Arc of Riolan revisited-proposal of a new classification system
, 1, 1, 1, 1
Abstract
Background: The arterial supply of the large colon is provided by the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). A particularly important area, especially in the field of colorectal surgery is the splenic flexure of the colon. There is a noticeable misunderstanding in the correct nomenclature of the major arterial anastomoses between SMA and IMA – Drummond’s Marginal Artery (DMA), Arc of Riolan (AOR), and Moskovitz Artery (MA). The aim of this study is to organize the nomenclature and propose a new simplified one to facilitate communication between physicians of various specialties.
Materials and methods: Fourteen formalin-fixed cadavers (9 male, 5 female) accessible from the Chair of Anatomy of the Jagiellonian University Collegium Medicum were dissected to examine and describe the anatomical variations of anastomoses between SMA and IMA.
Results: The artery of Drummond was present in all 14 specimens maintaining the continuity of the vessel along its entire course. The Arc of Riolan was found in 7 out of 14 cadavers (50%). The artery of Moskovitz was not found. The average length measured between IMA and aortic bifurcation and between IMA and SMA was 51,00 mm and 84,68mm respectively.
Conclusions: SMA and IMA anastomoses form an arterial network that is characterized by high variability and trail in surgically strategic areas. For this reason, simplifying the terminology and using unambiguous names of these vessels based on their trail and anatomical relationship with IMV are crucial for the proper planning and execution of surgical procedures performed on the colon.
Keywords: intermesenteric anastomosisIMASMAMoskowitz arteryinferior mesenteric veincadaveric study
References
- Al-Asari SF, Lim D, Min BS, et al. The relation between inferior mesenteric vein ligation and collateral vessels to splenic flexure: anatomical landmarks, technical precautions and clinical significance. Yonsei Med J. 2013; 54(6): 1484–1490.
- Battal B, Hamcan S, Akgun V, et al. Congenital superior-inferior mesenteric arterial variation or arc of Riolan due to occlusion of proximal superior mesenteric artery. Surg Radiol Anat. 2014; 36(3): 309–310.
- Bruzzi M, M'harzi L, El Batti S, et al. Inter-mesenteric connections between the superior and inferior mesenteric arteries for left colonic vascularization: implications for colorectal surgery. Surg Radiol Anat. 2019; 41(3): 255–264.
- Cai J, Wen X, Lin W, et al. [Evaluation of three-dimensional CT reconstruction on the anatomic variation of inferior mesenteric artery and left colic artery]. Zhonghua Wei Chang Wai Ke Za Zhi. 2017; 20(11): 1274–1278.
- de Mello Moura GC, Rezende LG, Navarro TP, et al. Angiographic characteristics of the intermesenteric artery. Surg Radiol Anat. 2022; 44(5): 697–701.
- Chen YT, Hsu MY, Lee YH, et al. Embolization of an arc of Riolan artery aneurysm. J Vasc Interv Radiol. 2020; 31(8): 1320.
- Cheruiyot I, Cirocchi R, Munguti J, et al. Surgical anatomy of the accessory middle colic artery: a meta-analysis with implications for splenic flexure cancer surgery. Colorectal Dis. 2021; 23(7): 1712–1720.
- Garcia-Granero A, Sánchez-Guillén L, Carreño O, et al. Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study. Tech Coloproctol. 2017; 21(7): 567–572.
- Karatay E, Javadov M. The importance of the Moskowitz artery as a lesser-known collateral pathway in the medial laparoscopic approach to splenic flexure mobilisation and its evaluation with preoperative computed tomography. Videosurgery Miniinv. 2021; 16(2): 305–311.
- Kwon SeH, Ahn HJ, Oh JH. Is it the arc of Riolan or meandering mesenteric artery? J Endovasc Ther. 2015; 22(5): 825–826.
- Lange JF, Komen N, Akkerman G, et al. Riolan's arch: confusing, misnomer, and obsolete. A literature survey of the connection(s) between the superior and inferior mesenteric arteries. Am J Surg. 2007; 193(6): 742–748.
- Nakayama Y, Hayashi S, Takeuchi K, et al. Positional relationships of abdominal aortic branches for contrast radiography of the inferior mesenteric artery using the coeliac trunk and superior mesenteric artery as landmarks. Okajimas Folia Anat Jpn. 2017; 93(4): 139–145.
- Patroni A, Bonnet S, Bourillon C, et al. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat. 2016; 38(4): 477–484.
- Patroni A, Bonnet S, Bourillon C, et al. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat. 2016; 38(4): 477–484.
- Santhanam A. The meandering mesenteric artery. Dis Colon Rectum. 2006; 49(2): 285–286.
- Sinkeet S, Mwachaka P, Muthoka J, et al. Branching pattern of inferior mesenteric artery in a black african population: a dissection study. ISRN Anat. 2013; 2013: 962904.
- Toh JW, Matthews R, Kim SH. Arc of Riolan-Preserving Splenic Flexure Takedown During Anterior Resection: Potentially Critical to Prevent Acute Anastomotic Ischemia. Dis Colon Rectum. 2018; 61(3): 411–414.
- Toh JW, Ramaswami G, Nguyen KS, et al. 3D mesenteric angiogram-based assessment of Arc of Riolan crossing the inferior mesenteric vein: important considerations in high ligation during splenic flexure takedown in anterior resection. Surg Radiol Anat. 2022; 44(8): 1165–1170.
- Xie Y, Jin C, Zhang S, et al. features and common causes of arc of Riolan expansion: an analysis with 64-detector-row computed tomographic angiography. Int J Clin Exp Med. 2015; 8(3): 3193–3201.
