Evidence map›Paper›PMID 35870000›Full record

ArticleSurgical and radiologic anatomy : SRA2022

3D mesenteric angiogram-based assessment of Arc of Riolan crossing the inferior mesenteric vein: important considerations in high ligation during splenic flexure takedown in anterior resection.

James Wei Tatt Toh, Geetha Ramaswami, Kim Son Nguyen, Geoffrey Peter Collins, Edgardo Solis, Nimalan Pathma-Nathan, Toufic El-Khoury, Seon Hahn Kim

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Surgical and radiologic anatomy : SRA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.3field-weighted citation impact, top 41% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 3 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

James Wei Tatt TohDiscipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia. James.Toh@health.nsw.gov.au.ORCID http://orcid.org/0000-0002-0110-2629
Geetha RamaswamiDepartment of Radiology, Westmead Hospital, Sydney, Australia.
Kim Son NguyenDepartment of Radiology, Westmead Hospital, Sydney, Australia.
Geoffrey Peter CollinsColorectal Department, Westmead Hospital, Sydney, Australia.
Edgardo SolisColorectal Department, Westmead Hospital, Sydney, Australia.
Nimalan Pathma-NathanDiscipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia.
Toufic El-KhouryDiscipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia.
Seon Hahn KimColorectal Department, Korea University Anam Hospital, Seoul, South Korea.
Westmead Hospital · AUThe University of Sydney · AUKorea University · KR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecent studies have described the finding of the Arc of Riolan (AoR) crossing the inferior mesenteric vein (IMV) seen during high ligation of IMV while performing minimally invasive colectomies. However, the AoR usually has a medial course, and this variant AoR anatomic course and the clinical importance of its preservation during splenic flexure takedown in anterior resection remains controversial.

methodsAfter institutional approval (QA-5775), radiological identification of and mapping of the vessel horizontally crossing the IMV under the pancreas, when present, was performed at a single institution (Westmead Hospital, New South Wales, Australia). One hundred consecutive computed tomographic (CT) mesenteric angiograms conducted in 2018 were reviewed retrospectively to determine the presence of a vessel horizontally crossing the IMV. 3D reconstructions were used to map out its course to understand its origin and full course. Baseline characteristics, including demographic and comorbidity data, were obtained from the medical record.

resultsOn 3D mesenteric angiogram reconstructions, a vessel crossing anterior to the IMV was present in 11 of 98 cases (11.2%). Two cases were excluded as the presence of this vessel was indeterminate. Eight of 11 patients (72.7%) were male, and the mean age was 49.3 years (range: 21-80 years). There was no statistically significant difference in age and comorbidities between the groups. Importantly, in all 11 cases, there was an arterial vessel crossing the IMV originating from the SMA and communicating with the IMA or a branch of the IMA, proving definitively that this vessel was by definition the AoR.

conclusionThis 3D mesenteric angiogram mapping study has shown definitively that the vessel horizontally crossing anterior to the IMV and inferior to the pancreas is an arterial vessel from the SMA to IMA, and by definition the Arc of Riolan. When present, identification and preservation of this collateral arterial vessel during splenic flexure takedown in anterior resection may be important in reducing the risk of post-operative bowel ischaemia.

Indexed as

Colon, TransverseRectal NeoplasmsAngiographyFemaleHumansMaleMesenteric Artery, InferiorMesenteric VeinsMiddle AgedRetrospective StudiesAnatomyArc of RiolanColorectal surgeryIntermesenteric trunkMeandering mesenteric arteryOperative technique

Identifiers

PMID35870000
PMCPMC9378323
OpenAlexW4286685123

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.