Angiographie Anatomy of the Peripheral Vasculature and the Non-invasive Assessment of Peripheral Vascular Disease
Richard R Heuser, Giancarlo Biamino in Peripheral Vascular Stenting, 1999
The descending thoracic aorta courses inferiorly to continue on as the abdominal aorta when it pierces the diaphragm through the median arcuate ligament (Fig. 2.6). Just inferior to the median arcuate ligament and at the level of the first lumbar vertebral body, the celiac axis arises from the anterior aspect of the aorta. The celiac axis gives rise to the left gastric artery. A rare cause of abdominal angina can be the median arcuate compression syndrome in which the celiac axis arises at the level of the ligament, thus impinging on the artery (Fig. 2.7). Next, the superior mesenteric arises from the anterior surface of the aorta. The superior mesenteric artery is responsible for the vascular supply of the small intestine, right colon and the transverse colon. The most distal anterior branch of the aorta is the inferior mesenteric artery, arising several centimeters above the aortic bifurcation. It is significantly smaller in caliber than either the celiac axis or the superior mesenteric artery. The inferior mesenteric artery is responsible for the vascular supply of the distal portion of the transverse colon, left colon, sigmoid, and a portion of the rectum. The origin of the major visceral branches of the aorta is best seen in the lateral projection (90° left anterior oblique).
Use of the stomach as an esophageal substitute
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
A knowledge of the arterial blood supply of the stomach is essential for its use as an esophageal substitute. The arterial supply of the stomach originates from the celiac trunk. This vessel has a short stem that immediately divides into three branches. The left gastric artery runs in a cranial ventral direction, covered by the peritoneum of the posterior wall of the lesser sac. Subcardially, it turns to the lesser curvature in an aborad direction, where it supplies the anterior and posterior gastric wall by small branches. The left gastric artery has anastomoses with the right gastric artery, which originates from the common hepatic artery and approaches from the region of the pylorus. By these means, an arterial ring along the lesser curvature is completed, with its strongest inflow being from the left gastric artery.
Mesenteric and renal angiography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
The mesenteric arteries arise from the anterior aspect of the lower thoracic and abdominal aorta. These vessels—the celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA)—are responsible for the blood supply to all organs located within the abdominal cavity. The celiac trunk is the first major branch of the abdominal aorta and is an essential source of blood supply to the liver, stomach, and parts of the esophagus, spleen, duodenum, and pancreas. Its origin from the anterior aorta is typically midline at the level of the T12 vertebral body, and it courses inferiorly for 1-2 cm before branching into the left gastric, common hepatic, and splenic arteries (Figure 24.1). The common hepatic artery divides into the proper hepatic artery and, typically, also the gastroduodenal artery. The proper hepatic gives off the right gastric artery before branching into the right and left hepatic arteries. The gastroduodenal artery then goes on to divide into the right gastroepiploic artery and the anterior and posterior superior pancreaticoduodenal arteries. The right gastroepiploic artery and the left gastroepiploic artery (from the splenic artery) join together along the greater curvature of the stomach. The right gastric artery and the left gastric artery join together to run along the lesser curvature of the stomach. Because of the redundant blood supply to the stomach, gastric ischemia is uncommon.
Gastric bleeding in giant cell arteritis
Published in Baylor University Medical Center Proceedings, 2021
Austin Childress, Thomas J. Kwarcinski, Joseph Scott H. Bittle, Clayton Trimmer
The patient was admitted and interventional radiology was consulted. Angiography with selection of the celiac axis revealed an irregular, beaded appearance of the left gastric artery (Figure 2a), characteristic of vasculitis. A small focus of active extravasation was also noted, and the left gastric artery was subsequently embolized utilizing Gelfoam and coils. The postembolization angiogram demonstrated no residual filling (Figure 2b). Following the procedure, the patient informed the care team that he recently underwent a temporal artery biopsy at an outside institution that confirmed GCA. He was prescribed daily prednisone and advised to follow-up with rheumatology. Following the procedure, his hemoglobin stabilized and he was discharged on hospital day 3 with no further complications.
A rare complication of laparoscopic Roux-en-Y gastric bypass: case report of gastric remnant necrosis
Published in Acta Chirurgica Belgica, 2023
Astrid Rycx, Hendrik Maes, Yves Van Nieuwenhove
Furthermore, compromised blood flow causing ischemia and necrosis of the gastric remnant may be due to surgical manipulation of the vessels. Ligation of part of the short gastric vessels and branches of the left gastric artery during LRYGB surgery to create the gastric pouch may contribute to vascular compromising of the gastric remnant [2,9]. In this case, vascular damage due to ligation of these vessels may explain the localization of the necrosis at the gastric remnant upper pole. Devascularisation of the gastric remnant from previous surgery might as well contribute to an increased risk of mesenteric ischemia, which in turn is a plausible cause of necrosis [5]. Apart from the LRYGB surgery three months before, the patient had a history of gastric banding. Injury of the left gastric artery caused by the gastric band may have contributed to vascular comprising of the gastric remnant upper pole in this case. Left gastric artery erosion was described previously in the light of gastric band erosion [10]. An association between previous gastric banding and gastric remnant necrosis post LRYGB was not yet described.
Acute necrotizing esophagitis presenting with severe lactic acidosis and shock
Published in Baylor University Medical Center Proceedings, 2018
Kenneth Iwuji, Sarah Jaroudi, Arpana Bansal, Ana Marcella Rivas
Although the etiology of acute esophageal necrosis is hypothesized to be multifactorial, vascular compromise seems to be a mainstay.2 The “two-hit” hypothesis describes an initial low flow state due to a vasculopathy or hemodynamic instability that leaves the esophageal mucosal barriers susceptible to gastric acid reflux insults in the setting of gastric outlet obstruction. The esophagus has an intricate vascular supply that is rarely susceptible to ischemia but in the case of the two-hit hypothesis can reveal transient necrosis that will rapidly recover with restoration of flow. The blood supply is distributed among segments of the esophagus, with the distal segment known as a “watershed” area where acute esophageal necrosis tends to be detected. The upper esophagus is supplied by the descending branches of the inferior thyroid arteries. The middle esophagus receives its blood supply from branches off the descending aorta that include the bronchial arteries, right third or fourth intercostal arteries, and esophageal arteries. Lastly, the distal esophagus derives its supply from the branches off the left gastric artery or left inferior phrenic artery. In addition, numerous contributions are derived from surrounding arteries leading to a rich vascular supply.2 This rich arterial connection makes ischemic esophagus necrosis a rare finding.
Related Knowledge Centers
- Anastomosis
- Esophageal Hiatus
- Esophagus
- Stomach
- Celiac Artery
- Body
- Curvatures of The Stomach
- Right Gastric Artery
- Esophageal Branches of Left Gastric Artery
- Esophageal Branches of Thoracic Part of Aorta