissection of the lymph nodes in the splenic hilum,number of lymph nodes dissected in the splenic hilum,volume of operative blood loss,duration of hospital stay and incidence of complications were ( 30 ±7)minutes,2.8 ±2.1,(20 ±7)ml (range,0-55 ml),(10 ± 1) days and 10％ (4/39).All patients were followed up until March,2012. One patient had hepatic metastasis,and no patient died postoperatively.ConclusionFamiliar with the variation of splenic hllar vascular anatomy is helpful in mastering and promoting laparoscopic spleen-preserving hilar lymph nodes dissection.

Vasculature anatomy in medial foot and its clinical application in foot and ankle reconstruction / 中华创伤杂志

ObjectiveTo investigate anatomical characteristics of the medial foot vessels and effects of different vascular pedicle skin flaps in repair of foot and ankle trauma.MethodsThirty adult cadaveric lower limbs were injected with red latex through the popliteal artery and posterior tibial artery to anatomically observe the cutaneous arterial origin,branches,distribution and anastomosis of the medial foot.Then,anterior medial malleolar artery perforator flaps and distally-based medial foot flaps were harvested and used for repairing foot and ankle trauma of 16 patients.Results The origin of cutaneous blood vessels of the medial foot was diversified and mainly included the anterior medial malleolar artery,medial tarsal artery,and arterial arcades anastomosing with anterior posterior branches of the two former arteries and the superficial branches of plantar digital artery and the medial plantar artery.According to distribution area of the anterior medial malleolar artery and the medial tarsal artery,the vascular anatomy of the medial foot skin was classified into three types.Clinically,all the flaps survived.Follow-up ranged from 2 weeks to 20 months,which showed normal color,good shape and good pain and warm sensation of the flaps.ConclusionThe anterior medial malleolar artery perforator flaps present good reconstruction of soft tissue defects around the ankle,whereas the distally-based medial foot flaps present good reconstruction of soft tissue defects of the mid-forefoot.

Right retroesophageal subclavian artery

PURPOSE: The subclavian arteries can vary on their origin, course or length. One of the most common anatomical variations is the right subclavian artery originating as the last branch of the aortic arch. This artery is known as a retroesophageal right subclavian artery or "lusory artery". The right retroesophageal subclavian artery usually is described as not producing symptoms, being most discoveries coincidental. Nevertheless, it may be the site of formation of atherosclerotic plaque, inflammatory lesions or aneurysm. CASE REPORT: The present study describes a case of right retroesophageal subclavian artery and discusses the findings according to their clinical and surgical implications. CONCLUSION: The anatomic and morphologic variations of the aortic arch and its branches are significant for diagnostic and surgical procedures in the thorax and neck. If a right retroesophageal subclavian artery is diagnosed during aortic arch repair, corrective surgery should be considered. Intensive care patients should be screened before long term placement of nasogastic tube, in order to avoid fistulization and fatal hemorrhage.

OBJETIVO: A artéria subclávia pode ser variável em sua origem, trajeto e/ou comprimento. Uma das variações anatômicas mais comuns é a origem da artéria subclávia direita como o último ramo do arco aórtico. Essa artéria é conhecida como artéria subclávia retroesofágica ou "artéria lusória". A artéria subclávia direita retroesofágica é comumente descrita como assintomática, sendo os achados, na maioria das vezes, acidentais. Entretanto, essa artéria pode ser um sítio de formação de placas ateromatosas, lesões inflamatórias ou até aneurismas. RELATO DE CASO: O presente estudo descreve um caso de artéria subclávia direita retroesofágica e discute os achados de acordo com sua importância clínica e implicações cirúrgicas. CONCLUSÃO: Variações anatômicas do arco aórtico e seus ramos são significantes para diagnósticos e procedimentos cirúrgicos do pescoço e do tórax. Caso uma artéria subclávia direita retroesofágica seja diagnosticada durante uma cirurgia do arco aórtico, um procedimento corretivo deve ser considerado. Pacientes em terapia intensiva devem ser investigados para a presença dessa variação anatômica antes de uma sondagem nasogástica de longa duração para se evitar complicações como fístulas e hemorragia.

Anatomical and Morphological Research for Laparoscopic Anterior Lumbar Interbody Fusion / 中国微创外科杂志

Objective To study the vascular anatomy for laparoscopic anterior lumbar interbody fusion(LALIF),and to evaluate the feasibility of the surgical approach.Methods Vascular anatomy of 36 adult human bodies were studied by infusing red latex into the arteries.They were classified according to the percentage of the exposed lumbosacral disc in the interiliac triangle.Results The mean height of the aortic bifurcation(AB)was(41.81?13.82)mm,and the height of the confluence of the common iliac vein(CCIV)was(20.22?14.20)mm.The angles of the AB and CCIV were(51.88?12.09)? and(77.08?20.98)? respectively.The width of the median sacral artery(MSA)were(1.57?0.42)mm and(1.33?0.50)mm respectively at the top and bottom of the lumbosacral disc.While the distance from the right iliac vessel(RIV)to MSA at the top and bottom of the lumbosacral disc were(20.83?7.73)mm and(27.60?7.80)mm.The average width of the exposed disc was(36.78?13.06)mm,which accounts for(72.29?25.64)% of that of the disc.According to our morphological classification,22 specimens(61.1%)belong to type Ⅰ(Standard type,being exposed by more than 65%),9(25.0%)type Ⅱ(Narrow type,being exposed by 45% to 65%),and 5(13.9%)type Ⅲ(Barrier type,being exposed by less than 45%).The height of CCIV was negatively,but not significantly,correlate to its angle(r=-0.287,P=0.089).Conclusions In 86.1% of our patients,anterior approach is a safe and effective way for laparoscopic interbody fusion.Moreover,in 61.1% of the patients,the procedure can be carried out without managing the iliac vessels arround the interiliac triangle.

Vascular Anatomy on the Nasal Tip in Koreans / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The blood supply of the nasal tip and columella was examined to determine whether the blood supply to the nasal tip could be damaged from transcolumellar incision during an external rhinoplasty approach in Koreans. MATERIALS AND METHODS: The blood vessels that supply the nasal tip were examined by dissecting 51 cadavers, and their corresponding 102 nasal sections were injected with red latex prior to the dissection. The size and distribution of the vessels were measured with unaided eyes to determine the primary supplying vessels. The subdermal layer in which the vessels lie and the course of the vessels were also investigated. RESULTS: The main vessels of the nasal tip proved to be the lateral nasal artery (78%) and the dorsal nasal artery (22%). Columellar branches were narrower in diameter than the lateral nasal and dorsal nasal arteries and varied in their size and appearance, and therefore they appeared insufficient to be main vessels to supply blood. These arteries passed through the musculoaponeurotic layer, but they were also close to the main surgical plane in the dome of the lower lateral cartilage. CONCLUSIONS: We speculate that the blood supply to nasal tip in Koreans is primarily derived from the lateral nasal or dorsal nasal arteries, with variable contribution from the columellar arteries. Therefore, it is the most important to determine the surgical plane below the musculoaponeurotic layer in order to prevent necrosis of skin flap or deformity due to damage of vessels in the case of external rhinoplasty.

A study of hepatopancreatic artery with DSA and its significance in transcatheter arterial chemoembolization of hepatocellular carcinoma / 介入放射学杂志

Objective To investigate the anatomic characteristics of hepatopancreatic artery(HPA) by DSA and its significance in preventing pancreatic complications after transcatheter arterial chemoembolization(TACE) in patients with hepatocellular carcinoma.Methods 1 000 cases of hepatic arteriograms have been retrospectively reviewed. The aberrant pancreatic arteries that originate from proper hepatic artery(PHA) and all distal intrahepatic branches to PHA were called hepatopancreatic arteries. The incidence of HPA has been summed up and its anatomic characteristics such as origine, course, branches and distribution have been described. Results Of 1000 cases, HPA were found in 16 cases(1.6%). There were 2 branches of HPA in one case and there was only one branch of HPA in other 15 cases. Altogether 17 branches of HPA were found; of which, 7 branches originated from PHA(41.2%,7/17), 6 branches arose from right hepatic artery(RHA)(35.3%,6/17) and 4 branches came from left hepatic artery(LHA)(23.5%,4/17). Conclusions HPA is a kind of rare variations of pancreatic artery. The importance to avoid embolizing HPA during TACE is preventing pancreatic complications.