open access
Types of inferior mesenteric artery: a proposal for a new classification
, 3
Affiliations- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
- Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
open access
Abstract
Background: The inferior mesenteric artery (IMA) is the third main branch of the abdominal aorta and arises at the level of L3, supplying the large intestine from the distal transverse colon to the upper part of the anal canal. The aim of this study was to characterise the course and morphology of the terminal branches of the IMA, and also creating a new IMA classification, which seems to be necessary for clinicians performing surgery in this area.
Materials and methods: The anatomical variations in the branching patterns of the IMA were examined in 40 cadavers fixed in a 10% formalin solution. Morphometric measurements were then obtained twice by two researchers.
Results: Due to the proposed classification system, type I characterised by a common trunk preceding bifurcation into sigmoidal branches and the superior rectal artery after giving left colic artery (LCA) occurred in 57.5% of cases, type II, trifurcation type, in 25%, type III with the superior rectal arteries originating firstly from the IMA in 5%, type IV with the ascending lumbar artery in 10% of cases and type V, a novelty, in 2.5%. The origin of IMA was observed at the level of L2/L3 in 22.5% of cases, at L3 in 25% of cases, at L3/L4 in 15% of cases, at L4 in 35% of cases and at the level of L5 in 2.5% of cases. More than one third (38.1%) of total cases with additional arteries and rapidly bifurcating branches occurred in types III, IV, and V. In women, only the IMA and LCA were significantly narrower than in men. Only the diameter of the IMA correlated with the diameter of the superior rectal artery.
Conclusions: The IMA is characterised by high morphological variability. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.
Abstract
Background: The inferior mesenteric artery (IMA) is the third main branch of the abdominal aorta and arises at the level of L3, supplying the large intestine from the distal transverse colon to the upper part of the anal canal. The aim of this study was to characterise the course and morphology of the terminal branches of the IMA, and also creating a new IMA classification, which seems to be necessary for clinicians performing surgery in this area.
Materials and methods: The anatomical variations in the branching patterns of the IMA were examined in 40 cadavers fixed in a 10% formalin solution. Morphometric measurements were then obtained twice by two researchers.
Results: Due to the proposed classification system, type I characterised by a common trunk preceding bifurcation into sigmoidal branches and the superior rectal artery after giving left colic artery (LCA) occurred in 57.5% of cases, type II, trifurcation type, in 25%, type III with the superior rectal arteries originating firstly from the IMA in 5%, type IV with the ascending lumbar artery in 10% of cases and type V, a novelty, in 2.5%. The origin of IMA was observed at the level of L2/L3 in 22.5% of cases, at L3 in 25% of cases, at L3/L4 in 15% of cases, at L4 in 35% of cases and at the level of L5 in 2.5% of cases. More than one third (38.1%) of total cases with additional arteries and rapidly bifurcating branches occurred in types III, IV, and V. In women, only the IMA and LCA were significantly narrower than in men. Only the diameter of the IMA correlated with the diameter of the superior rectal artery.
Conclusions: The IMA is characterised by high morphological variability. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.
Keywords
anatomical variations, inferior mesenteric artery, left colic artery, superior rectal artery, sigmoid branches, new classification, cadavers
About this articleTitle
Types of inferior mesenteric artery: a proposal for a new classification
Journal
Issue
Article type
Original article
Pages
827-838
Published online
2020-09-15
Page views
7147
Article views/downloads
1708
DOI
Pubmed
Bibliographic record
Folia Morphol 2021;80(4):827-838.
Keywords
anatomical variations
inferior mesenteric artery
left colic artery
superior rectal artery
sigmoid branches
new classification
cadavers
Authors
A. Balcerzak
O. Kwaśniewska
M. Podgórski
Ł. Olewnik
M. Polguj
References (28)- Benton RS, Cotter WB. A hitherto undocumented variation of the inferior mesenteric artery in man. Anat Rec. 1963; 145: 171–173.
- Bergman RA, Afifi AK, Miyauchi R. Anatomy Atlases, An anatomy digital library [WWW Document]. Illus. Encycl. Hum. Anat. Var. 2015.
- Bergman R, Thompson S, Afifi A, Saadeh F. Compendium of human anatomic variation. Urban & Schwarzenberg, Baltimore 2018.
- Bonnet S, Berger A, Hentati N, et al. High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses. Dis Colon Rectum. 2012; 55(5): 515–521.
- Boström P, Rutegård J, Haapamäki M, et al. Arterial ligation in anterior resection for rectal cancer: A validation study of the Swedish Colorectal Cancer Registry. Acta Oncol. 2014; 53(7): 892–897.
- Cavasse . Deux anomalies artérielles, cartiods et inferiuer diaphragmatiques. Bulletins et Mem. de la Société Anatomique de Paris. 1856; XXXI(3): 72–73.
- Chiene . Complete obliteration of the cœliac and mesenteric arteries; the viscera receiving their supply through the extra-peritoneal system of vessels. Am J Med Sci. 1869; 57(113): 231–232.
- Chin CC, Yeh CY, Tang R, et al. The oncologic benefit of high ligation of the inferior mesenteric artery in the surgical treatment of rectal or sigmoid colon cancer. Int J Colorectal Dis. 2008; 23(8): 783–788.
- Gwyn DG, Skilton JS. A rare variation of the inferior mesenteric artery in man. Anat Rec. 1966; 156(2): 235–237.
- Horton KM, Fishman EK. CT angiography of the mesenteric circulation. Radiol Clin North Am. 2010; 48(2): 331–45, viii.
- Ke J, Cai J, Wen X, et al. Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: Insights into rectal cancer surgery - A retrospective observational study. Int J Surg. 2017; 41: 106–111.
- Kitamura S, Nishiguchi T, Sakai A, et al. Rare case of the inferior mesenteric artery arising from the superior mesenteric artery. Anat Rec. 1987; 217(1): 99–102.
- Kostinovitch LI. A case of simultaneous occurrence of a number of variations of the visceral branches of the abdominal aorta. Anat Rec. 1937; 67(4): 399–403.
- Moore KL, Dalley AF. Clinical Oriented Anatomy, 4th ed. Lippincott Williams & Wilkins, Philadeplphia 1999.
- Nuzhat A. Anatomy of inferior mesenteric artery in fetuses. Scientifica (Cairo). 2016; 2016: 5846578.
- Olewnik Ł. Fibularis tertius: anatomical study and review of the literature. Clin Anat. 2019; 32(8): 1082–1093.
- Olewnik Ł, Łabętowicz P, Podgórski M, et al. Variations in terminal branches of the popliteal artery: cadaveric study. Surg Radiol Anat. 2019; 41(12): 1473–1482.
- Olewnik Ł, Waśniewska A, Polguj M, et al. Rare combined variations of renal, suprarenal, phrenic and accessory hepatic arteries. Surg Radiol Anat. 2018; 40(7): 743–748.
- Olewnik Ł, Wysiadecki G, Polguj M, et al. A rare anastomosis between the common hepatic artery and the superior mesenteric artery: a case report. Surg Radiol Anat. 2017; 39(10): 1175–1179.
- Olewnik Ł, Wysiadecki G, Polguj M, et al. Types of coeliac trunk branching including accessory hepatic arteries: a new point of view based on cadaveric study. Folia Morphol. 2017; 76(4): 660–667.
- 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.
- Poynter CWM. Congenital anomalies of the arteries and veins of the human body with bibliography. University Studies of the University of Nebraska, 1922 22: 1–106.
- Pinal-Garcia DF, Nuno-Guzman CM, Gonzalez-Gonzalez ME, et al. The celiac trunk and its anatomical variations: a cadaveric study. J Clin Med Res. 2018; 10(4): 321–329.
- Samura M, Morikage N, Mizoguchi T, et al. Effectiveness of embolization of inferior mesenteric artery to prevent type II endoleak following endovascular aneurysm repair: a review of the literature. Ann Vasc Dis. 2018; 11(3): 259–264.
- Testut L, Latarjet A. Traité d’anatomie humaine. Doin & Cie, Paris 1949.
- Torres K, Staśkiewicz G, Denisow M, et al. Anatomical variations of the coeliac trunk in the homogeneous Polish population. Folia Morphol. 2015; 74(1): 93–99.
- Yi SQ, Li J, Terayama H, et al. A rare case of inferior mesenteric artery arising from the superior mesenteric artery, with a review of the review of the literature. Surg Radiol Anat. 2008; 30(2): 159–165.
- Zebrowski W, Augustyniak E, Zajac S. Variation of origin and branches of the inferior mesenteric artery and its anastomoses. Folia Morphol. 1971: 510–517.
