3D mesenteric angiogram-based assessment of Arc of Riolan crossing the inferior mesenteric vein: important considerations in high ligation during splenic flexure takedown in anterior resection,Surgical and Radiologic Anatomy

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3D mesenteric angiogram-based assessment of Arc of Riolan crossing the inferior mesenteric vein: important considerations in high ligation during splenic flexure takedown in anterior resection
Surgical and Radiologic Anatomy ( IF 1.2 ) Pub Date : 2022-07-23 , DOI: 10.1007/s00276-022-02992-x
James Wei Tatt Toh _{1,

2,

3} , Geetha Ramaswami ₄ , Kim Son Nguyen ₄ , Geoffrey Peter Collins _{2,

5} , Edgardo Solis ₂ , Nimalan Pathma-Nathan _{1,

2} , Toufic El-Khoury _{1,

2,

5} , Seon Hahn Kim _{6,

7}

Affiliation

Background

Recent studies have described the finding of the Arc of Riolan (AoR) crossing the inferior mesenteric vein (IMV) seen during high ligation of IMV while performing minimally invasive colectomies. However, the AoR usually has a medial course, and this variant AoR anatomic course and the clinical importance of its preservation during splenic flexure takedown in anterior resection remains controversial.

Methods

After institutional approval (QA-5775), radiological identification of and mapping of the vessel horizontally crossing the IMV under the pancreas, when present, was performed at a single institution (Westmead Hospital, New South Wales, Australia). One hundred consecutive computed tomographic (CT) mesenteric angiograms conducted in 2018 were reviewed retrospectively to determine the presence of a vessel horizontally crossing the IMV. 3D reconstructions were used to map out its course to understand its origin and full course. Baseline characteristics, including demographic and comorbidity data, were obtained from the medical record.

Results

On 3D mesenteric angiogram reconstructions, a vessel crossing anterior to the IMV was present in 11 of 98 cases (11.2%). Two cases were excluded as the presence of this vessel was indeterminate. Eight of 11 patients (72.7%) were male, and the mean age was 49.3 years (range: 21–80 years). There was no statistically significant difference in age and comorbidities between the groups. Importantly, in all 11 cases, there was an arterial vessel crossing the IMV originating from the SMA and communicating with the IMA or a branch of the IMA, proving definitively that this vessel was by definition the AoR.

Conclusion

This 3D mesenteric angiogram mapping study has shown definitively that the vessel horizontally crossing anterior to the IMV and inferior to the pancreas is an arterial vessel from the SMA to IMA, and by definition the Arc of Riolan. When present, identification and preservation of this collateral arterial vessel during splenic flexure takedown in anterior resection may be important in reducing the risk of post-operative bowel ischaemia.

中文翻译：

基于 3D 肠系膜血管造影的 Riolan 弧穿过肠系膜下静脉的评估：前切除术中脾曲切除期间高位结扎的重要考虑因素

背景

最近的研究描述了在进行微创结肠切除术时，在 IMV 的高位结扎期间看到的 Riolan 弧 (AoR) 穿过肠系膜下静脉 (IMV) 的发现。然而，AoR 通常有一个内侧走行，这种变异的 AoR 解剖走行以及在前切除术中脾曲切除期间保留其的临床重要性仍然存在争议。

方法

在机构批准 (QA-5775) 后，在单个机构（澳大利亚新南威尔士州 Westmead 医院）对水平穿过胰腺下 IMV 的血管进行放射学识别和绘图。回顾性审查了 2018 年进行的 100 次连续计算机断层扫描 (CT) 肠系膜血管造影，以确定是否存在水平穿过 IMV 的血管。3D 重建用于绘制其路线以了解其起源和完整路线。从病历中获得基线特征，包括人口统计和合并症数据。

结果

在 3D 肠系膜血管造影重建中，98 例中有 11 例 (11.2%) 存在穿过 IMV 前方的血管。两个案例被排除在外，因为这艘船的存在是不确定的。11 名患者中有 8 名（72.7%）为男性，平均年龄为 49.3 岁（范围：21-80 岁）。各组之间年龄和合并症无统计学差异。重要的是，在所有 11 例病例中，都有一条动脉血管穿过 IMV，起源于 SMA，并与 IMA 或 IMA 的一个分支相通，这明确地证明了这条血管根据定义是 AoR。