Coeliac trunk and its anatomic variations : a cadaveric study

Background: Coeliac trunk (CT) is the first major visceral branch of the abdominal aorta. The aim of this work was to present the CT division pattern and its anatomical variants in a sample of Polish population. Materials and methods: Coeliac trunk dissection was performed in 50 adult cadavers in the Department of Anatomy, Jagiellonian University Medical College. Cadavers of Polish subjects were included. Cadavers with previous upper abdominal surgery, abdominal trauma, disease process that distorted arterial anatomy or signs of putrefaction were excluded. CT variations, accessory vessels, and vertebral level of origin were described. CT patterns were reported according to the Adachi classification. This study was reviewed and approved by the local Ethics Committee. Results: Coeliac trunk consisting of the left gastric, common hepatic and splenic artery (type 1 according to the Adachi classification) was found in 82% of cadavers. The true tripod was found in 20% and the false one in 80%. Additional vessels were also found: greater pancreatic from the splenic artery and left inferior phrenic from the left gastric artery, which accounted for 2% sections. Type 2 according to the Adachi classification (i.e. the hepatosplenic trunk) was found in 16% of the sections. Other types of CT were not observed. The level of origin was found to be at the inter-vertebral disc between T12 and L1 in all of the cases. Conclusions: Based on the analysis of the sectional material of the Department of Anatomy, it was found that the typical visceral segmental division is approximate to that observed by Adachi in its classification, whereas the second type of CT was twice as frequent and no other, less frequent types were found

Surgical anatomy of the breast revisited

With the advent of breast conservation options in the 1970s, as well as wider acceptance of breast reconstruction in cancer patients in 1980/1990, ending up with evolution of oncoplastic concepts in the early 2000s, detailed surgical anatomy of the breast became important. This short article reviews surgical anatomy of breast with particular emphasis on innervation and blood supply to the skin and nipple-areolar complex, as well as points out the concept of compartmental breast cancer anatomy. Meticulous dissection and avoidance of transection of major vessels and nerves constitutes the crucial factor for satisfactory results of surgery in terms of preservation of sensation as well as appropriate vitality of skin

Arc of Riolan revisited-proposal of a new classification system

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. 

The evaluation of vasculature in post-mortem angio-computed tomography for anatomy research purposes: method description based on celiac trunk analysis

Background: Anatomical research based on deceased body specimens is a time-consuming process that requires a great deal of skill and time to perform correctly. Three-dimensional medical image analysis is an excellent tool for anatomic evaluation, but it often includes patients with comorbidities in the study group, which can skew the results. The purpose of this study was to develop and evaluate methods for anatomic research based on postmortem contrast-enhanced computed tomography angiography 3D reconstruction of the celiac trunk. Materials and methods: Postmortem contrast-enhanced computed tomography angiography of 105 (28.6% female, age 50.8±18.7) decedents without abdominal trauma or tumor was analyzed. The abdominal portion of the aorta and the celiac trunk with its branches were reconstructed and evaluated. The type of celiac trunk was evaluated. The results were analyzed. Results: The celiac trunk, splenic artery, and common hepatic artery were visualized in all cases. The left gastric artery was visible in 97.1% of cases. The dorsal pancreatic artery was visualized in 61.0% of cases. The most common type of celiac trunk was 1 (88.6%), and the rarest types were 2, 3, and 6 (1.0%). We observed 4 morphologies of the truncus celiacus that did not fit the classification presented previously. Conclusions: This study has demonstrated that three-dimensional reconstruction of postmortem contrast-enhanced computed tomography is an excellent tool for performing accurate morphometric analyzes for anatomic research purposes. This method can serve as a source for anatomic studies in the healthy population

Superior mesenteric artery clinical classification and morphometrical analysis

Background: The superior mesenteric artery is one of the most important arteries in the abdominal cavity, which is of great clinical importance, especially in surgical procedures and fatal ischemic complications. The aim of this study was to develop a clinical classification of the superior mesenteric artery. Materials and methods: Postmortem contrast-enhanced computed tomography of 104 (29.8% female, age 50.7±18.7) human bodies were analyzed. Based on anatomic predisposition to ischemic and iatrogenic complications, a three-tiered clinical classification of the superior mesenteric artery was developed. Type 0 was defined as standard risk for ischemic and iatrogenic complications. Type 1 was defined as increased thromboembolic risk with decreased risk of iatrogenic bleeding, and type 2 was defined as decreased ischemic risk with increased risk of iatrogenic bleeding. The supply area of the superior mesenteric artery was divided into 4 regions: pancreas, caecum, ascending colon, and transverse colon. Results: Type 0 (standard risk) was found in 62.5% of cases. Type 1 was most frequently observed in the ascending colon region (15.4%). Type 2 was most frequently observed in the pancreatic region (17.3%). Regarding type, most abnormalities were found in the region of the ascending colon (18.3%), pancreas region (17.3%), and transverse colon (16.3%). Conclusions: The proposed clinical classification of SMA links anatomic variations in morphology with their clinical significance. A simple, three-level classification can be easily applied in daily practice and serve as a great support for preoperative evaluation and recognition of patients at risk of iatrogenic or thromboembolic complications

The occipital-vertebral anastomosis revisited

Background: The goal of the study was to provide relevant data about the location and prevalence of the OA-VA anastomosis in patients without visible occlusive disease, as well as to thoroughly discuss the clinical significance of these anastomotic channels. Furthermore, the morphometric properties of the OA and its branches were also analyzed. Materials and methods: A retrospective study was carried out to indicate anatomical variations, their prevalence, and morphometrical data on the OA and its branches. The study was performed on 55  randomly selected computed tomography angiographies (CTA) of the head and neck region. Each CTA result was analyzed bilaterally. Thus, 110 results were originally assessed. Results: The OA median maximal diameter was demonstrated at 4.85 mm (LQ: 4.11; UQ: 5.53) and the median maximal diameter of VA at 3.60 mm (LQ: 2.79; UQ: 4.38). The distances between OA and its branches were also measured giving a median result of 21.73, 30.29, 60.84, 34.88, 18.02, 55.16 mm for the LSCMB, USCMB, MeB, MaB, and DB respectively. The median distance between OA and its first anastomosis was set to be 51.15 mm (LQ: 37.20; UQ: 60.10). Moreover, a set of additional measurements was carried out in order to create a 3-dimensional anatomical heat-map of the occurrence of the OA-VA anastomosis. Conclusions: Knowledge about the anatomy of the OA-VA anastomosis might be of immense importance to avoid potentially fatal complications during embolization of the OA and its branches

Surgical anatomy of the breast revisited

With the advent of breast conservation options in the 1970s, as well as wider acceptance of breast reconstruction in cancer patients in 1980/1990, ending up with evolution of oncoplastic concepts in the early 2000s, detailed surgical anatomy of the breast became important. This short article reviews surgical anatomy of breast with particular emphasis on innervation and blood supply to the skin and nipple-areolar complex, as well as points out the concept of compartmental breast cancer anatomy. Meticulous dissection and avoidance of transection of major vessels and nerves constitutes the crucial factor for satisfactory results of surgery in terms of preservation of sensation as well as appropriate vitality of skin.With the advent of breast conservation options in the 1970s, as well as wider acceptance of breast reconstruction in cancer patients in 1980/1990, ending up with evolution of oncoplastic concepts in the early 2000s, detailed surgical anatomy of the breast became important. This short article reviews surgical anatomy of breast with particular emphasis on inne­rvation and blood supply to the skin and nipple-areolar complex, as well as points out the concept of compartmental breast cancer anatomy. Meticulous dissection and avoidance of transection of major vessels and nerves constitutes the crucial factor for satisfactory results of surgery in terms of preservation of sensation as well as appropriate vitality of skin