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Anatomical Variations of the Superior Mesenteric Artery and Its Clinical and Surgical Implications in Humans

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Anatomical Variations of the Superior Mesenteric Artery and Its Clinical and Surgical Implications in Humans ABCD Arq Bras Cir Dig 2020;33(2):e1508 Review Article DOI: https://doi.org/10.1590/0102-672020190001e1508 ANATOMICAL VARIATIONS OF THE SUPERIOR MESENTERIC ARTERY AND ITS CLINICAL AND SURGICAL IMPLICATIONS IN HUMANS Variações anatômicas da artéria mesentérica superior e suas implicações clínicas e cirúrgicas em humanos Natasha Gabriela Oliveira da SILVA1 , Ana Beatriz Marques BARBOSA1 , Nathalie de Almeida SILVA1 , Diego Neves ARAÚJO1 , Thiago de Oliveira ASSIS1,2,3 ABSTRACT – Introduction: Superior mesenteric artery (SMA) usually arises from the abdominal aorta, just below the celiac trunk and it supplies the midgut-derived embryonic structures. Anatomical variations in this vessel contribute to problems in the formation and/or absorption of this part of the intestine and its absence has been recognized as the cause of congenital duodenojejunal atresia. Objective: To analyze SMA anatomical variations in humans and the possible associated clinical and surgical implications. Methods: This is a systematic review of papers indexed in PubMed, SciELO, Springerlink, Science Direct, Lilacs, and Latindex databases. The search was performed by two independent reviewers between September and December 2018. Original studies involving SMA variations in humans were included. SMA presence/absence, level, place of origin and its terminal branches were considered. Results: At the end of the search, 18 studies were selected, characterized as for the sample, method to evaluate the anatomical structure and main results. The most common type Different morphological patterns of SMA of variation was when SMA originated from the right hepatic artery (6.13%). Two studies (11.11%) evidenced the inferior mesenteric artery originating from the SMA, whereas other Conclusion: two (11.11%) found the SMA sharing the same origin of the celiac trunk. SMA Mensagem central variations are not uncommon findings and their reports evidenced through the scientific The superior mesenteric artery (SMA) originates literature demonstrate a great role for the development of important clinical conditions, from the abdominal aorta and is responsible for making knowledge about this subject relevant to surgeons and professionals working in irrigating the structures of the midgut. Anatomical this area. variations contribute to defects in the formation HEADINGS: Mesenteric artery, superior. Anatomy. Intestinal atresia. Intestinal obstruction. and / or absorption of this part of the intestine and Anatomic variation. its absence is recognized as the cause of congenital duodenojejunal atresia RESUMO – Introdução: A artéria mesentérica superior (AMS), normalmente, tem sua origem a Perspective partir da aorta abdominal, um pouco abaixo do tronco celíaco e é responsável pela irrigação das estruturas derivadas, embrionariamente, do intestino médio. Variações anatômicas Variations in SMAare not uncommon and their reports demonstrate great importance for the nesse vaso contribui para defeitos na formação e/ou absorção dessa parte do intestino e development of important clinical conditions, a sua ausência tem sido reconhecida como a causa da atresia duodenojejunal congênita. making knowledge on this subject relevant for Objetivo: Analisar as variações anatômicas dela em humanos e as possíveis implicações professionals working in this area, especially for clínicas e cirúrgicas associadas. Métodos: Trata-se de uma revisão sistemática de artigos surgeons who need a thorough understanding indexados nas bases de dados PubMed, SciELO, Springerlink, Scienc Direct, Lilacs e Latindex. of blood irrigation. of the abdominal viscera. A busca ocorreu por dois revisores independentes entre setembro e dezembro de 2018. Knowledge about the variant forms of this vessel Foram incluídos artigos originais envolvendo as variações da AMS em humanos. Considerou- allows professionals to plan and better conduct their surgical interventions with as little iatrogenesis se para este estudo a presença/ausência da AMS, o nível, local de origem e seus ramos as possible. terminais. Resultados: Ao final da busca foram selecionados 18 artigos, caracterizados quanto à amostra, método para avaliar a estrutura anatômica e principais resultados. O tipo de variação mais comum foi aquele cuja AMS se originou da artéria hepática direita (6,13%). Dois estudos (11,11%) evidenciaram a artéria mesentérica inferior originando-se a partir da AMS, enquanto outros dois (11,11%) constataram ser ela compartilhada na mesma origem do tronco celíaco. Conclusão: Variações na AMS não são achados incomuns e seus relatos evidenciados através da literatura científica demonstram grande importância para o desenvolvimento de condições clínicas importantes, tornando o conhecimento sobre esse assunto relevante para os cirurgiões e profissionais atuantes nesta área. DESCRITORES: Artéria mesentérica superior. Anatomia. Atresia intestinal. Obstrução intestinal. Variação anatômica. www.facebook.com/abcdrevista www.instagram.com/abcdrevista www.twitter.com/abcdrevista From the 1Centro Universitário Unifacisa, Campina Grande, PB, Brasil; 2Departamento de Biologia, Universidade Estadual da Paraíba, Campina Grande, PB, Brasil; e 3Unidade Acadêmica de Ciências Médicas da Universidade Federal de Campina Grande, Campina Grande, PB, Brasil (1Unifacisa University Center, Campina Grande, PB, Brazil; 2Department of Biology, Paraíba State University, Campina Grande, PB, Brazil; and 3Academic Unit of Medical Sciences, Federal University of Campina Grande, Campina Grande, PB, Brazil). How to cite this article: Da Silva NGO, Barbosa ABM, Silva NA, Nevesaraújo D, Assis TO. Anatomical variations of the superior mesenteric artery and its clinical and surgical implications in humans. ABCD Arq Bras Cir Dig. 2020;33(2):e1508. DOI: /10.1590/0102-672020190001e1508 Correspondence: Financial source: none Thiago de Oliveira Assis Conflict of interest: none Email: [email protected] Received for publication: 29/11/2019 Accepted for publication: 02/04/2020 ABCD Arq Bras Cir Dig 2020;33(2):e1508 1/5 REVIEW ARTICLE INTRODUCTION in Pubmed and 0 in Latindex, totaling 2,362 papers. After abstract screening, the inclusion and exclusion criteria were applied, and 18 papers were selected for analysis. he superior mesenteric artery (SMA) arises, classically, The selected studies were critically analyzed by an in the anterior part of the aorta and it is located interpretation guide, used to evaluate their individual 1 cm below the celiac trunk, posteriorly to the quality, based on the studies of Greehalgh8 and adapted pancreasT body and the splenic vein, at the level of intervertebral 15 by Mcdermid et al. The studies quality evaluation items discs between L1 and L2, then going into the mesentery20. are expressed by scores in Table 1, in which 0=absent; This vessel arises from the aorta through the left renal vein 1=incomplete; and 2=complete. and it supplies part of the small intestine, cecum, ascending colon and 2/3 of proximal transverse colon. Together with the Statistical analysis inferior mesenteric artery and celiac trunk, SMA contributes The search was performed by two independent reviewers, to the vascularization of the gastrointestinal tract7. and the interobserver agreement analysis was performed SMA originates the middle colic, right colic, ileocolic, using the Kappa test, using Prism V 5.0 software, according jejunal, ileal and appendicular arteries. Although this is to Landis and Koch14 method. The value found was K=0.77 commonly the classical anatomical pattern, some changes (substantial agreement). have been observed regarding the SMA branches, level and its origin. Such variations and their relationship with the surrounding structures are, therefore, important from RESULTS a clinical and surgical perspective17,20. In a study with 607 kidney donors and trauma patients, Table 1 shows the quality analysis of the selected it was observed that 388 (63.9%) had a classic arterial pattern, studies for this study. whereas 219 (36.1%) presented some type of variation. Among the observed changes, one variation was more common than TABLE 1 - Quality analysis of studies on SMA variations in humans others, in which the SMA originated the right hepatic artery in 58 (9.6%) of the cases2. EVALUATION CRITERIA STUDIES Total 1 2 3 4 5 6 7 8 9 10 11 12 Variations in the anatomy of this vessel may be related (%) to the development of important clinical conditions, such Farghadani et al. (2016) 2 1 2 2 2 NA 2 2 2 2 2 2 95.45 as congenital duodenojejunal atresia, since SMA absence Fonseca Neto et al. (2017) 1 2 2 1 2 NA 1 0 2 2 1 1 68.18 has been recognized as one of its causes in newborns. SMA Gamo et al. (2016) 2 2 2 2 2 NA 2 2 2 2 2 1 95.45 absence contributes to problems in midgut formation or Gomes et al. (2014) 1 NA 1 0 1 NA 0 0 0 1 1 0 25.00 absorption. Patients with this type of variation are subject Jain e Motwani et al. (2013) 2 0 2 1 1 NA 2 2 1 2 2 2 77.27 23,24,25 to death with no chance of surgical intervention . Kitamura et al. (1987) 1 NA 2 1 1 NA 0 0 1 2 0 0 40.00 In this context, knowledge about these variations are Koops et al. (2004) 2 2 2 2 2 NA 2 2 2 1 2 1 90.90 relevant, considering that their study and investigation are Matusz et al. (2013) 2 NA 2 1 1 NA 2 0 2 2 2 2 80.00 important and valid, mainly for surgeons and professionals Olave et al. (2009) 2 1 1 2 1 NA 1 1 2 2 1 1 68.18 who work in this area, thus avoiding complications and Olga et al. (2010) 2 1 2 2 2 NA 2 2 2 2 2 2 95.45 iatrogenic situations. Saša et al. (2016) 2 NA 2 0 1 NA 1 1 2 1 0 1 60.00 This study aims to analyze the anatomical variations Sebben et al. (2013) 2 1 2 1 1 NA 1 1 2 2 2 1 72.72 of SMA in humans and its possible clinical and surgical Taha et al. (2017) 2 NA 1 0 1 NA 0 0 1 1 0 2 40.00 implications.
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