Secondary to ischemia collateral circulation variations of the stenoses celiac trunk and superior mesenteric artery

Objective: Mesenteric circulation is provided by the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). The collateral circulation between CA and SMA and between SMA and IMA plays a protective role against intestinal ischemia if there is narrowing or occlusion of the mesenteric vessels. The aim of this study was to determine the CA and SMA stenosis rates in patients with CA and SMA stenosis seen on angiography images, the occurrence of collateral variations, and the frequency of these variations. Method: The angiography images were examined of 215 patients (130 males, 85 females) who presented at Akdeniz University Hospital with symptoms of chronic mesenteric ischemia (CMI). The angiography images were evaluated in respect of CA and SMA stenosis rates, and collateral variations between mesenteric vessels. Results: Stenosis of the CA was observed in 14 patients and SMA stenosis in 12 patients. The most common collateral vessel in these patients was the gastroduodenal artery. Stenosis of both the CA and SMA was present in 9 patients, in which the most common collateral vessel type was the Riolan arch. Conclusion: It was observed that mesenteric circulation was mainly provided by the gastroduodenal artery in patients with isolated CA or SMA stenosis or occlusion, while in patients with stenosis or occlusion of both the CA and SMA, mesenteric circulation was mainly provided by the Riolan arch. A significant increase was observed in the prominence of collateral vessels in patients with stenosis of more than 70%. Key words: Mesenteric ischemia, mesenteric collateral circulation, celiac artery, superior mesenteric artery