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The Relation between Inferior Mesenteric Vein Ligation and Collateral Vessels to Splenic Flexure: Anatomical Landmarks, Technical Precautions and Clinical Significance

Authors
 Sami F. Al-Asari  ;  Daero Lim  ;  Byung Soh Min  ;  Nam Kyu Kim 
Citation
 YONSEI MEDICAL JOURNAL, Vol.54(6) : 1484-1490, 2013 
Journal Title
 YONSEI MEDICAL JOURNAL 
ISSN
 0513-5796 
Issue Date
2013
MeSH
Duodenum/anatomy & histology ; Female ; Humans ; Ligation/methods* ; Male ; Mesenteric Veins/surgery* ; Middle Aged ; Pancreas/anatomy & histology ; Prospective Studies
Keywords
Inferior mesenteric vein ; arc of Riolan ; collateral ; meandering artery
Abstract
PURPOSE: Our aim to assess clinical significance of the relation between inferior mesenteric vein ligation and collateral blood supply (meandering mesenteric artery) to the splenic flexure with elaboration more in anatomical landmarks and technical tips. MATERIALS AND METHODS: We review the literature regarding the significance of the collateral vessels around inferior mesenteric vein (IMV) root and provide our prospective operative findings, anatomical landmarks and technical tips. We analyzed the incidence and pattern of anatomic variation of collateral vessels around the IMV. RESULTS: A total of 30 consecutive patients have been prospectively observed in a period between June 25-2012 and September 7-2012. Nineteen males and eleven females with mean age of 63 years. Major colorectal procedures were included. There were three anatomical types proposed, based on the relation between IMV and the collateral vessel. Type A and B in which either the collateral vessel crosses or runs close to the IMV with incidence of 43.3% and 13.3%, respectively, whereas type C is present in 43.3%. There was no definitive relation between the artery and vein. No intra or postoperative ischemic events were reported. CONCLUSION: During IMV ligation, inadvertent ligation of Arc of Riolan or meandering mesenteric artery around the IMV root "in type A&B" might result in compromised blood supply to the left colon, congestion, ischemia and different level of colitis or anastomotic dehiscence. Therefore, careful dissection and skeletonization at the IMV root "before ligation if necessary" is mandatory to preserve the collateral vessel for the watershed area and to avoid further injury.
Files in This Item:
T201305647.pdf Download
DOI
10.3349/ymj.2013.54.6.1484
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Lim, Dae Ro(임대로)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/89150
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