Celiomesenteric anomaly and aneurysm: Clinical and etiologic features

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Presentation transcript:

Celiomesenteric anomaly and aneurysm: Clinical and etiologic features Robert W. Bailey, MD, Thomas S. Riles, MD, Robert J. Rosen, MD, Leo P. Sullivan, MD Journal of Vascular Surgery Volume 14, Issue 2, Pages 229-234 (August 1991) DOI: 10.1067/mva.1991.28728 Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Selective arteriogram of celiomesenteric aneurysm. Anterior view of aneurysm sac demonstrates its size and anatomic location. Journal of Vascular Surgery 1991 14, 229-234DOI: (10.1067/mva.1991.28728) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 CT scan of abdomen reveals the large aneurysm sac (long arrow) and the common celiomesenteric trunk (short arrow). The relationship of the aneurysm to surrounding viscera is demonstrated. Journal of Vascular Surgery 1991 14, 229-234DOI: (10.1067/mva.1991.28728) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Drawing identifies the anatomic relationship of the aneurysm (and its major branches) to the abdominal aorta, left gastric artery, pancreas, and duodenum. (LGA, Left gastric artery; HEP, hepatic artery; SPL, splenic artery; SMA, superior mesenteric artery). Journal of Vascular Surgery 1991 14, 229-234DOI: (10.1067/mva.1991.28728) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Control of the common arterial trunk was achieved with a vascular clamp placed just proximal to the neck of the aneurysm. Exposure of the base of the aneurysm was accomplished by opening of the aneurysm sac anteriorly. Journal of Vascular Surgery 1991 14, 229-234DOI: (10.1067/mva.1991.28728) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Surgical repair of celiomesenteric aneurysm. Anterior view of the surgical repair, which was fashioned with a circular Dacron patch with a continuous 3-0 polypropylene suture. Journal of Vascular Surgery 1991 14, 229-234DOI: (10.1067/mva.1991.28728) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Artist's representation of the embryonic development of the celiac and mesenteric circulation. A, Normal configuration of the primitive vascular roots involving the upper abdominal aorta during the early stages of development. The future location of the four major vessels are identified. During this early stage all four roots are united by a common vascular channel referred to as the ventral longitudinal anastomosis. (LGA, Left gastric artery; HEP, hepatic artery; SPL, splenic artery; SMA, superior mesenteric artery; VLA, ventral longitudinal anastomosis). B, During normal development the first, second, and third roots begin to fuse together to form the celiac axis. Simultaneously, the fourth root becomes more prominent and eventually becomes anatomically separated from the celiac axis (roots 1 through 3). C1 Normal embryonic development progresses from A to B to C1. To achieve this configuration, the first, second, and third roots must coalesce to form the celiac axis, and the fourth root develops into the superior mesenteric artery. Furthermore, the ventral longitudinal anastomosis must be interrupted between roots three and four for there to be complete anatomic separation of the celiac and mesenteric trunks. C2, Configuration of a complete celiomesenteric anomaly wherein all four major visceral branches (left gastric, hepatic, splenic, and superior mesenteric arteries) arise from a single, common trunk of the abdominal aorta. This pattern will develop if the ventral longitudinal anastomosis remains patent throughout roots 1-4. In this situation the superior mesenteric artery will not become anatomically separated from the celiac axis resulting in the formation of a celiomesenteric anomaly. C3, Configuration of the celiomesenteric anomaly described in the case report. In this condition the left gastric artery arises independently from the abdominal aorta, while the hepatic, splenic, and superior mesenteric arteries originate from a single, common trunk of the abdominal aorta. To achieve this end result, the ventral longitudinal anastomosis must be interrupted between roots 1 and 2, and the remaining roots (2 through 4) remain united by the ventral longitudinal anastomosis during development. Journal of Vascular Surgery 1991 14, 229-234DOI: (10.1067/mva.1991.28728) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions