- Standardize the Surgical Technique and Clarify the Relevant Anatomic Concept for Complete Mobilization of Colonic Splenic Flexure Using da Vinci Xi® Robotic System. [Journal Article]
- WJWorld J Surg 2019; 43(4):1129-1136
- CONCLUSIONS: With increased maneuverability of Xi® robotic arms and the clarification of relevant anatomic concept, the surgical technique for the complete mobilization of colonic splenic flexure can be standardized; and the standardization of surgical technique is the first step toward the enhanced automation in the rapidly evolving robotic systems.
- Inter-mesenteric connections between the superior and inferior mesenteric arteries for left colonic vascularization: implications for colorectal surgery. [Journal Article]
- SRSurg Radiol Anat 2019; 41(3):255-264
- CONCLUSIONS: Three arterial arches exist at the level of the left colic angle: (1) the Marginal Artery, (2) the "V" termination of the ascending branch of the LCA, and (3) the inter-mesenteric trunk. The knowledge of this anatomy is essential for performing colorectal surgeries involving ligation of the IMA.
- The Riolan arch compensates for infra-renal abdominal aorta occlusion. [Journal Article]
- JVJ Vasc Surg Cases Innov Tech 2018; 4(3):237
- "Mesenteric Steal" Physiology as a Cause of Claudication and Chronic Mesenteric Ischemia. [Case Reports]
- AVAnn Vasc Surg 2018; 51:329.e1-329.e4
- Aortoiliac occlusive disease results in varying degrees of pelvic and lower extremity arterial insufficiency. Treatment approach has evolved, and endovascular therapies are being successfully reporte…
Aortoiliac occlusive disease results in varying degrees of pelvic and lower extremity arterial insufficiency. Treatment approach has evolved, and endovascular therapies are being successfully reported for high-grade lesions. However, Trans Atlantic Inter-Society Consensus D often necessitates open revascularization. Disease limited to the infrarenal segment does not typically affect intestinal perfusion in the absence of visceral aortic or mesenteric vessel involvement. Chronic mesenteric ischemia most commonly occurs due to atherosclerotic disease of 2 or 3 of the mesenteric vessels. The marginal artery of Drummond is an important component of the collateral network that allows for continued intestinal perfusion. We report a case of short-segment subtotal infrarenal aortic occlusion, proximal to the inferior mesenteric artery (IMA) in the absence of significant mesenteric disease. The patient had resultant lifestyle limiting claudication and chronic mesenteric ischemia. Angiographic evaluation demonstrated "mesenteric steal" physiology with retrograde flow via the arc of Riolan and IMA to perfuse the aortoiliac circulation. Successful endovascular recanalization with a balloon-expandable covered stent was achieved, resolving the arterial insufficiency in both the mesenteric and lower extremity vascular beds. The patient denied any symptoms on postoperative day 1 and at 1-month follow-up.
- StatPearls: Anatomy, Abdomen and Pelvis, Inferior Mesenteric Artery [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- The inferior mesenteric artery (IMA) comes off the abdominal aorta a few inches below the takeoff of the superior mesenteric artery. The artery runs slightly lateral to the abdominal aorta after its …
The inferior mesenteric artery (IMA) comes off the abdominal aorta a few inches below the takeoff of the superior mesenteric artery. The artery runs slightly lateral to the abdominal aorta after its origin at the level of the third lumbar vertebrae behind the third part of the duodenum. Embryologically, the inferior mesenteric artery supplies the area of the hindgut, the distal portions of the intestinal tract. More specifically, it supplies the distal third of the transverse colon, descending colon, sigmoid colon and superior segment of the rectum. The superior mesenteric and inferior mesenteric arteries form an anastomosis by means of the marginal artery, also known as the artery of Drummond, via their branches, the colic, and the sigmoid arteries, respectively. These anastomoses form arcades, which parallel the colon. There is further anastomosis via Riolan’s arcade, also referred to as the meandering artery. This is an arterial connection between the left colic artery and the middle colic artery. The marginal artery of Drummond is a collateral pathway that connects the superior and inferior mesenteric arterial systems. The anastomotic network originates from the descending branch of the ileocolic artery. The ileocolic artery connects with the right colic artery via the right colic's ascending and descending branches. This network is connected to the right and left branches of the middle colic artery, the ascending and descending branches of the left colic artery, and the sigmoid branches of the inferior mesenteric artery terminating in the superior rectal artery. The marginal artery often runs close to the bowel wall or within the mesentery. Less than half of the population has this collateral network fully complete around the splenic flexure (Griffith's point). This void of collaterals from the left branch of the middle colic artery to the ascending left colic artery can result in colonic ischemia in the setting of bowel surgery or occlusive disease. Meandering mesenteric artery (Riolan artery) is another collateral network between the IMA and SMA. If present, this pathway connects the SMAs middle colic artery with the IMAs left colic artery. This collateral supply is surgically relevant with regards to endovascular aneurysm repair. Meandering mesenteric artery collateralization is an important pathway to permit coil embolization for type II endoleaks.
- Arc of Riolan-Preserving Splenic Flexure Takedown During Anterior Resection: Potentially Critical to Prevent Acute Anastomotic Ischemia. [Journal Article]
- DCDis Colon Rectum 2018; 61(3):411-414
- CONCLUSIONS: Recognizing and preserving the arc of Riolan, if visualized, during high inferior mesenteric vein ligation and splenic flexure takedown may be an important step in reducing the risk of acute colonic ischemia postanterior resection. See Video at http://links.lww.com/DCR/A535.
- Endovascular recanalization of occluded superior mesenteric artery using retrograde access through the inferior mesenteric artery. [Case Reports]
- JVJ Vasc Surg Cases Innov Tech 2017; 3(3):155-158
- Symptomatic occlusion of the superior mesenteric artery can be treated by open repair, hybrid procedure, or endovascular revascularization. In most cases, endovascular procedures are done by the ante…
Symptomatic occlusion of the superior mesenteric artery can be treated by open repair, hybrid procedure, or endovascular revascularization. In most cases, endovascular procedures are done by the antegrade approach. We report a case of a 67-year-old woman who presented with acute-on-chronic mesenteric ischemia successfully treated by retrograde endovascular recanalization of an occluded common hepatomesenteric trunk through the inferior mesenteric artery and arc of Riolan.
- Renal artery revascularization by using the Riolan anastomosis as feeding vessel in a patient with abdominal aortic coarctation due to fibromuscular dysplasia. [Case Reports]
- VASAVasa 2017; 46(4):313-318
- Fibromuscular dysplasia is a non-inflammatory, non-atherosclerotic vascular disease, occurring predominantly in younger females. A histologically heterogeneous group of fibroplasia without an inflamm…
Fibromuscular dysplasia is a non-inflammatory, non-atherosclerotic vascular disease, occurring predominantly in younger females. A histologically heterogeneous group of fibroplasia without an inflammatory component causes arterial narrowing. It affects mostly one or both renal arteries, cervicocranial or visceral arteries, leading to hypertension, renal failure/renal infarction or stroke/transient ischaemic attack. We present the case of a young female patient with abdominal aortic coarctation, history of acute renal failure, and critical hypertension due to pseudo-occlusion of both renal arteries. We performed renal artery revascularization specifically by using the Riolan anastomosis as feeding vessel.
- Multidetector Computed Tomographic Angiography for Optimal Cartography of the Visceral Abdominal Arterial Network: An Extensive Pictorial Review with Emphasis on Common and Uncommon Collateral Pathways, Complications and some Specific Syndromes. [Case Reports]
- JBJ Belg Soc Radiol 2017 Feb 01; 101(1):6
- Multidetector computed tomographic angiography (MDCTA) is the new gold standard for diagnostic evaluation of the abdominal and/or mesenteric arteries. It is not invasive and provides a 2D and 3D glob…
Multidetector computed tomographic angiography (MDCTA) is the new gold standard for diagnostic evaluation of the abdominal and/or mesenteric arteries. It is not invasive and provides a 2D and 3D global cartography of all abdominal arteries and that with only a limited amount of contrast media. MDCTA allows the optimal diagnosis of single or multiple arterial stenosis and easily analyses sometimes very complex collateral pathways. It constitutes a major advance to plan the arterial visceral safety of major commonly performed abdominal surgical procedures such as aorto-iliac surgery, endovascular aneurysm repair (EVAR), but also complex pancreatic and gastrointestinal or colonic surgery. It also allows to plan the most optimal strategy for revascularization of the mesenteric system through percutaneous angioplasty, stent placement or surgical bypass. This extensive pictorial review illustrates a large variety of situations which may be found during clinical practise. Single compression or stenosis of each digestive artery, combined and/or complex associations of stenosis and/or compressions of several arteries, secondary complications like aneurysms and classical but also sometimes unusual patterns of collateralization are richly illustrated. Specific syndromes comprising the median arcuate ligament syndrome (MALS) and the Leriche's syndrome are also discussed.
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- [Influences of inferior mesenteric artery types and Riolan artery arcade absence on the incidence of anastomotic leakage after laparoscopic resection of rectal cancer]. [Journal Article]
- ZWZhonghua Wei Chang Wai Ke Za Zhi 2016 Oct 25; 19(10):1113-1118
- CONCLUSIONS: IMA type III( with Riolan artery arcade absence increases AL incidence significantly in laparoscopic resection of rectal cancer. IMA type and Riolan aretry arcade absence or not contribute to the selection of IMA ligation site in the operation. For the colorectal cancer patients with IMA type III( and Riolan artery arcade absence, selective low IMA ligation with root lymph node dissection should be recommended.