Superior mesenteric artery clinical classification and morphometrical analysis

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BACKGROUND: The superior mesenteric artery is one of the most important arteries in the abdominal cavity, which is of great clinical significance, especially in surgical procedures and fatal ischaemic complications. The aim of this study was to develop a clinical classification of the superior mesenteric artery. MATERIAL AND METHODS: Postmortem contrast-enhanced computed tomography of 104 (29.8% female, age 50.7 ± 18.7 years) human bodies were analysed. Based on anatomic predisposition to ischaemic and iatrogenic complications, a 3-tiered clinical classification of the superior mesenteric artery was developed. Type 0 was defined as standard risk for ischaemic and iatrogenic complications. Type 1 was defined as increased thromboembolic risk with decreased risk of iatrogenic bleeding, and type 2 was defined as decreased ischaemic risk with increased risk of iatrogenic bleeding. The supply area of the superior mesenteric artery was divided into 4 regions: pancreas, caecum, ascending colon, and transverse colon. RESULTS: Type 0 (standard risk) was found in 62.5% of cases. Type 1 was most frequently observed in the ascending colon region (15.4%). Type 2 was most frequently observed in the pancreatic region (17.3%). Regarding type, most abnormalities were found in the region of the ascending colon (18.3%), pancreas (17.3%), and transverse colon (16.3%). CONCLUSIONS: The proposed clinical classification of SMA links anatomic variations in morphology with their clinical significance. A simple, 3-level classification can be easily applied in daily practice and serve as a great support for preoperative evaluation and recognition of patients at risk of iatrogenic or thromboembolic complications.

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