Differential growth patterns of the abdominal aorta and vertebrae during childhood

Abstract

The adult vertebral level of the splanchnic branches of the abdominal aorta relies on a complex series of fusion and regression steps during embryological development, such that variation is common. Little is known however regarding the anatomy of the abdominal aorta in children. This study aimed to investigate the spatial relationship between the abdominal aorta and the vertebral column during childhood development to inform clinical management of pediatric patients. Retrospective multislice computed tomography abdominopelvic angiograms of children aged neonate to 19 years (n = 232) were used to examine vertebral levels of the celiac trunk (CoT), superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and aortic bifurcation (AB) using multiplanar formatting views in OsiriX. The abdominal aorta length, AB angle, and displacement of the aorta from the midline were quantified with the effect of age and sex analyzed using multinomial logistic regression and general linear models. The most frequent origins of CoT, SMA, IMA, and AB were T12, L1, L3, and L4, respectively, with significant variation in vertebral level for each vessel. SMA level was significantly more proximal with age, and CoTand AB demonstrated marked sex differences in vertebral level. As the age of the child increased, AB angle decreased, aortic displacement increased, and the length of the abdominal aorta increased at a slower velocity to the vertebral column (P < 0.001). Our study highlights the variation of the location and geometry of the abdominal aorta in children; this knowledge will positively impact pediatric surgical approaches and endovascular procedures. Clin. Anat. 32:783-793, 2019.

Case series and a systematic review concerning the level of the aortic bifurcation

“…However, both range and mean level of aortic bifurcation did not seem to differ according to age. Additionally, in the two studies which were conducted exclusively in children [15,38] a great range was also recorded (L4 to L5-S1 and L3 to L5, respectively). Nevertheless, all above mentioned facts, combined with the lack of age details in some studies [1,2,7,12,18,22,36] could not lead to a safe result concerning the correlation between age and level range of AA bifurcation.…”

“…All details regarding the selection of eligible studies are presented in Figure 4 (PRISMA flow diagram). Eventually 31 articles were found eligible and were [11,15], 1 multidetector computed tomography (MDCT) study [20], 1 was angiographic study [38] and 1 was based on pelvic arteriograms [25]. Mean age or age range where included when available.…”

Aortic Origins of the Celiac Trunk and Superior Mesenteric Artery

“…Numerous studies evaluated the CT and SMA branching patterns [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ], with little emphasis on their origin relating to vertebral levels. However, the abdominal aorta’s topography and its branches, related to the vertebral column, are surgically significant [ 23 ]. When a main artery, CT or SMA, switches its vertical position as referred to the vertebral column, all its branches could have modified topographical patterns, which various branching patterns could complicate.…”

“…When a main artery, CT or SMA, switches its vertical position as referred to the vertebral column, all its branches could have modified topographical patterns, which various branching patterns could complicate. Different procedures, such as the anterior access to the lumbar spine, lymphadenectomy of the splanchnic lymph nodes, and celiac plexus block, rely on the adequate identification of arterial–vertebral topographic patterns [ 23 ]. The surgical fixation of lumbar spine instability using anterior lumbar interbody fusion gained popularity after the introduction of minimally invasive surgical techniques, mini-laparotomic or endoscopic approaches [ 24 ].…”

Features of the Topography of the Abdominal Aorta and Its Unpaired Branches in Sexual and Age Aspects

“…По данным литературных источников, в пубертатном периоде рост аорты по отношению к позвоночному столбу замедляется [11]. С учетом того, что у лиц мужского пола скачок роста отмечается в более позднем периоде и длится дольше, чем у лиц женского пола [12], у взрослых мужчин и женщин возникают изученные топографические отличия между аортой и ее ветвями с одной стороны и позвоночником с другой.…”