Evaluating distribution of the left branch of the middle colic artery and the left colic artery by CT angiography and colonography to classify blood supply to the splenic flexure

Abstract

Introduction: CT angiography has gained widespread acceptance for preoperative

A three-dimensional computed tomography angiography study of the anatomy of the accessory middle colic artery and implications for colorectal cancer surgery

“…The origin of the artery was in the superior mesenteric artery in 47 cases (67.1%; 32.9% of the total), in the inferior mesenteric artery in 21 cases (30%; 14.9% of the total), and in the celiac artery in two cases (2.9%; 1.4% of the total). As previous studies report that it exists in 4-8% of cases in the USA and Europe, and in 33-49% of cases in Japan [1,4,7,15,20,21,28,30], its frequency of occurrence in the present study (48.9%) is high. Moreover, although there are reports of an accessory middle colic artery that arises in the inferior mesenteric artery, it occurs infrequently, appearing in 5-9% of cases (30% in the present study) [20,30].…”

“…The 7% of cases in the present study in which the ascending artery divided and became the left colic artery and accessory middle colic artery would be included among such cases. In a study of 191 cases in which the blood supply to the splenic flexure was evaluated, there was only one case in which the arc of Riolan connected these two marginal arteries [4]. We believe it is possible that part of the arc of Riolan mentioned in that study was the same as the vessel described in the present study that connects the left colic artery and accessory middle colic artery.…”

Evaluation of the vascular anatomy of the left‐sided colon focused on the accessory middle colic artery: a single‐centre study of 734 patients

“…Because the image of 2D and 3D CTA can be acquired non-invasively and preoperatively, it is useful for preoperative simulation. Recently, Fukuoka et al evaluated the AMCA using 3D CTA and reported that the AMCA was present in only 6.6% of cases [4]. Recognizing the AMCA by using only 3D CTA in the case of a tiny AMCA or an AMCA originating from the SMA flow is sometimes difficult.…”

“…The MCA was defined as the branch of the SMA towards the right side, which ran to supply the transverse colon . Although the MCA typically bifurcated into right and left branches, these branches sometimes originated independently from the SMA.…”

“…Griffiths explained that the splenic flexure is the watershed area between the perfusion area of the MCA and the LCA [2]. Another artery, called the accessory middle colic artery (AMCA), running toward the splenic flexure has recently been recognized [3][4][5][6][7][8][9][10]. The AMCA usually originates from the superior mesenteric artery (SMA), running along the inferior border of the pancreas and toward the splenic flexure.…”