Aneurysms of anomalous splenomesenteric trunk: Clinical features and surgical management in two cases Piergiorgio G. Settembrini, MD, Jean-Michel Jausseran,

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Presentation transcript:

Aneurysms of anomalous splenomesenteric trunk: Clinical features and surgical management in two cases Piergiorgio G. Settembrini, MD, Jean-Michel Jausseran, MD, Sergio Roveri, MD, Marcel Ferdani, MD, Michele Carmo, MD, Philippe Rudondy, MD, Maria Grazia Serra, MD, Giuseppe Pezzuoli, MD, PhD Journal of Vascular Surgery Volume 24, Issue 4, Pages 687-692 (October 1996) DOI: 10.1016/S0741-5214(96)70085-X Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Complete celiac trunk can be found in 84% of human beings. A, Trunk as described in textbooks (tripus Halleri). CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery (25%). B, LGA leaves trunk as collateral artery (49%). C, Celiac trunk presents four main branches (tetrapus), the fourth being additional dorsal pancreatic artery (10%). (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Complete celiac trunk can be found in 84% of human beings. A, Trunk as described in textbooks (tripus Halleri). CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery (25%). B, LGA leaves trunk as collateral artery (49%). C, Celiac trunk presents four main branches (tetrapus), the fourth being additional dorsal pancreatic artery (10%). (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Complete celiac trunk can be found in 84% of human beings. A, Trunk as described in textbooks (tripus Halleri). CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery (25%). B, LGA leaves trunk as collateral artery (49%). C, Celiac trunk presents four main branches (tetrapus), the fourth being additional dorsal pancreatic artery (10%). (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Incomplete celiac trunk, with different combinations of main branches. CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery. A, 5%; B, 3%; C, 1%; D, <1%. (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Incomplete celiac trunk, with different combinations of main branches. CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery. A, 5%; B, 3%; C, 1%; D, <1%. (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Incomplete celiac trunk, with different combinations of main branches. CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery. A, 5%; B, 3%; C, 1%; D, <1%. (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Incomplete celiac trunk, with different combinations of main branches. CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery. A, 5%; B, 3%; C, 1%; D, <1%. (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Common origin of whole celiac trunk or of its main branches with SMA. CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery. A, 2%; B, 1%; C, 3%; D, 1%. (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Common origin of whole celiac trunk or of its main branches with SMA. CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery. A, 2%; B, 1%; C, 3%; D, 1%. (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Common origin of whole celiac trunk or of its main branches with SMA. CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery. A, 2%; B, 1%; C, 3%; D, 1%. (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Common origin of whole celiac trunk or of its main branches with SMA. CHA, Common hepatic artery; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery. A, 2%; B, 1%; C, 3%; D, 1%. (Modified from Lippert H, Pabst R. Arterial variations in man. Munich: JF Bergmann Verlag, 1985.) Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Case 1. Transverse CT scan shows aneurysm behind pancreas. L, Liver; S, spleen; P, pancreas; A, aorta; IVC, inferior vena cava; An, aneurysm. Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Case 1. Selective dye injection into SMA shows aneurysm involving splenic artery just after its anomalous origin. Yellow drawing represents relationship with pancreatic head. Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Case 1. A, Artist's drawing of region as found at operation. CT, Celiac trunk, composed of LGA and CHA; SA, splenic artery; SMA, superior mesenteric artery; An, aneurysm. B, Artist's drawing of mobilization of entire splenopancreatic bloc. CT, Celiac trunk, composed of LGA and CHA; SA, splenic artery; SMA, superior mesenteric artery; SMT, splenomesenteric trunk; An, aneurysm. Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Case 1. A, Artist's drawing of region as found at operation. CT, Celiac trunk, composed of LGA and CHA; SA, splenic artery; SMA, superior mesenteric artery; An, aneurysm. B, Artist's drawing of mobilization of entire splenopancreatic bloc. CT, Celiac trunk, composed of LGA and CHA; SA, splenic artery; SMA, superior mesenteric artery; SMT, splenomesenteric trunk; An, aneurysm. Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Case 2. Transverse CT scan shows location of aneurysm behind pancreatic body. L, Liver; S, spleen; P, pancreas; A, aorta; IVC, inferior vena cava; An, aneurysm. Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Case 2. A, Transfemoral aortography shows aneurysm in front of celiac aorta. B, Selective dye injection into SMA shows aneurysm developing in front of common (spleno-mesenteric) trunk's bifurcation. SA, Splenic artery; SMA, superior mesenteric artery; An, aneurysm. Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Case 2. A, Transfemoral aortography shows aneurysm in front of celiac aorta. B, Selective dye injection into SMA shows aneurysm developing in front of common (spleno-mesenteric) trunk's bifurcation. SA, Splenic artery; SMA, superior mesenteric artery; An, aneurysm. Journal of Vascular Surgery 1996 24, 687-692DOI: (10.1016/S0741-5214(96)70085-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions