Indian Journal of Vascular and Endovascular Surgery

CASE REPORT
Year
: 2015  |  Volume : 2  |  Issue : 1  |  Page : 41--42

Aorto-common Celiaco-Mesenteric Bypass for Chronic Mesenteric Angina


Periyanarkunan Ramaiya Murugesan1, Sivagnanam Karthikeyan2, MS Murugan1,  
1 Department of Cardiothoracic Surgery, PSG institute of Medical Sciences, Coimbatore, Tamil Nadu, India
2 Sri Jayadeva Institute of Cardiovascular Sciences, India

Correspondence Address:
Dr. Sivagnanam Karthikeyan
Department of Cardiothoracic Surgery, PSG institute of Medical Sciences, Coimbatore, Tamil Nadu
India

Abstract

A common celiaco-mesenteric trunk is the rarest of the anatomical anomalies of Coeliac axis seen in 1-2% of patients. A 55-year-old male was admitted with postprandial angina for 2 months with significant weight loss. He underwent a successful retrograde infra renal aorta to common celiaco-mesenteric trunk bypass with expanded polytetrafluoroethylene graft. Postprocedure symptoms improved well during the follow-up period with good weight gain.



How to cite this article:
Murugesan PR, Karthikeyan S, Murugan M S. Aorto-common Celiaco-Mesenteric Bypass for Chronic Mesenteric Angina.Indian J Vasc Endovasc Surg 2015;2:41-42


How to cite this URL:
Murugesan PR, Karthikeyan S, Murugan M S. Aorto-common Celiaco-Mesenteric Bypass for Chronic Mesenteric Angina. Indian J Vasc Endovasc Surg [serial online] 2015 [cited 2023 Jan 27 ];2:41-42
Available from: https://www.indjvascsurg.org/text.asp?2015/2/1/41/152837


Full Text

 Introduction



The majority of the blood supply of the gastro-intestinal tract is provided by the anterior branches of the abdominal aorta: Celiac trunk, superior mesenteric artery (SMA) and inferior mesenteric artery. Usually, the aforementioned branches arise independently from the abdominal aorta, the first one at the level of the twelfth thoracic vertebra, the second one at the level of the first lumbar vertebra. Anomalies of vasculature of the gastro-intestinal tract are frequent, but the presence of the celiaco-mesenteric trunk (derived by common origin of celiac trunk and SMA) is rare.

 Case Report



A 55-year-old gentleman, chronic smoker with gradual weight loss of 10 kg over 6 months was referred from Department of Medical Gastroenterology with symptoms of the chronic mesenteric angina. Computer tomography angiogram revealed severely stenotic common origin of Coeliac and SMA with occluded inferior mesenteric artery collateralized with good retrograde filling [Figure 1]. He underwent the retrograde infra renal aorta to common celiaco-mesenteric trunk bypass with 7 mm ringed expanded polytetrafluoroethylene graft [Figure 2] and [Figure 3]. The celiaco-mesenteric trunk was approached by Kocher's maneuver. Postoperative period was uneventful with relief of symptoms. On follow-up, the patient had gained 8 kg weight within 2 months.{Figure 1}{Figure 2}{Figure 3}

 Discussion



The fetal digestive tube is supplied by four primitive splanchnic roots which arise from the abdominal aorta. Variations of the normal vasculature described above may be caused by the retention or disappearance of the roots of the primitive arterial plexus as indicated by Tandler [1] in 1908. There is a ventral longitudinal anastomosis (Lang's anastomosis) between these branches: The closure of the longitudinal anastomosis between the third and the fourth root and the disappearance of the central two roots lead to normal anatomy. [2] Retention of the ventral longitudinal anastomosis higher than the fourth root keeps one or more celiac trunk branches with the SMA; disappearance of the first or fourth root causes a common celiaco-mesenteric trunk. [2] Moreover, the simple arboriform scheme of the gastroduodenal and hepatobiliary vasculature is profoundly altered by the growth of the liver and pancreas, and by the assumption of a curved form in the stomach and duodenum. These factors operate to complicate the branching of the coeliac axis and the SMA. [3] In our case, the common celiaco-mesenteric trunk is formed by an anomalous separation of the ventral longitudinal anastomosis, with the common hepatic, left gastric and splenic arteries joining with the fourth root. The celiaco-mesenteric trunk is one of the most striking among the different variations of the normal vascularization of the gastro-intestinal tract [3],[4],[5],[6],[7],[8] as it is found in 1-2% of all anomalies involving the celiac axis. [4],[9]

Vitelline arteries are initially a number of paired vessels supplying the yolk sac. Gradually they fuse and form the arteries located in the dorsal mesentery of the gut. In the adult, they are represented by the celiac, superior mesenteric, and inferior mesenteric arteries. These vessels supply the derivatives of foregut, midgut, and hindgut, respectively. As anterior branches of the aorta, the celiac trunk and SMA are the most important as they supply the gastro-intestinal tract.

Celiac and superior mesenteric arteries having a common origin from the aorta accounts for <1% of all abdominal vascular anomalies, and it is estimated to have an incidence of 0.25%. [3],[8],[9] SMA is developmentally considered as a part of the celiac complex, and it follows that variations in the SMA are related to the celiac trunk. [10]

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