ArticleFrontiers in physiology2021
The New Concept of Physiological "Riolan's Arch" and the Reconstruction Mechanism of Pathological Riolan's Arch After High Ligation of the Inferior Mesenteric Artery by CT Angiography-Based Small Vessel Imaging.
Article in Frontiers in physiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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11 citing papers in PubMed, 17 citations in OpenAlex.
- Optimization of artery-first approach in right-sided colon cancer CME: preoperative CTA assessment of MCA branching and MCV-Henle's trunk relationship.World journal of surgical oncology · 2026Observational
- The Arc of Riolan artery may serve as the only pathway for lymphatic metastasis in advanced splenic flexure cancer.Techniques in coloproctology · 2026Article
- Retrospective analysis of IMA ligation level effects on nodal dissection and anastomosis in colorectal cancer.Scientific reports · 2025Article
- Changes in Abdominal Artery Diameter in Patients Treated for Acute Aortic Dissection.Journal of cardiovascular development and disease · 2025Article
- Negative-Pressure Wound Therapy: A Novel Approach for Terminal Ileum Anastomosis Success.The American journal of case reports · 2025Article
- Endovascular Repair of Spontaneous Rupture of Stent Graft Branch in Thoracoabdominal Aortic Aneurysm-Management, Case Study, and Review.Journal of clinical medicine · 2024Article
- Comparison of robotic assisted and laparoscopic radical resection for rectal cancer with or without left colic artery preservation.Scientific reports · 2024Article
- The value of ICG-guided left colon vascular variation and anatomical rules for the radical resection of proctosigmoid colon cancer.Frontiers in oncology · 2023Article
- Inferior Mesenteric Artery Snorkel for Endovascular Treatment of a Large Degenerating Saccular Aneurysm.EJVES vascular forum · 2023Article
- Does the level of inferior mesenteric artery ligation affect short-term and long-term outcomes of patients with sigmoid colon cancer or rectal cancer? A single-center retrospective study.World journal of surgical oncology · 2022Article
- A novel knotless hand-sewn end-to-end anastomosis using V-loc barbed suture vs. stapled anastomosis in laparoscopic left colonic surgery: A propensity scoring match analysis.Frontiers in surgery · 2022Article
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6 authors at 3 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundDue to the complexity of anatomical relationship between superior mesenteric artery (SMA) and left colic artery (LCA), there is no unified anatomical concept of "Riolan's arch." There is no consensus as to tie off the inferior mesenteric artery (IMA) at its origin or just below the origin of the left colic artery during radical surgery of sigmoid colon and rectal cancers. The aim of the study is to investigate the anatomy of shortcut anastomotic branches (adjacent branches) of SMA at splenic flexure and to explore how the shortcut pathway (Riolan's arch) was formed, as the compensation of anastomotic branches between MCA and LCA under pathological conditions and the reconstruction and the mechanism of pathological Riolan's arch after high ligation of the inferior mesenteric artery.
methodsBetween January 2018 and May 2020, patients with colorectal cancer who underwent CTA before surgery were enrolled in the study. The anatomy of shortcut anastomotic branch of SMA and LCA was investigated by volume rendering technique (VR) and maximum-intensity projection (MIP). GE's small vessel extraction technology (selected VR) was used to directly display these shortcut anastomotic branches on a map and to establish their three-dimensional anatomical classification. Then, we used the axonometric drawing to make the model more exact. Next, combining with some cases of pathological Riolan's arch and basing on hydrodynamic principle, we speculate the mechanism of collateral circulation. Finally, based on the retrospective study of high ligation cases and combined principles of fluid mechanics, we show how these shortcut anastomotic branches evolved into Riolan's arch.
resultsWe report the classification of the ascending branch of LCA (which approaches the splenic flexure) and the left branch of MCA, display these shortcut anastomotic branches on a map, and establish their three-dimensional anatomical classification. We found that Riolan's arch is a shortcut pathway for the compensation of anastomotic branches, between MCA and LCA under pathological conditions, and that the formation mechanism of shortcut path accords with the principle of hydrodynamics.
conclusionsOur results show the mechanism of pathological Riolan's arch formation and provide new anatomic thinking for the battle between high and low ligation of IMA in colorectal cancer surgery.
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