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      Congenitally absent superior mesenteric artery in an asymptomatic adult

      case-report

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          Abstract

          Congenitally absent superior mesenteric artery is an extremely rare anatomic anomaly with only one other case reported in an adult. We have described an elderly patient who presented with complete absence of the superior mesenteric artery found incidentally on computed tomography imaging. The patient had no abdominal pain, nausea, or other gastrointestinal symptoms. An abnormally enlarged inferior mesenteric artery provided collateral circulation to the midgut. No intervention was performed at the time given the patient's adequate circulation and lack of symptoms. The present case highlights consideration of anatomic mesenteric vascular anomalies before procedures involving inferior mesenteric artery ligation or coverage.

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          Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: Evaluation with multidetector computed tomography angiography

          Background: The celiac axis, superior mesenteric artery (SMA), and hepatic artery are the most important branches of abdominal aorta due to their vascularization field. The aim of our study was to evaluate the prevalence of different anatomical variation of celiac axis, SMA, hepatic artery, and its branches with multidetector computed tomography (MDCT) angiography of upper abdomen arteries. Materials and Methods: MDCT of 607 kidney donor and traumatic patients that referred to MDCT unit at Al Zahra Hospital in Isfahan from 2012 to 2015 were retrospectively evaluated. We excluded patients with history of abdominal vascular surgery and hepatic or pancreatic surgery. Computed tomography images of the patient were obtained with 64-row MDCT scanner and anatomical variations were analyzed. Results: Three hundred and eighty-eight (63.9%) of the 607 patients had classic arterial anatomy and 219 (36.1%) patients had variant types. The most common type of variation was the origin of the right hepatic artery (RHA) from SMA (9.6%), and the next common variation was the origin of the left hepatic artery (LHA) from the left gastric artery (6.9%). Variations in the origin of the common hepatic artery (CHA) were seen in 16 (2.6%) patients. Buhler arc was identified in two patients. The RHA originated from the celiac axis in 11 (1.8%) patients and from the aorta in 8 (1.3%) patients. Trifurcation of CHA into gastroduodenal artery, RHA, and LHA was detected in 11 (1.8%) patients. Conclusion: The results of the present study showed that anatomical variation occurs in a high percentage of patients. Detection of these variations can guide surgical and radiological interventional planning.
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            Absence of the superior mesenteric artery in an adult and a new classification method for superior-inferior mesenteric arterial variations.

            This paper aims to report the complete absence of the superior mesenteric artery (SMA) in an adult and to propose a new classification method for the superior-inferior mesenteric arterial variations (SIMAV).
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              ANATOMICAL VARIATIONS OF THE SUPERIOR MESENTERIC ARTERY AND ITS CLINICAL AND SURGICAL IMPLICATIONS IN HUMANS

              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 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 two (11.11%) found the SMA sharing the same origin of the celiac trunk. Conclusion: SMA variations are not uncommon findings and their reports evidenced through the scientific literature demonstrate a great role for the development of important clinical conditions, making knowledge about this subject relevant to surgeons and professionals working in this area.
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                Author and article information

                Contributors
                Journal
                J Vasc Surg Cases Innov Tech
                J Vasc Surg Cases Innov Tech
                Journal of Vascular Surgery Cases and Innovative Techniques
                Elsevier
                2468-4287
                04 June 2021
                September 2021
                04 June 2021
                : 7
                : 3
                : 443-446
                Affiliations
                [a ]Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minn
                [b ]Division of Vascular Surgery, Department of Surgery, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minn
                Author notes
                []Correspondence: Julie M. Duke, MD, Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Phillips Wangensteen Bldg, 402 Delaware St SE, MMC 195 Minneapolis, MN duke0053@ 123456umn.edu
                Article
                S2468-4287(21)00098-8
                10.1016/j.jvscit.2021.04.027
                8263521
                34278080
                7f093292-17c5-4183-90be-6c9dd4d9cca9
                © 2021 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 11 February 2021
                : 29 April 2021
                Categories
                Case report

                atresia,collateral circulation,congenital,mesenteric artery,superior

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