Japanese Society for Cancer of the Colon and Rectum (JSCCR) guideline 2019 recommended that lymph node dissection for advanced rectal cancer should include the lymphatic adipose tissue at the root of the inferior mesenteric vessels, but the ligation site of the inferior mesenteric artery (IMA) was not determined, and the NCCN guideline did not indicate clearly whether to retain the left colonic artery (LCA). Controversy over whether to retain LCA is no more than whether it can reduce the incidence of anastomotic complications or postoperative functional damage without affecting the patients' oncological outcome. Focusing on the above problems, this paper reviews the latest research progress. In conclusion, it is believed that the advantages of retaining LCA are supported by most studies, which can improve the blood supply of the proximal anastomosis, and technically can achieve the same range of lymph node dissection as IMA high ligation. However, whether it affects the survival of patients, reduces the incidence of anastomotic leakage, and improves the quality of life of patients, more high-quality evidence-based medical evidence is still needed.
Arteries ; Humans ; Laparoscopy ; Mesenteric Artery, Inferior/surgery* ; Quality of Life ; Rectal Neoplasms/surgery*

The preservation of left colonic artery (LCA) has been accepted by more and more surgeons in the radical resection of rectal cancer, but whether it can reduce anastomotic complications and affect the oncology efficacy remains controversial. This consensus elaborates the significance, anatomical structure, key points of operation techniques, indications and contraindications, and surgical approaches of LCA preservation. Each statement and recommendation was recognized by most experts in the field of colorectal surgery. The purpose of this consensus is to improve the cognitive level of Chinese colorectal surgeons on LCA preservation, so as to standardize the surgical strategies and methods of LCA preservation and furthermore practice, and promote it. The pending issues in this consensus need further high-quality clinical studies.
Anastomotic Leak ; Arteries ; China ; Consensus ; Humans ; Laparoscopy ; Mesenteric Artery, Inferior ; Rectal Neoplasms/surgery*

OBJECTIVE: To investigate the effects of Xiaotan Huayu Liqiao formula (the Chinese Medicine) on mesenteric artery function in rats exposed to chronic intermittent hypoxia (CIH), and to explore the related mechanism. METHODS: Forty-eight male SD rats were randomly divided into four groups as Normoxia, CIH, Formula+CIH and formula group. Rats were exposed to normoxia in the Normoxia and Formula group, or intermittent hypoxia in CIH or Formula+CIH group. Xiaotan Huayu Liqiao formula was given at 24g/kg by intragastric administration before intermittent hypoxia exposure. The pathological changes of mesenteric artery were determined by HE staining, and the relaxation of mesenteric artery (induced by acetylcholine(ACh) and L-arginine(L-Arg)) was recorded by microvascular ring technique. Serums of all rats were collected (0 d and 21 d) and the content of NO was detected by ELISA. The levels of endothelial nitric oxide synthase (eNOS) and p-eNOS were measured by Western blot. RESULTS: Compared with Normoxia group, the mesenteric arterial endothelial injury and media thickening were observed and the relaxation of mesenteric artery was significantly reduced in rats exposed to CIH. The level of NO in serum and the ratio of p-eNOS/eNOS were also decreased in the CIH group. Xiaotan Huayu Liqiao formula administration improved the pathologic changes and dilatation function of mesenteric artery, increased the levels of NO and p-eNOS. Compared with Normoxia group,all the results were not observed significant difference in Formula group. CONCLUSION Xiaotan Huayu Liqiao formula increased the bioavailability of NO, and ameliorated the CIH induced mesenteric artery function injury.
Acetylcholine ; Animals ; Drugs, Chinese Herbal ; pharmacology ; Hypoxia ; pathology ; Male ; Mesenteric Arteries ; drug effects ; pathology ; Nitric Oxide ; metabolism ; Nitric Oxide Synthase Type III ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley

Free fatty acid (FFA) intake regulates blood pressure and vascular reactivity but its direct effect on contractility of systemic arteries is not well understood. We investigated the effects of saturated fatty acid (SFA, palmitic acid), polyunsaturated fatty acid (PUFA, linoleic acid), and monounsaturated fatty acid (MUFA, oleic acid) on the contractility of isolated mesenteric (MA) and deep femoral arteries (DFA) of Sprague–Dawley rats. Isolated MA and DFA were mounted on a dual wire myograph and phenylephrine (PhE, 1–10 µM) concentration-dependent contraction was obtained with or without FFAs. Incubation with 100 µM of palmitic acid significantly increased PhE-induced contraction in both arteries. In MA, treatment with 100 µM of linoleic acid decreased 1 µM PhE-induced contraction while increasing the response to higher PhE concentrations. In DFA, linoleic acid slightly decreased PhE-induced contraction while 200 µM oleic acid significantly decreased it. In MA, oleic acid reduced contraction at low PhE concentration (1 and 2 µM) while increasing it at 10 µM PhE. Perplexingly, depolarization by 40 mM KCl-induced contraction of MA was commonly enhanced by the three fatty acids. The 40 mM KCl-contraction of DFA was also augmented by linoleic and oleic acids while not affected by palmitic acid. SFA persistently increased alpha-adrenergic contraction of systemic arteries whereas PUFA and MUFA attenuated PhE-induced contraction of skeletal arteries. PUFA and MUFA concentration-dependent dual effects on MA suggest differential mechanisms depending on the types of arteries. Further studies are needed to elucidate underlying mechanisms of the various effects of FFA on systemic arteries.
Animals ; Arteries ; Blood Pressure ; Fatty Acids ; Fatty Acids, Unsaturated ; Femoral Artery ; Linoleic Acid ; Mesenteric Arteries ; Oleic Acid ; Oleic Acids ; Palmitic Acid ; Phenylephrine ; Rats ; Receptors, Adrenergic, alpha ; Vasoconstriction

Behçet’s disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient’s clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.
Abdominal Pain ; Aneurysm, False ; Angiography ; Arteries ; Behcet Syndrome ; Celiac Artery ; Diagnosis ; Embolectomy ; Emergency Service, Hospital ; Female ; Humans ; Mesenteric Artery, Superior ; Mortality ; Transplants ; Vasculitis ; Weight Loss

PURPOSE: Type II endoleaks (T2ELs) are the most common type of endoleaks observed after endovascular aneurysm repair (EVAR). However, whether T2ELs should be treated remains debatable. In the present study, we aimed to describe the natural course of T2ELs and suggest the direction of their management. MATERIALS AND METHODS: We reviewed the data of 383 patients who underwent EVAR between 2007 and 2016. Data, including demographic and anatomical details, were collected, and patients with T2ELs were compared to those without them. Patients with T2ELs were categorized into subgroups according to changes in sac size and treatment requirement. RESULTS: We found patent lumbar artery count and lesser thickness of mural thrombi to be significant risk factors for T2ELs. Among the 383 patients, 85 (22.2%) patients were diagnosed with pure T2ELs. Among these 85 patients, the sac size increased in 29 (34.1%) patients, showed no significant change in 39 (45.9%) patients, and decreased in 17 (20.0%) patients. Fifteen (17.6%) patients, among 85 with initial pure T2ELs, showed spontaneous resolution. Five (5.9%) patients among 29, in whom the sac size increased, developed combined-type endoleaks. No sac ruptures were noted among the patients with T2ELs. CONCLUSION: T2ELs with sac expansion potentially contribute to other types of endoleaks. Therefore, periodic screening is important for these patients, particularly for those showing an increasing sac size. In addition, intervention should be considered when other types of endoleaks occur.
Aneurysm ; Aortic Aneurysm ; Arteries ; Endoleak ; Endovascular Procedures ; Humans ; Mass Screening ; Mesenteric Artery, Inferior ; Risk Factors ; Rupture

PURPOSE: Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion. METHODS: This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as <0.4. RESULTS: Critically low MAP index (<0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index. CONCLUSION: Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.
Angiography ; Arterial Pressure ; Arteries ; Atherosclerosis ; Colon ; Colonic Neoplasms ; Constriction ; Humans ; Ligation ; Mesenteric Arteries ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Multivariate Analysis ; Perfusion ; Prospective Studies ; Risk Assessment ; Tertiary Care Centers

PURPOSE: To compare high and low inferior mesenteric artery (IMA) ligation in a large number of patients, and investigate the short-term and long-term outcomes. METHODS: This retrospective study compared outcomes between high IMA ligation and low IMA ligation with dissection of lymph nodes (LNs) around the IMA origin. A total of 1,213 patients underwent elective low anterior resection with double-stapling anastomosis for stage I–III rectal cancer located ≥6 cm from the anal verge (835 patients underwent IMA ligation at the IMA origin; 378 patients underwent IMA ligation directly distal to the root of the left colic artery along with dissection of LNs around the IMA origin). RESULTS: There was no difference in anastomotic leakage rate between groups. The 2 groups did not significantly differ in intraoperative blood loss, perioperative complications, total number of harvested LNs, and metastatic IMA LNs. However, more metastatic LNs were harvested in the high-tie than in the low-tie group (1.3 ± 2.9 vs. 0.8 ± 1.9, P = 0.002), and the incidence of positive pathologic nodal status was higher in the high-tie group (37.9% vs. 28.6%, P = 0.001). The 5-year local recurrence-free and metastasis-free survival rates were similar between groups, as were the 5-year overall and cancer-specific survival rates. CONCLUSION: Low IMA ligation with dissection of LNs around the IMA origin showed no differences in anastomotic leakage rate compared with high IMA ligation, without affecting oncologic outcomes. High IMA ligation did not seem to increase the number of total harvested LNs, whereas the ratio of metastatic apical LNs were similar between groups.
Anastomotic Leak ; Arteries ; Cohort Studies ; Colic ; Humans ; Incidence ; Ligation ; Lymph Nodes ; Mesenteric Artery, Inferior ; Rectal Neoplasms ; Retrospective Studies ; Survival Rate ; Treatment Outcome

The aim of the present study is to evaluate the vasodilation effects of Tongmai Yangxin Pills (TMYX) on rat mesenteric artery as well as its mechanism of action. The relaxation effects of TMYX extracts with different concentrations were determined on isolated rat mesenteric artery in normal condition as well as pretreating by phenylephrine and KCl. Vascular relaxation effects of TMTX were also determined in mesenteric artery preincubated with L-ANME and indomethacin or in endothelium denuded mesenteric artery. Moreover, effects of TMYX by 50 mg·L⁻¹ on NO secretion and the phosphorylation of eNOS in a cellular model of human umbilical vein endothelial cell (HUVEC) pretreated with or without L-NAME were also observed. The experimental results showed that TMYX has no obvious effect on vasodilation of arteries in normal or KCl pretreated condition, while it can dose-dependently relax the rat mesenteric artery with intact endothelium stimulated with phenylephrine at a maximal diastolic rate of (64.71±10.03)%. After preincubating with L-NAME for 15 min or removal of mesenteric artery endothelium, the maximal diastolic rate was decreased to (35.77±8.93)% and (25.85±10.84)% respectively. However, preincubating with indomethacin had no inhibitory effect on TMYX induced vascular relaxation. Meanwhile, TMYX at 50 mg·L⁻¹ could increase the expression of P-eNOS and the secretion of NO in HUVEC. L-NAME significantly inhibited NO release and phosphorylation of eNOS induced by TMYX. The results suggested TMYX exerted endothelium-dependent relaxation effects against PE-induced contractions of isolated rat mesenteric artery through NO-cGMP signaling pathway.
Animals ; Endothelium, Vascular ; Humans ; Mesenteric Arteries ; Rats ; Vasodilation

A 57-year-old woman presented to vascular surgery clinic with visceral artery aneurysms that were incidentally detected during regular check-up. Imaging studies revealed occlusion of the celiac axis and severe stenosis of the superior mesenteric artery and 3 aneurysms along the posterior and inferior pancreaticoduodenal arteries, as well as the right gastroepiploic artery. Endovascular embolization of all aneurysms was rejected because of the risk of hepatic ischemia. These complicated lesion caused by polyarteritis nodosa were successfully treated using a hybrid operation with coil embolization, aneurysm resection, and antegrade aorto-celiac-superior mesentery artery bypass.
Aneurysm ; Arterial Occlusive Diseases ; Arteries ; Constriction, Pathologic ; Embolization, Therapeutic ; Female ; Gastroepiploic Artery ; Humans ; Ischemia ; Mesenteric Artery, Superior ; Mesentery ; Middle Aged ; Polyarteritis Nodosa