Aorta abdominalis’in ana dallarının multi-dedektör bilgisayarlı tomografik anjiyografi ile incelenmesi

Amaç: Çalışmamızda, aorta abdominalis (AA)’in ana dallarını incelemeyi ve bazı ölçümler yaparak cinsiyet farkını da göz önüne alıp değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmamız, 18-97 yaş aralığında; 200 kişinin (61 kadın, 139 erkek) Multi- dedektör bilgisayarlı tomografi (MDBT) anjiyografi görüntüsünde retrospektif olarak yapılmıştır. Aorta abdominalis ve dallarından, Truncus coeliacus (TC), arteria mesenterica superior (AMS), arteria renalis dextra (ARD), arteria renalis sinistra (ARS), arteria mesenterica inferior (AMI) incelendi. Bu arterlerin anatomik varyasyon gözlenen olguları sınıflandırıldı ve AA’den orjin aldığı vertebra çıkış seviyeleri, birbirleri ile olan uzaklık ölçümlerinin ortalamaları kaydedildi. Ayrıca AA’in ana dalları seviyesinde sagittal ve transvers çap ölçümleri yapıldı ve incelenen tüm veriler cinsiyet faktörüne göre karşılaştırıldı. Bulgular: 200 vakanın %91’inde normal TC anatomisi, % 9’unda ise TC varyasyonları izlenmiştir. AMS’dan çıkan replase sağ hepatik arter varlığı sadece bir hastada tespit edildi. AMI’da varyasyon izlenmedi. İncelenen arterlerin vertebra çıkış seviyelerinin genelinde cinsiyetler arasında anlamlı bir farklılık gözlemlenmedi. Sonuç: Mezenterik ve renal arteriyel varyasyonların farkında olunması, kolon, rectum, hepatobiliyer, pankreatik hastalıklarda ve renal tranplantasyonlarda hayati önem taşır ve bu arterlerin vertebra seviyeleri, çap ve mesafe ölçümleri klinik çalışanlarına ve anatomide kadavra diseksiyonlarında büyük kolaylıklar sağlar.

Anahtar Kelimeler:

MDCT, abdominal aortae, variation, retrospective, radiological

Examination of the main branches of aorta abdominalis with multi-detector computed tomography angiography

Purpose: The aim of this study was to examine the main branches of abdominal aortae (AA) and to make evaluation by carrying out some measurements by considering gender difference. Materials and Methods: This study was designed as a retrospective research subjecting multi-detector computed tomography (MDCT) angiography images of 200 individuals (61 women, 139 men). Coeliac trunk (CT), superior mesenteric artery (SMA), right renal artery (RRA), left renal artery (LRA), inferior mesenteric artery (IMA) were examined by abdominal aortae and its branches. The cases of these arteries with anatomical variation were classified, and vertebral outflow levels originated from AA and the mean of distance measurements with each other were recorded. In addition, sagittal and transverse diameter measurements at the level of the main branches of AA were conducted, all examined data were compared according to gender. Results: While normal CT anatomy was observed in 91% of 200 cases, the rate of CT variations was 9%. The replaced right hepatic artery originated from SMA was found only in one patient. No variation was observed in IMA. No significant difference was determined between genders in most of the vertebral outflow levels of the arteries examined. Conclusion: Diagnosing mesenteric and renal arterial variations is of vital importance in colon, hepatobiliary and renal transplantations, and vertebra levels of these arteries, diameter and distance measurements provide convenience for clinical staff and cadaver dissection in anatomy.

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1. Arıncı K. Anatomy: Circulatory system, peripheral nervous system, central nervous system, sensory organs, Güneş Bookstore, 2006;2,18-54.
2. Standring S. Gray's Anatomy International Edition: The Anatomical Basis of Clinical Practice. London, Elsevier, 2015.
3. Yang SH, Yin YH, Jang JY, Lee SE, Chung JW, Suh KS, et al. Assessment of hepatic arterial anatomy in keeping with preservation of the vasculature while performing pancreatoduodenectomy: an opinion. World J Surg. 2007;31:12,2384-91.
4. Hyare H, Desigan S, Nicholl H, Guiney MJ, Brookes JA, Lees WR. Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease. Eur J Radiol. 2006;59:2,295-300.
5. Ganeshan A, Upponi S, Hon LQ, Warakaulle D, Uberoi R. Hepatic arterial infusion of chemotherapy: the role of diagnostic and interventional radiology. Ann Oncol. 2007;19:5,847-51.
6. Acu R, Şahinalp CÇ, Küçükay MB, Acu L, Ökten S, Parlak E et al. Evaluation of mesenteric arterial variations with multi-detector computed tomographic angiography. Am J Gastroenterol. 2016;15:259-71.
7. Uflacker R. Atlas of Vascular Anatomy. An Angiographic Approach. Lippincott Williams&Wilki Baltimore, 1997;4-16.
8. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220:150-56.
9. Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar, M., Ors F et al. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol.2010;83:992,661-67.
10. Astik RB, Dave UH. Uncommon branching pattern of the celiac trunk: origin of seven branches. International Journal of Anatomical Variations. 2011;4:1-10.
11. Selvaraj L, Sundaramurthi I. Study of normal branching pattern of the coeliac trunk and its variations using CT angiography. J Clin Diagn Res. 2015;9:9-18.
12. Yan H, Kaneko M, Kato T, Takahashi M, Takai M, Nishimura T. Relationship of the celiac and superior mesenteric arteries to the vertebral bodies and its clinical relevance. Radiat Med. 1994;12:3,105-9.
13. Lipshutz B. A composite study of the coeliac axis artery. Ann Surg.1917;65:2,159-60.
14. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966;112:3,337-347.
15. Osman AM, Abdrabou A. Celiac trunk and hepatic artery variants: A retrospective preliminary MSCT report among Egyptian patients. Egyptian Journal of Radiology and Nuclear Medicine. 2016;47:4,1451-58.
16. Al-Saeed O, Ismail M, Sheikh M, Al-Moosawi M, Al- Khawari H. Contrast-enhanced three-dimensional fast-spoiled gradient magnetic resonance angiography of the renal arteries for potential living renal transplant donors: A comparative study with digital subtraction angiography. Australas Radiol. 2005;49:3,214-17.
17. Shoja MM, Tubbs RS, Shakeri A, Loukas M, Ardalan MR, Khosroshahi HT et al. Peri-hilar branching patterns and morphologies of the renal artery: a review and anatomical study. Surg Radiol Anat. 2008;30:5,375-82.
18. Vázquez R, Garcia L, Morales-Buenrostro L, Gabilondo B, Alberú J, Vilatobá M. Renal grafts with multiple arteries: a relative contraindication for a renal transplant?. Transplant Proc. 2006;42:6,2369-71.
19. Beregi JP, Mauroy B, Willoteaux S, Mounier-Vehier C, Remy-Jardin M, Francke JP. Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation. Eur Radiol.1999;9:7,1330-34.
20. Özkan U, Oguzkurt L, Tercan F, Kizilkılıç O, Koç Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol. 2006;12:41,83-85.
21. Khamanarong K, Prachaney P, Utraravichien A, Tong-Un T, Sripaoraya K. Anatomy of renal arterial supply. Clin Anat. 2004;17:4,334-36.
22. Gümüş H, Bükte Y, Özdemir E, Çetinçakmak MG, Tekbaş G, Ekici F. Variations of renal artery in 820 patients using 64-detector CT-angiography. Ren Fail. 2012;34:3,286-290.
23. Palmieri BJ, Petroianu A, Silva LC, Andrade LM, Alberti LR. Study of arterial pattern of 200 renal pedicle through angiotomography. Rev Col Bras Cir. 2011;38:2,116-121.
24. Ferrari R, De Cecco CN, Iafrate F, Paolantonio P, Rengo M, Laghi A. Anatomical variations of the coeliac trunk and the mesenteric arteries evaluated with 64-row CT angiography. Radiol Med. 2007;112:7,988-998.
25. Kornafel O, Baran B, Pawlikowska I, Laszczynski P, Guzinski M, Sasiadek M. Analysis of anatomical variations of the main arteries branching from the abdominal aorta, with 64-detector computed tomography. Pol J Radiol. 2010;75:238-242.
26. Araujo Neto SA, Franca HA, Mello Júnior CFD, Silva Neto EJ, Negromonte GRP, Duarte CMA et al. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography. Radiol Bras. 2015;48:6,358-362.
27. Yahel J, Arensburg B. The topographic relationships of the unpaired visceral branches of the aorta. Clin Anat. 1998;11:5,304-9.
28. Pennington N, Soames RW. The anterior visceral branches of the abdominal aorta and their relationship to the renal arteries. Surg Radiol Anat. 2005;27:5,395- 403.
29. Takahashi T, Takeuchi K, Ito T, Itoh M. Positional relationships among the celiac trunk, superior mesenteric artery, and renal artery observed from the intravascular space. Surg Radiol Anat. 2013;35:5,411- 17.
30. Turba UC, Uflacker R., Bozlar U, Hagspiel KD. Normal renal arterial anatomy assessed by multidetector CT angiography: are there differences between men and women? Clin Anat. 2009;22:2,236- 42.