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Evaluation of Blood Flow of Small Bowel Artery and Bridging Between Superior and Inferior Mesenteric Artery By 3D CTA
Jia Ke*, Zhiyang Zhou, Zhen He, Weixin Lin, Xiaofeng Wen, Xian-rui Wu, Xiaosheng He, Xiaowen He, Xiaojian Wu, Jianping Qiu
6th affiliated hospital, Sun Yat-sen university, Guangzhou, China
Background:
With advances in computer-assisted radiographic analysis, surgeons can obtain anatomical details of abdominal vascular by 3D CT angiography (CTA), and make preoperative strategies based on blood supply evaluation.
Aim:
To investigate the branches, length and volume distribution of superior mesenteric artery (SMA), and the bridging pattern between SMA and inferior mesenteric artery (ICA) system.
Methods:
Abdominal CTA on random patients were used. Number, site, diameter and CT signal of the branches from SMA were recorded, including small bowel artery, ileocolic artery, right colic artery and middle colic artery. Main structure of IMA system was also tracked, especially the left colic artery and the bridging pathway between SMA and IMA system.
Results:
SMA and each branches could be visualized and analyzed by 3D CTA (Figure 1A,B). 5 small bowel arteries were mostly observed (27%), followed by 5 (24%) and 6 branches (18%) (Figure 1C). In half of the patients, over 80% of the branches reside in the upper part of SMA (Figure 1D). Combining CT signal and the square of diameter, Volume distribution of SMA revealed as a stair curve, with a drop after each braches (Figure 1E). Distance from the root of SMA to anal verge was 36±12 mm longer than that to symphysis pubis (Figure 1B, Table 1). Vessel anatomy between SMA and IMA systems can be classified as “MSA dominant” (23.7%), “balanced” (62.7%) and “LCA dominant” (13.6%) (Figure 1F).
Conclusions:
Detailed anatomy and volume distribution of small bowel arteries can be clearly analyzed by 3D CTA. 2. Bottom line of ileum pouch do not have to be released to 6 cm below symphysis pubis to ensure tension-free anastomosis with anus. 3. Anatomy of the vessel bridge between SMA and IMA systems vary among patients, and this may provide anatomic basis of anastomotic complications after rectal cancer surgery.
Distance from the root of SMA to symphysis pubis, anal verge and full length of SMA. n=47
| From root of SMA | To anal verge (A) | To symphysis pubis (B) | Difference
(A-B) | To tip of SMA (C) | Difference
(A-C) | | Length (mm) | 327±18 | 292±17 | 36±12 | 240±26 | 87±24 |
Distance A was measured by a broken line between the root of SMA and bottom line of anal verge, folded at the level of sacropromontory (Fig. 2A). Distance B was measured by a direct line between the root of SMA and the bottom of symphysis pubis (Fig. 2A). Distance C was measured by 3D curved line created by software to evaluate spatial length of SMA (Fig. 1A). 
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