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Purpose:
Endovascular navigation in aortic, renal and visceral procedures are based on precise knowledge of arterial anatomy. Our aim was to define the anatomical localization of the ostia of renovisceral arteries and their distribution to establish anatomical landmarks for endovascular catheterization.
Methods:
Computer-assisted measurements pe...
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Background:
A controversy on bridging covered stent (BCS) choice, between self-expanding (SECS) and balloon-expandable (BECS) stents, still exists in branched endovascular repair. This study aimed to determine the primary target vessel (TV) patency in patients treated with the t-Branch device and identify factors impairing the outcomes.
Methods:...
Citations
... In particular, the LRA originates from the anterolateral wall in 52%, from the lateral wall in 45%, and from the posterior wall of the aorta in 3% of cases [5]. Cadaveric studies have shown great variability in the distance between the ostia of origin of the CT, SMA, and RA, generally not exceeding the value of 10 mm [5][6][7][8], varying around an average of 6 mm between the SMA and the LRA [9][10][11] in studies based on in vivo computed tomography scans ( Figure 1). wall in most cases, whereas RAs originate from the lateral or anterolateral wall of the aorta. ...
... In particular, the LRA originates from the anterolateral wall in 52%, from the lateral wall in 45%, and from the posterior wall of the aorta in 3% of cases [5]. Cadaveric studies have shown great variability in the distance between the ostia of origin of the CT, SMA, and RA, generally not exceeding the value of 10 mm [5][6][7][8], varying around an average of 6 mm between the SMA and the LRA [9][10][11] in studies based on in vivo computed tomography scans (Figure 1). ...
... The risk factors most commonly reported for the occurrence of an iatrogenic injury of the SMA and/or CT during left nephrectomy/adrenalectomy are the close spatial relationship between renal and visceral arteries [5][6][7][8][9][10][11]; surgery indicated for large neoplasms of the left upper renal pole or left adrenal gland (Figure 2), extra-renal spread, or bulky hilar lymph node involvement [15,21]; surgery indicated for inflammatory renal diseases or completion nephrectomy after partial resection with perivisceral inflammatory adhesion to the aorta and its visceral branches [15]; morbid obesity [35]; and the surgeon's lack of experience [28,36]. ...
Due to their proximity to the left renal hilum, injuries to the superior mesenteric artery and celiac trunk are still reported during left radical nephrectomy, whether performed via open, laparoscopic, or robotic methods. The aim of this 50-year narrative review is to emphasize the anatomical and pathophysiological bases, risk factors, and strategies for the prevention, diagnosis, and treatment of such injuries.
... In particular, the LRA originates from the anterolateral wall in 52%, from the lateral wall in 45% and from the posterior wall of the aorta in 3% of cases [5]. Cadaveric studies have shown great variability of the distance between the ostia of origin of CT, SMA, and RA, generally not exceeding the value of 10 mm [5][6][7][8], varying around an average of 6 mm between the SMA and the LRA [9][10][11] in studies based on in-vivo computed tomography scans (Figure 1). Moreover, the left renal vein (LRV) generally crosses the abdominal aorta anteriorly and courses posterior to the SMA in the crotch of the angle between the SMA and the aorta. ...
... Risk factors most commonly reported for the occurrence of a iatrogenic injury of the SMA and/or CT during left nephrectomy/adrenalectomy are: the close spatial relations between renal and visceral arteries [5][6][7][8][9][10][11]; surgery indicated for large neoplasms of the left upper renal pole or left adrenal gland (Figure 2), or with extra-renal spread or bulky hilar lymph node involvement [15,21]; surgery indicated for inflammatory renal diseases or completion nephrectomy after partial resection with perivisceral inflammatory adhesion to the aorta and its visceral branches [15]; morbid obesity [35]; lack of surgeon's experience [28,36]. ...
... Unfortunately, in the vast majority of cases the procedure continues after clipping and division of the misperceived LRA, and further intraoperative suspect of extra-renal arterial injury may arise because of: 1) venous engorgement of the renal stump of the divided left renal vein; 2) identification of a LRA anterior to the LRV; 3) atypical course of the artery (i.e., transversal); 4) arterial origin from the anterior aortic wall; 5) finding another artery after division of the first LRA (with preoperative imaging negative for multiple LRA); 6) impossibility of clear identification of the left aortic wall due to the disease (neoplastic and/or inflammatory). Considering the above-reported variability of origin of the RA close to the visceral vessels, therefore, the first measure for the prevention of iatrogenic arterial injuries is preoperative evaluation of the vascular anatomy of the kidneys before nephrectomy [22,39], using a computed tomography scan with intravenous contrast (Figure 5), which allows the number and course of renal arteries to be identified in 99% of cases [11,40]. In a non-negligible number of cases, however, the diagnosis is suspected later, once the nephrectomy is completed, due to the change in color of the small intestine induced by arterial hypoperfusion, or, even later in the postoperative course, due to the appearance of abdominal pain, metabolic acidosis and/or increased serum lactates due to intestinal necrosis. ...
Due to their close anatomical and spatial relationships with left renal hilum, both superior mesenteric artery and celiac trunk injuries continue to be reported during left radical nephrectomy, either through an open, laparoscopic or robotic approach. The aim of this review, 50 years after the first reported cases, is to highlight anatomical and pathophysiological basis, risk factors, as well as diagnostic and therapeutic strategies for dealing with these injuries.
... Tuổi trung bình nghiên cứu của chúng tôi thấp hơn so với nghiên cứu của các tác giả Panagouli [9] nhưng cao hơn của các tác giả Nguyễn Thị Thanh Thiên [6], Lawton [7] và Binit Sureca [8]. Về độ phân bố tuổi nghiên cứu của chúng tôi hẹp hơn tác giả Nguyễn Thị Thanh Thiên [6] nhưng rộng hơn tác giả Panagouli [9]. ...
Đặt vấn đề: Hệ thống động mạch gan là một hệ động mạch có nhiều biến đổi giải phẫu khác nhau. Với sự phát triển và hữu ích của hình ảnh học, việc khảo sát giải phẫu mang đặc trưng dịch tễ giúp ích cho phẫu thuật nói chung và can thiệp nội mạch nói riêng. Mục tiêu nghiên cứu: (1) Khảo sát dạng phân nhánh động mạch gan trên chụp cắt lớp vi tính, (2) Tương quan giữa kích thước động mạch gan với tuổi, giới và dạng phân nhánh. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang, hồi cứu, người ≥ 18 tuổi, không mắc các bệnh ảnh hưởng đến giải phẫu động mạch gan được chụp cắt lớp vi tính vùng bụng có tiêm thuốc tương phản thì động mạch. Khảo sát mối tương quan giữa kích thước động mạch gan với tuổi, giới và dạng phân nhánh. Kết quả: Tuổi trung bình của đối tượng là 59,2 tuổi, nữ giới chiếm 42%, nam giới chiếm 58%. Dạng phân nhánh phổ biến nhất theo Michels là động mạch gan chung (ĐMGC) xuất phát từ động mạch thân tạng (dạng 1) chiếm tỉ lệ 94,9%. Đường kính trung bình của ĐMGC là 5,3 ± 1,0 mm. Chiều dài trung bình của ĐMGC là 34,9 ± 8,4 mm. Đường kính trung bình của động mạch gan riêng (ĐMGR) là 4,4 ±1,0 mm. ĐMGR có 96,6% nguyên uỷ từ ĐMGC, 3,4% trường hợp còn lại không có ĐMGR. Chiều dài ĐMGC tăng theo nhóm tuổi (p<0,05). Đường kính ĐMGC và đường kính ĐMGR ở nam lớn hơn nữ. Sự khác biệt có ý nghĩa thống kê (p<0,05). Kết luận: Do tần suất biến thể giải phẫu động mạch gan ngày càng cao. Nên hiểu rõ kiến thức giải phẫu của động mạch gan là cần thiết đối với bác sĩ lâm sàng, cũng như bác sĩ chẩn đoán hình ảnh.
... The current study is the initial and unique imaging study to evaluate the vascular distances in children according to their age and gender. The mean distances between the origins of the CTR-SMA, CTR-RRA, CTR-LRA, and CTR-IMA were between 20% and 30% lower than those reported in adults [7][8][9]13 . Moreover, these distances increased significantly with age possibly related to aortic elongation with the age and body height of the children. ...
... Although not statistically significant, these distances were slightly longer among females probably due to the fact that girls in the pubertal and prepubertal periods tend to be taller than the boys. These findings were consistent with previously published results 8,14 . ...
... Our distance measurements were more than 20% lower than those reported in adults 9,14 . In the current study, the origin of the RRA was higher than LRA, which is in agreement with previous reports on adults 8 14 . In the present study, the distances between the aorta at the diaphragmatic region and the origins of the major branches in children were between 40% and 65% lower than those reported by Anamaria et al. 14 Moreover, these distances were significantly longer among females, which is in disagreement with the previous study 14 . ...
Aim:The aim of the present study was to determine the normal distances between the origins of the major branches of the abdominal aorta, and their distances to the aorta at the diaphragmatic region and iliac bifurcation on multidetector computed tomography (MDCT) angiography in pediatric patients.Materials and Methods:The MDCT angiography scans obtained from 245 children aged between 0 and 18 years (mean age±standard deviation, 8.48±5.14 years) were retrospectively re-evaluated. The distances between the origins of the celiac trunk (CTR), superior mesenteric artery (SMA), right renal artery (RRA), left renal artery (LRA), and inferior mesenteric artery (IMA) were measured. The distance measurements between the aorta at the diaphragmatic region, iliac bifurcation, and the origins of the major branches (CTR, SMA, RRA, LRA, IMA) were performed as well.Results:The distances between the abdominal aorta and its branches were reported to vary in the age groups. All the distance measurements increased significantly with increasing age (p
... Trong khi nhiều nơi trên thế giới đã công bố các công trình nghiên cứu giải phẫu mạch máu gan bằng XQCLVT [6], [7], [8], [9], các nghiên cứu ở Việt Nam về vấn đề này vẫn còn hạn chế. Trên cơ sở đó, chúng tôi tiến hành nghiên cứu nhằm xác định các số đo chiều dài, đường kính mạch máu gan bao gồm hệ ĐMG, TMC và TMG. ...
TÓM TẮTMục tiêu nghiên cứu: Xác định mối tương quan giữa các chỉ số kích thước của hệ động mạch gan (ĐMG), hệ tĩnh mạch cửa (TMC) và hệ tĩnh mạch gan (TMG) với các yếu tố tuổi, giới tính và dạng giải phẫu bằng hình x quang cắt lớp vi tính (XQCLVT).Phương pháp: Nghiên cứu hồi cứu, cắt ngang mô tả. Dân số chọn mẫu bao gồm 611 các bệnh nhân trưởng thành (344 nam, 277 nữ, tuổi trung bình 55,0 ± 13,1 tuổi), đến khám bệnh tại bệnh viện Đại học Y Dược (BV ĐHYD) tpHCM vì nhiều triệu chứng khác nhau từ tháng 08/2017 đến tháng 08/2018, được chụp XQCLVT vùng bụng có tiêm thuốc tương phản thỏa tiêu chuẩn chọn mẫu. Từ hình chụp XQCLVT lưu trên hệ thống PACS của bệnh viện, sử dụng các phần mềm xử lý hình ảnh để dựng hình hệ ĐMG, TMC và TMG nhằm xác định kích thước các mạch máu gan, mối tương quan giữa các chỉ số này với các yếu tố tuổi, giới tính và dạng giải phẫu.Kết quả: Ở hệ ĐMG, có mối tương quan giữa đường kính ĐMG chung và dạng phân chia giải phẫu cụ thể đường kính động mạch này ở nhóm biến thể nhỏ hơn so với nhóm có dạng giải phẫu thường gặp (p<0,05), chiều dài của ĐMGC tăng theo tuổi (p<0,05). Chúng tôi cũng tìm thấy mối tương quan thuận với mức độ mạnh (r = 0,77) giữa đường kính ĐMG chung và ĐMG riêng. Ở hệ TMC, chúng tôi không tìm thấy mối tương quan giữa dạng phân chia giải phẫu với kích thước TMC, chúng tôi xác định được các đường kính của hệ TMC (bao gồm TMC chính, TMC trái và TMC phải) giảm theo tuổi (p<0,05). Ở hệ TMG, không có mối tương quan giữa yếu tố tuổi, giới tính và dạng phân chia giải phẫu với các chỉ số kích thước của hệ TMG. Nghiên cứu cũng chỉ ra đa số các chỉ số đường kính của hệ ĐMG và TMC ở nam giới lớn hơn nữ giới (p<0,05).Kết luận: XQCLVT là phương tiện hữu hiệu trong việc đánh giá mối tương quan giữa kích thước mạch máu gan với các yếu tố tuổi, giới và dạng giải phẫu.
... Multiple renal arteries (MRA) were founded in 4.146 kidneys (19,95%) of the total. The number of MRA arriving to the kidney varied from two to six (Thomson et al., 1889;Satyapal et al., 2001;Sampaio et al., 1992;Saldarriaga et al., 2008;Ali-El-Dein et al., 2003;Katariya et al., 2015;Bordei et al., 2004;Raman et al., 2007;Çiçekcibaşi et al., 2005;Hung et al., 2012;Harrison et al., 1978;Ugurel et al., 2010;Kaneko et al., 2008;Virendra et al., 2010;Budhiraja, et al., 2013;Özkan et al., 2006;Natsis et al., 2014;Bouali et al., 2012;Stanca et al., 2009;Jacek et al., 2007;Kornafel et al., 2010;Aristotle et al., 2013;Tarzamni et al., 2008;Méndez López et al., 2014;Sofía et al., 2008;Olave et al., 2009;Shaikh et al., 2014;Vasi et al., 2015;Palmieri et al., 2011;Ayuso et al., 2006;Patil et al., 2001;Jee et al., 2008;Platt et al., 1997;Johnson et al., 2013;Soares et al., 2013;Talović et al., 2007;Munnusamy et al., 2016;Zağyapan et al., 2009;Saritha et al., 2013;Vatsala et al., 2014;Zăhoi et al., 2015;Tayyba et al., 2016;Refaat et al., 2013;Aragão et al., 2012;Calle Toro et al., 2016;Khamanarong et al., 2004;Aubert et al., 1975;Holden et al., 2005;Janschek et al., 2004;Costa et al., 2011;Tyson et al., 2011;Kapoor et al., 2011;Tao et al., 2013;Kok et al., 2008;Han et al., 1998;Chabchoub et al., 2011;Sezer et al., 2012;Lloyd et al., 1935;Vilhova et al., 2001;Gümüş et al., 2012;Mustafa et al., 2016;Lawton et al., 2017;Cases et al., 2017). ...
Introduction: vascular anatomy variations are important in academic, clinical and surgical areas as well as nephrology, urology, oncological and vascular surgery, among others. The main objective of this review is to know the real prevalence of multiple renal arteries in a wide, mul-tiethnic population. Secondary objectives are to establish the prevalence of early branching of the renal artery and the prevalence of these variations in left and right kidneys. Methods: this study analyzes the renal arterial anatomy of 20.782 kidneys from 64 anatomical and radiological studies. Results: Multiple renal arteries (MRA) were present in 19,95% of the total kidneys, in number of 2 to 6 arteries arriving to the hilum. The most frequent number of MRA was 2 renal arteries (89,48%), followed by 3 (9,31%), 4 (1,06%), 5 (0,02%) and 6 (0,005%). This last one being found in only one kidney. Reported data on the lateralization of the MRA are rather poor, and among these no side's predilection was found: MRA were found in 49,83% on the right side and 50,17% of left kidneys. Early branching patterns were described in only one third of the published data, being present in 11,4% of the total kidneys from those data (corresponding in 4,23% of right kidney cases and in 4,52% of left kidney cases; 2,66% had no right/left information). Discussion: the most difficult part was to merge the results from the different studies due to the heterogeneity of their descriptions. A universally accepted medical nomenclature is needed in order to allow a more precise lecture and transmission of results in clinical practice. Renal anatomical variations have clinical and surgical implications in renal transplantation, cor-rectable hydronephrosis, ablation treatment for refractory hypertension or endovascular reconstructions and should be taken into account by every physician.
... Aortic remodeling with ageing and important heterogeneity of visceral vessels distribution should be carefully studied in preoperative course and the patients must be evaluated by himself' measurements which may be variated by various factors such as age, hypertension, atherosclerosis and genetic (Lawton et al., 2016). Kornreich et al. remarked that the positions of the aortic branching (as well as common iliac bifurcation) and venous confluence showed a highly significant downward shift with increasing age and the shift was more pronounced in Gynecologic Oncology Reports xxx (2017) xxx-xxx GORE-00216; No. of pages: 2; 4C: ...
Highlights
• Variation of aortic morphology such as aortic dimensions, branching points, and correlation with adjacent structures is highlighted.
• The mechanism of variance relies on the diseases such as arteriosclerosis, syphilis and hypertension.
• Patients with hypertension, atherosclerosis, and aortic aneurysm should be excluded from the study because of the variation of aortic morphology is concluded.
AIM
To assess the factors affecting visceral suitability of the use of the Zenith T-branchTM system in a group of patients with thoraco-adbominal aortic aneurysms (TAAAs).
METHODS
Computer tomography angiography (CTA) of patients who presented a TAAA from 01/2015 to 12/2019 were retrospectively examined. Multi-Planar Reconstructions were performed on CTA images to assess the anatomic suitability of the Zenith T-branchTM in the visceral district. In particular, the branch deviation angle (BDA) and the branch-length were computed for each target vessel.
RESULTS
Fifty-four CTA were examined. In 33.3% of these patients the presence of either a common origin of the superior mesenteric artery and the celiac trunk, or the diameter of one or more visceral/renal artery limited the visceral suitability of the device. All patients except one (97.9%) fitted the BDA criterion when the graft was placed in a position in which the BDA for the SMA was 5 degrees to the left. The branch-length criteria was met in all patients, except for one (97.9%), when the graft was placed in the center of the aorta. The eccentrical placement of the endograft decreased the suitability to 93.7%.
CONCLUSIONS
The Zenith T-branchTM system can be suitable in the visceral district for about 67% of patients. The target artery diameter was the most limiting criterion. The central location of the graft within the aortic lumen significantly affected the branch-length distance criteria.
The aim of this study is to determine vertebral levels of the coeliac trunk, the superior mesenteric artery, and the inferior mesenteric artery originated from the abdominal aorta and to calculate the distance measurements between these arteries and between these arteries and the aortic bifurcation by multidetector computed tomography angiography technique. It was determined that the nine different vertebral levels of the coeliac trunk, the nine different vertebral levels of the superior mesenteric artery, and the eleven different vertebral levels of the inferior mesenteric artery. The distance measurements between the coeliac trunk and the superior mesenteric artery, the inferior mesenteric artery, the aortic bifurcation were found significant between female and male. In this study, it was determined more different levels than the levels described in classical anatomy. The preoperative information of these morphological variations can contribute to the reduction of surgical time and perioperative vascular complications especially for anterior lumbar interbody fusion and defining the location of the primary lymphatic drainage site for gastrointestinal malignancies.