Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2020; 26(24): 3484-3494
Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3484
Evaluation of characteristics of left-sided colorectal perfusion in elderly patients by angiography
Chao Zhang, Ang Li, Tao Luo, Yu Li, Fei Li, Jia Li
Chao Zhang, Ang Li, Tao Luo, Yu Li, Fei Li, Jia Li, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Chao Zhang, Ang Li, Tao Luo, Yu Li, Fei Li, Jia Li, Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
Author contributions: Zhang C and Li A are co-first authors; Zhang C, Li A, and Li J designed and performed the research; Zhang C, Li A and Luo T performed the angiography; Li Y and Li F contributed the analytical tools; Zhang C, Li Y, and Li F analyzed and interpreted the data; Zhang C wrote the manuscript; Li A and Li J revised the manuscript; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81800483.
Institutional review board statement: The study was reviewed and approved by the Ethical Committee of Xuanwu Hospital, Capital Medical University (Beijing).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: This study meets the requirements of the STROBE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jia Li, MD, PhD, Chief Doctor, Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China. Jiali35@126.com
Received: February 1, 2020
Peer-review started: February 1, 2020
First decision: March 15, 2020
Revised: March 17, 2020
Accepted: May 19, 2020
Article in press: May 19, 2020
Published online: June 28, 2020
Abstract
BACKGROUND

Handling of the inferior mesenteric artery (IMA) and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer. However, the branching of this artery and the drainage patterns of this vein vary among individuals, and the characteristics and perfusion region of this artery in elderly patients remain unclear.

AIM

To evaluate the characteristics and perfusion region of the IMA in elderly patients using angiography.

METHODS

We enrolled 154 patients (> 65 years old) who underwent digital subtraction angiography of the IMA. The characteristics, bifurcation, and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined using digital subtraction angiography. Collateral arterial arches and the IMA hemoperfusion region were also recorded. Perfusion regions were cross-referenced with clinical and anatomical features by the univariate analysis.

RESULTS

Of 154 patients, 25 (16.2%) had IMA lesions. The left colic artery arose independently from the IMA in 44.2% of patients, shared a trunk with the sigmoid artery in 35.1%, shared an opening with the sigmoid and superior rectal arteries in 16.9%, and was absent in 5.1%. The IMA perfusion region stopped at the splenic flexure in 50 (32.5%) patients. The collateral circulation existed in the colonic perfusion region, including the marginal artery (Drummond’s artery), the ascending branch of the left colonic artery to supply the transverse colon, and the arc of Riolan with a frequency of 100%, 22.7%, and 1.9%, respectively. The IMA perfusion region was independently associated with the comorbidity of atherosclerosis, IMA atherosclerotic lesion, branching pattern, collateral circulation, and marginal artery integrity.

CONCLUSION

The IMA and its branches are prone to arteriosclerosis, and IMA perfusion may be interrupted at the splenic flexure in elderly patients. The applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion patterns could facilitate geriatric laparoscopic left-sided colorectal cancer surgery with suspicion of poor IMA perfusion.

Keywords: Anatomy, Digital subtraction angiography, Elderly, Inferior mesenteric artery, Left-sided colorectum

Core tip: In this study, we enrolled 154 patients (> 65 years old) who underwent digital subtraction angiography of the inferior mesenteric artery (IMA). The characteristics and perfusion patterns of the IMA were examined. Perfusion regions were cross-referenced with clinical and anatomical features. Our study demonstrated that 25 (16.2%) patients had IMA lesions and the IMA perfusion region stopped at the splenic flexure in 50 (32.5%) elderly patients. The IMA perfusion region was independently associated with IMA atherosclerotic lesion, branching pattern, collateral circulation, and marginal artery integrity. Thus, the applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion patterns could facilitate geriatric laparoscopic left-sided colorectal cancer surgery with suspicion of poor IMA perfusion.