Aberrant branches of the superior mesenteric artery detected by MDCT angiography of abdominal aorta

Background: The anatomy of superior mesenteric artery (SMA) is complicated and has numerous variations. Awareness of aberrant branches of SMA can result in accurate interpretation of disease and vascular involvement, optimal selection of treatment options or operative planning, and help avoid iatrogenic injury from surgical and interventional radiological procedures.

Objective: We determined different aberrant arterial branches of SMA and their order of frequencies by using MDCT angiography of the abdominal aorta in order to achieve accurate diagnostic interpretation and for safety of surgical, laparoscopic, and interventional procedures.

Material and Methods: One hundred ninety nine MDCT angiography of abdominal aorta or whole aorta studies, done between January 1, 2007 and December 31, 2009, were retrospectively reviewed by consensus of two radiologists. Interobserver reliability is obtained using ⃞-statistics. Assessment for the presence of aberrant arterial branches of SMA was performed. The number and specific name of each aberrant arteries of mesenteric circulation were recorded.

Results: One hundred sixty three patients (81.8%) have classic normal branches of SMA. Thirty-six patients (18.1%) have single arterial variant identified, and none has multiple arterial variant from SMA. Identified aberrant branches of SMA are replaced right hepatic artery (8.5%), celiacomesenteric trunk (3.5%), inferior pancreatic artery (2.5%), common hepatic artery (2%), right gastroepiploic artery (0.5%), splenic artery (0.5%), and cystic artery (0.5%). Associations of single arterial variant of SMA with other variation of mesenteric circulation are found in seven patients.

Conclusion: Aberrant branches of SMA in Thai people present in 18.1% of cases. The highest incidence is replaced right hepatic artery arising from SMA (8.5%). Incidence and order of frequency are conformed to previous reports in other nationalities. There is also associated variation of other mesenteric circulation in 3.5% of cases presented with aberrant arterial branch from SMA, while none has shown multiple aberrant branches from SMA.