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ANATOMIC BASES OF MEDICAL, RADIOLOGICAL AND SURGICAL TECHNIQUES
Computer-assisted study of the axial orientation and distances
between renovisceral arteries ostia
James Lawton
1
•Joseph Touma
1
•Jean Se
´ne
´maud
1
•Paul de Boissieu
2
•
Julien Brossier
1
•Hicham Kobeiter
3
•Pascal Desgranges
1
Received: 9 March 2016 / Accepted: 15 June 2016 / Published online: 25 June 2016
ÓSpringer-Verlag France 2016
Abstract
Purpose Endovascular navigation in aortic, renal and vis-
ceral 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 performed on
55 CT scans and patients features (age, sex, aortic diame-
ter) were analyzed. pvalues \0.05 were considered sta-
tistically significant.
Results The mean axial angulation of CeT and the SMA
origin was 21.8°±10.1°and 9.9°±10.5°, respectively.
The ostia were located on the left anterior edge of the aorta
in 96 % of cases for the CeT and 73 % for the SMA. CeT
and SMA angles followed Gaussian distribution. Left renal
artery (LRA) rose at 96°±15°and in 67 % of cases on
the left posterior edge. The right renal artery (RRA) rose at
-62°±16.5°and in 98 % of cases on the right anterior
edge of the aorta. RRA angle measurements and cranio-
caudal RRA-LRA distance measurements did not follow
Gaussian distribution. The mean distances between the
CeT and the SMA, LRA, and RRA were 16.7 ±5.0,
30.7 ±7.9 and 30.5 ±7.7 mm, respectively. CeT-SMA
distance showed correlation with age and aortic diameter
(p=0.03). CeT-LRA distance showed correlation with
age (p=0.04). The mean distance between the renal ostia
was 3.75 ±0.21 mm. The RRA ostium was higher than
the LRA ostium in 52 % of cases. RRA and LRA origins
were located at the same level in 7 % of cases.
Conclusion Our results illustrate aortic elongation with
ageing and high anatomical variability of renal arteries.
Our findings are complementary to anatomical features
previously published and might contribute to enhance
endovascular procedures safety and efficacy for vascular
surgeons and interventional radiologists.
Keywords Visceral branches orientations Celiac trunk
Superior mesenteric artery Renal arteries Radiological
anatomy Endovascular navigation
Introduction
Endovascular treatment is the procedure of choice for
aortic aneurysms (AAA) and aorto-iliac or aortic branches
occlusive disease in cases with favorable anatomy [22].
Endovascular approach can also be used as an alternative
procedure in patients deemed unfit for open surgery [7].
Endovascular techniques are based on fluoroscopy-guided
intra-arterial navigation. Catheterization of renal and
digestive arteries is mandatory in numerous procedures
such as the treatment of renovisceral arteries stenosis or
aneurysms [22], para-renal and thoraco-abdominal aneur-
ysms repair [11] and selective embolization.
Target vessels ostia localization is often possible with
repeated contrast agent injections and prolonged radiation
time with, however, an increased morbidity of the
&James Lawton
jameslawton.ihp@gmail.com
1
Department of Vascular Surgery, Henri Mondor University
Hospital, 51 Avenue du Mare
´chal de Lattre de Tassigny,
94010 Cre
´teil, France
2
Department of Research and Innovation, Robert Debre
´
Hospital, Reims University Hospitals, rue du Ge
´ne
´ral Koenig,
51100 Reims, France
3
Department of Radiology, Henri Mondor University
Hospital, 51 Avenue du Mare
´chal de Lattre de Tassigny,
94010 Cre
´teil, France
123
Surg Radiol Anat (2017) 39:149–160
DOI 10.1007/s00276-016-1718-6
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