Avaliação da anatomia vascular da flexura cólica esquerda por angiotomografia 3D
Data
2022-09-01
Autores
Lins, Rodrigo Rego 
Orientadores
Waisberg, Jaques
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar a anatomia vascular das artérias cólica esquerda, do ramo esquerdo da artéria cólica média e da artéria cólica média acessória pela angiotomografia computadorizada tridimensional para classificar a vascularização da flexura cólica esquerda. Métodos: Estudo retrospectivo transversal, com análise de 200 exames de angiotomografia computadorizada tridimensional da aorta abdominal e de seus principais ramos, realizados desde maio de 2014 e armazenados no banco de imagem do Serviço de Radiologia do Hospital Copa D’Or. Todos os exames foram reavaliados por dois radiologistas que classificaram a vascularização da flexura cólica esquerda e as variações das artérias cólica média acessória, do ramo esquerdo da artéria cólica média e da artéria mesentérica inferior. Resultados: A vascularização da flexura cólica esquerda foi classificada em 6 tipos sendo tipo 1 – exclusiva pela ACE (60%); tipo 2 – exclusiva pelo ACM-E (4%); tipo 3 – pelas ACE e ACM-E (10%); tipo 4 - pela ACM-A (7,5%); tipo 5 – pelas ACE e ACM-A (12%); tipo 6 – nenhuma artéria (6,5%). A frequência da ACM-A foi de 22%. O ACM-E teve sua origem junto com ao ACM-D em tronco comum na ACM na maioria dos casos (93,4%) e separadamente como ramo direto da AMS em 6,6% dos casos. A variação da AMI e seus ramos foi classificada em três tipos sendo tipo A - ACE ramo direto da AMI (42%); tipo B - tronco comum originando ACE e AS (18%); tipo C - ponto comum da AMI originando ACE e AS (40%). Conclusões: A irrigação exclusiva da flexura cólica esquerda pela ACE (tipo 1) foi a mais prevalente (60%). A frequência da ACM-A foi de 22%, e quando presente, na maioria dos casos (39/44) participou na irrigação da flexura esquerda. Observamos uma maior participação da ACE na irrigação da flexura quando a ACM-A não participava. A variação anatômica da AMI e seus ramos mais frequente foi do tipo A (42%) em que a origem da ACE ocorre diretamente da AMI e não observamos nenhuma relação entre a variação da AMI e os padrões de irrigação da flexura.
Objective: To assess the vascular anatomy of the left colic arteries, the left branch of the middle colic artery, and the accessory middle colic artery by three-dimensional computed tomography angiography to classify the vascularization of the splenic flexure. Method: A retrospective cross-sectional study, with an analysis of 200 threedimensional computed tomography angiography exams of the abdominal aorta and its main branches, performed since May 2014 and stored in the image bank of the Radiology Service of Hospital Copa D'Or. All exams will be reassessed by two radiologists who will classify the vascularization of the left flexure and the variations of the accessory middle colic arteries, the left branch of the middle colic artery, and the inferior mesenteric artery. Results: The arterial patterns of the splenic flexure were classified into six types, type 1, exclusive by the LCA (60%); type 2 – exclusive by the MCA-Left (4%); type 3 – by LCA and MCA-Left (10%); type 4 - by AMCA (7.5%); type 5 – by LCA and AMCA (12%); type 6 – no artery (6.5%). The frequency of AMCA was 22%. In most cases, the MCA had the common trunk of the right and left branches (93.4%), and the right and left branches arose separately from the SMA in 6.6% of the cases. The IMA variation was classified into three types, type A - LCA originates independently from IMA (42%); type B – LCA shared a common trunk with SA (18%); type C - LCA and SA arose in a common point of the IMA (40%). Conclusions: Exclusive irrigation of the splenic flexure by the LCA (type 1) was the most prevalent (60%). The AMCA existed in 22% of the patients in this study, and when present, in most cases (39/44), it participated in splenic flexure blood supply. We observed greater participation of LCA in the splenic flexure blood supply when AMCA did not participate. The most frequent IMA variation was type A (42%), and we did not observe any relationship between the IMA variation and arterial patterns of the splenic flexure.
Objective: To assess the vascular anatomy of the left colic arteries, the left branch of the middle colic artery, and the accessory middle colic artery by three-dimensional computed tomography angiography to classify the vascularization of the splenic flexure. Method: A retrospective cross-sectional study, with an analysis of 200 threedimensional computed tomography angiography exams of the abdominal aorta and its main branches, performed since May 2014 and stored in the image bank of the Radiology Service of Hospital Copa D'Or. All exams will be reassessed by two radiologists who will classify the vascularization of the left flexure and the variations of the accessory middle colic arteries, the left branch of the middle colic artery, and the inferior mesenteric artery. Results: The arterial patterns of the splenic flexure were classified into six types, type 1, exclusive by the LCA (60%); type 2 – exclusive by the MCA-Left (4%); type 3 – by LCA and MCA-Left (10%); type 4 - by AMCA (7.5%); type 5 – by LCA and AMCA (12%); type 6 – no artery (6.5%). The frequency of AMCA was 22%. In most cases, the MCA had the common trunk of the right and left branches (93.4%), and the right and left branches arose separately from the SMA in 6.6% of the cases. The IMA variation was classified into three types, type A - LCA originates independently from IMA (42%); type B – LCA shared a common trunk with SA (18%); type C - LCA and SA arose in a common point of the IMA (40%). Conclusions: Exclusive irrigation of the splenic flexure by the LCA (type 1) was the most prevalent (60%). The AMCA existed in 22% of the patients in this study, and when present, in most cases (39/44), it participated in splenic flexure blood supply. We observed greater participation of LCA in the splenic flexure blood supply when AMCA did not participate. The most frequent IMA variation was type A (42%), and we did not observe any relationship between the IMA variation and arterial patterns of the splenic flexure.