Anatomical variations of the inferior mesenteric artery are extremely uncommon, since the inferior mesenteric artery is regularly diverged at the level of the third lumbar vertebra. We found a rare case in which the inferior mesenteric artery arose from the superior mesenteric artery. The findings were made during a routine dissection of the cadaver of an 82-yr-old Korean woman. This is the tenth report on this anomaly, the second female and the first Korean. The superior mesenteric artery normally arising from abdominal aorta sent the inferior mesenteric artery as the second branch. The longitudinal anastomosis vessels between the superior mesenteric artery and inferior mesenteric artery survived to form the common mesenteric artery. This anatomical variation concerning the common mesenteric artery is of clinical importance, performing procedures containing the superior mesenteric artery.
Aged, 80 and over ; Aorta, Abdominal/abnormalities ; Female ; Humans ; Mesenteric Artery, Inferior/*abnormalities/anatomy & histology ; Mesenteric Artery, Superior/*abnormalities/anatomy & histology ; Republic of Korea

OBJECTIVE: To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI. MATERIALS AND METHODS: Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described. RESULTS: The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization. CONCLUSION: The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anatomic Landmarks/*anatomy & histology ; Aorta, Abdominal/anatomy & histology ; Diagnostic Errors ; Female ; Humans ; Intervertebral Disc/anatomy & histology ; Lumbar Vertebrae/*anatomy & histology ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Mesenteric Artery, Superior/anatomy & histology ; Middle Aged ; Renal Artery/anatomy & histology ; Reproducibility of Results ; Sacrum/*anatomy & histology ; Spinal Cord/anatomy & histology ; Spine ; Young Adult

OBJECTIVETo explore the safety and efficiency of endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) which have the complex aortic anatomy.

METHODSThe clinical date of 48 AAA patients with complex aortic anatomy treated by EVAR from January 2003 to March 2011 was retrospectively analyzed. There were 37 male and 11 female patients, aged from 50 to 81 years with a mean of 71.4 years. Fourteen patients had short aortic neck (< 15 mm), 13 patients had severe infrarenal angulation (> 60°), 15 patients had severely tortuous iliac, 6 patients had small iliac (< 8 mm). The stent-grafts were deployed by both femoral arteries to treat the AAA.

RESULTThe primary technical success rate was 100%. The perioperative survival rate was 100%. Intraoperative angiograms revealed two type I endoleaks, in which one disappeared in two weeks, another existed. Follow-up was available in 40 patients with a median of 63 months (4 to 122 months). During the follow-up period, 2 patients died with no relationship to the procedures. The rest patients survived well. The accumulative survival rate was 95.8%. There were no new endoleak, stent-graft migration, aneurysm expansion, or secondary intervention during the follow-up time.

CONCLUSIONSEVAR is safety and efficiency to treat the patient of infrarenal abdominal aortic aneurysm with the complex aortic anatomy. By the accumulation of experience, EVAR will play a more important role for these patients.

Aged ; Aged, 80 and over ; Aorta, Abdominal ; anatomy & histology ; Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

PURPOSE: It is important to know the normal diameter of artery throughout the body so that clinicians are able to determine when an artery becomes aneurysmal. However, there are no previous studies on the normal diameter of arteries in the general Korean population. The purpose of this article is to determine the normal reference diameters of the abdominal aorta and iliac arteries in the Korean population. MATERIALS AND METHODS: We recruited the study population from three cities in Korea for the abdominal aortic aneurysm (AAA) screening. We measured the diameter of the aorta and iliac arteries. We analyzed the reference diameter of the population without AAA. The results were analyzed by Student's t-test and ANOVA on SPSS version 19. A p value <0.05 was considered to be statistically significant. RESULTS: One thousand two hundred and twenty-nine people were enrolled. 478 men and 751 women, with a mean age of 63.9+/-10.1 years (range 50 to 91) were examined. Eleven out of 1229 (0.89%) were diagnosed with AAA. In the population of 1218 people without AAA, the mean diameters (cm) of male/female were 2.20/2.11 (p<0.001) at suprarenal, 2.04/1.90 (p<0.001) at renal, 1.90/1.79 (p<0.001) at infrarenal, 1.22/1.17 (p<0.001) at right iliac and 1.47/1.15 (p=0.097) at the left iliac, respectively. There was a significantly larger diameter in the male population. The diameter of each level increased with age. CONCLUSION: The normal reference diameter of the infrarenal abdominal aorta in the Korean population is 1.9 cm in males and 1.79 cm in females. The diameter of the abdominal aorta increases with age.
Age Factors ; Aged ; Aged, 80 and over ; Aorta, Abdominal/*anatomy & histology/ultrasonography ; Aortic Aneurysm, Abdominal/diagnosis/epidemiology ; Female ; Humans ; Hypertension/complications ; Iliac Artery/*anatomy & histology ; Male ; Middle Aged ; Reference Values ; Republic of Korea ; Risk Factors

OBJECTIVE: To determine whether the time-intensity curves acquired by test and main dose contrast injections for MR angiography are similar. MATERIALS AND METHODS: In 11 patients, repeated contrast-enhanced 2D-turbo-FLASH scans with 1-sec interval were obtained. Both test and main dose time-intensity curves were acquired from the abdominal aorta, and the parameters of time-intensity curves for the test and main boluses were compared. The parame-ters used were arterial and venous enhancement times, arterial peak enhance-ment time, arteriovenous circulation time, enhancement duration and enhance-ment expansion ratio. RESULTS: Between the main and test boluses, arterial and venous enhance-ment times and arteriovenous circulation time showed statistically significant correlation (p < 0.01), with correlation coefficients of 0.95, 0.92 and 0.98 respectively. Although the enhancement duration was definitely greater than infusion time, reasonable measurement of the end enhancement point in the main bolus was impossible. CONCLUSION: Only arterial and venous enhancement times and arteriovenous circulation time of the main bolus could be predicted from the test-bolus results. The use of these reliable parameters would lead to improvements in the scan timing method for MR angiography.
Adult ; Aorta, Abdominal/anatomy & histology ; Contrast Media/*administration & dosage ; Female ; Gadolinium DTPA/*administration & dosage/diagnostic use ; Human ; Magnetic Resonance Angiography/*methods ; Male ; Time Factors

OBJECTIVE: To determine whether the time-intensity curves acquired by test and main dose contrast injections for MR angiography are similar. MATERIALS AND METHODS: In 11 patients, repeated contrast-enhanced 2D-turbo-FLASH scans with 1-sec interval were obtained. Both test and main dose time-intensity curves were acquired from the abdominal aorta, and the parameters of time-intensity curves for the test and main boluses were compared. The parame-ters used were arterial and venous enhancement times, arterial peak enhance-ment time, arteriovenous circulation time, enhancement duration and enhance-ment expansion ratio. RESULTS: Between the main and test boluses, arterial and venous enhance-ment times and arteriovenous circulation time showed statistically significant correlation (p < 0.01), with correlation coefficients of 0.95, 0.92 and 0.98 respectively. Although the enhancement duration was definitely greater than infusion time, reasonable measurement of the end enhancement point in the main bolus was impossible. CONCLUSION: Only arterial and venous enhancement times and arteriovenous circulation time of the main bolus could be predicted from the test-bolus results. The use of these reliable parameters would lead to improvements in the scan timing method for MR angiography.
Adult ; Aorta, Abdominal/anatomy & histology ; Contrast Media/*administration & dosage ; Female ; Gadolinium DTPA/*administration & dosage/diagnostic use ; Human ; Magnetic Resonance Angiography/*methods ; Male ; Time Factors

PURPOSE: The present study was aimed to assess the feasibility of using decellularized aortic allograft in a rat small animal surgical model for conducting small diameter vascular tissue engineering research. MATERIALS AND METHODS: Decellularized aortic allografts were infra-renally implanted in 12 Sprague-Dawley (SD) adult rats. The conduits were harvested at 2 (n = 6) and 8 weeks (n = 6), and assessed by hematoxylin and eosin (H&E), van Gieson, Masson Trichrome staining, and immunohistochemistry for von Willebrand factor, CD 31+, and actin. RESULTS: Consistent, predictable, and reproducible results were produced by means of a standardized surgical procedure. All animals survived without major complications. Inflammatory immune reaction was minimal, and there was no evidence of aneurysmal degeneration or rupture of the decellularized vascular implants. However, the aortic wall appeared thinner and the elastic fibers in the medial layer showed decreased undulation compared to the normal aorta. There was also minimal cellular repopulation of the vascular media. The remodeling appeared progressive from 2 to 8 weeks with increased intimal thickening and accumulation of both collagen and cells staining for actin. Although the endothelial like cells appeared largely confluent at 8 weeks, they were not as concentrated in appearance as in the normal aorta. CONCLUSION: The results showed the present rat animal model using decellularized vascular allograft implants to be a potentially durable and effective experimental platform for conducting further research on small diameter vascular tissue engineering.
Animals ; Aorta, Abdominal/anatomy & histology/cytology/*surgery ; Biocompatible Materials/*therapeutic use ; *Disease Models, Animal ; Female ; Graft Survival/immunology ; Rats ; Rats, Sprague-Dawley ; Tissue Engineering/*methods ; Transplantation, Homologous/*methods

INTRODUCTIONKnowledge of anatomical variations of the great vessels of the abdomen, including the coeliac trunk, is important for clinicians planning surgical intervention and radiological imaging. The present study aimed to record the prevalence of variations in the vascular pattern of branches of the coeliac trunk in cadavers.

METHODSA total of 50 properly embalmed and formalin-fixed cadavers from the Indian population were selected for the study. Dissection included surgical incision, followed by mobilisation of the anatomical viscera, to observe and record the branching pattern of the coeliac trunk.

RESULTSThe left gastric, common hepatic and splenic arteries were found to arise from the coeliac trunk in 86% of cadavers. In 76% of cadavers, the origin of the gastric artery was proximal to the bifurcation of the coeliac trunk into the common hepatic and splenic arteries. In one case, all three branches arose directly from the abdominal aorta, and the origin of the splenic artery was 1 cm distal to the origin of the left gastric and common hepatic arteries. In another case, the common hepatic and left gastric arteries arose from the coeliac trunk, and the origin of the splenic artery was 1.5 cm distal to the abdominal aorta.

CONCLUSIONVessel ligation and anastomosis are important in surgical procedures like liver transplantation, and background knowledge of the different vascular patterns of branches of the coeliac trunk is vital. The findings of our study could help to minimise complications related to abdominal surgery, including bleeding and necrosis, and facilitate better and more accurate radiological interpretations.

Adult ; Aged ; Anastomosis, Surgical ; Aorta, Abdominal ; anatomy & histology ; surgery ; Cadaver ; Celiac Artery ; anatomy & histology ; surgery ; Female ; Hepatic Artery ; anatomy & histology ; surgery ; Humans ; Liver ; blood supply ; surgery ; Liver Transplantation ; methods ; Male ; Middle Aged ; Splenic Artery ; anatomy & histology ; surgery ; Vascular Surgical Procedures ; methods ; Young Adult

OBJECTIVETo reconstruct a digital three-dimensional model of the rectum and the surrounding structures based on CT angiographic (CTA) data.

METHODSBased on air pressure enema and CTA, the chest T12 level to upper portion of the femur of a healthy volunteer was scanned with 64-slice spiral CT in the arterial phase and venous phase. The rectum and the surrounding structures were reconstructed with Mimics software based on the two-dimensional images of 856 consecutive layers obtained by Dicom 3.0 standard CT. The model was validated using finite element analysis software.

RESULTS AND CONCLUSIONThe established three-dimensional digital model allowed clear visualization of such structures of the lumbar vertebrae, pelvis, femur, abdominal aorta, internal iliac artery, external iliac artery, branches of the external iliac artery, skin, rectum, the colons, part of the small intestines, and the urinary bladder and prostate. The application of thin-layer CT and Dicom 3.0 standard renders better accuracy of the established digital model, which can provide a platform for surgical skill training and teaching of anatomy.

Adult ; Angiography ; methods ; Aorta, Abdominal ; diagnostic imaging ; Finite Element Analysis ; Humans ; Iliac Artery ; diagnostic imaging ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; methods ; Male ; Models, Anatomic ; Rectum ; anatomy & histology ; diagnostic imaging ; Tomography, Spiral Computed ; methods