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Celiac and Superior Mesenteric Arteries

Celiac and Superior Mesenteric Arteries Pollard, M.D., and Nicholas A. Michels, D.Sc. Cloth Pp. 226, with figures. Boston, Mass., Little, Brown, 1969. This book on the celiac and mesenteric arteries has been long overdue and fulfills an important need for the vascular radiologist, the surgeon, and the gastroenterologist. The work is divided into eight chapters, the first two of which are devoted to embryology and anatomic considerations. The embryology is clearly presented, and the description of the embryological basis for the high incidence of anatomical variations in the arterial supply of the gastrointestinal tract is excellent. Doctor Michels has reduced the great detail and minutiae of his atlas to a useful summary. The use of the terms "accessory," "aberrant," "partially replaced," and "wholly replaced" when referring to the hepatic arteries was confusing in Dr. Michels' original atlas and remains so in the present book. It is uncertain why the distinction has to be made when, as is pointed out by Michels, "both accessory and replaced hepatic arteries are end arteries. As such they are vital to the area of hepatic parenchyma they supply." Chapter 3 consists of a brief description of the technic employed by the authors in performing celiac and superior mesenteric arteriography. This chapter is abbreviated and is certainly not sufficient nor was it intended for the novice who has never performed celiac or mesenteric arteriography. The remaining six chapters are devoted to reporting the results of a detailed evaluation of the arterial vasculature of 300 patients studied by selective celiac and superior mesenteric arteriography at the Massachusetts General Hospital. Attempts were made to correlate the arteriograms with the 400 cadaver dissections made by Drs. Michels and Kornblith. The results are remarkably successful, and almost all of the major anatomical variations described by the morbid anatomists were seen by the angiographers. The chapter on collateral blood flow describes and arteriographically illustrates the many collateral arterial pathways to the upper abdominal organs. The final chapter points out the clinical importance of many of the arterial variations. The authors introduced the idea of "visibility index" of blood vessels which they defined as the number of times that a branch artery was clearly seen if its parent vessel was filled with contrast material. This is expressed as a percentage. They claim that the low visibility index of vessels such as the dorsal pancreatic artery is a major factor in the disappointing angiographic results seen in small carcinomas of the tail of the pancreas. In contrast, the high visibility index of the hepatic artery makes hepatic angiography a reliable diagnostic procedure. The visibility indices of all of the major vessels supplying the upper abdominal organs are listed in the appendix. This entire concept appears to be helpful; however, the authors themselves point out that one of the factors that influence the visibility index relates to the resolution of the image of an artery on the arteriogram. This is, among other things, dependent on the kVp and rnA used, film and screen quality, and also the catheter position at the time the contrast material is injected as well as the pressure of the injection itself. The visibility indices, therefore, will be different in celiac arteriography as compared to "superselective studies." The transverse pancreatic artery was seen in 60 per cent of patients who had the dorsal pancreatic or arteria pancreatica magna visualized. What would the visibility index of the same vessel be if the dorsal pancreatic artery was selectively catheterized? The book reads easily and the quality of the illustrations is excellent. Wide margins, generous use of blank space, and large type face, however, uneconomic ally increase the size of the book in relation to the amount of material covered in the text. This reviewer finds this type of format acceptable, but one of his older colleagues remarked that under wartime economy restrictions this book would shrink to less than 100 pages. The authors are to be congratulated on making a valuable contribution to the rapidly growing field of vascular radiology. The excellent correlation of the anatomy with the arteriogram make the book unique. It is recommended to all those involved in performing or interpreting celiac and superior mesenteric arteriograms. STANLEY BAUM, M.D. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Celiac and Superior Mesenteric Arteries

Stanley Baum
Radiology , Volume 93: 380 – Aug 1, 1969
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Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © August 1969 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
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Abstract

Pollard, M.D., and Nicholas A. Michels, D.Sc. Cloth Pp. 226, with figures. Boston, Mass., Little, Brown, 1969. This book on the celiac and mesenteric arteries has been long overdue and fulfills an important need for the vascular radiologist, the surgeon, and the gastroenterologist. The work is divided into eight chapters, the first two of which are devoted to embryology and anatomic considerations. The embryology is clearly presented, and the description of the embryological basis for the high incidence of anatomical variations in the arterial supply of the gastrointestinal tract is excellent. Doctor Michels has reduced the great detail and minutiae of his atlas to a useful summary. The use of the terms "accessory," "aberrant," "partially replaced," and "wholly replaced" when referring to the hepatic arteries was confusing in Dr. Michels' original atlas and remains so in the present book. It is uncertain why the distinction has to be made when, as is pointed out by Michels, "both accessory and replaced hepatic arteries are end arteries. As such they are vital to the area of hepatic parenchyma they supply." Chapter 3 consists of a brief description of the technic employed by the authors in performing celiac and superior mesenteric arteriography. This chapter is abbreviated and is certainly not sufficient nor was it intended for the novice who has never performed celiac or mesenteric arteriography. The remaining six chapters are devoted to reporting the results of a detailed evaluation of the arterial vasculature of 300 patients studied by selective celiac and superior mesenteric arteriography at the Massachusetts General Hospital. Attempts were made to correlate the arteriograms with the 400 cadaver dissections made by Drs. Michels and Kornblith. The results are remarkably successful, and almost all of the major anatomical variations described by the morbid anatomists were seen by the angiographers. The chapter on collateral blood flow describes and arteriographically illustrates the many collateral arterial pathways to the upper abdominal organs. The final chapter points out the clinical importance of many of the arterial variations. The authors introduced the idea of "visibility index" of blood vessels which they defined as the number of times that a branch artery was clearly seen if its parent vessel was filled with contrast material. This is expressed as a percentage. They claim that the low visibility index of vessels such as the dorsal pancreatic artery is a major factor in the disappointing angiographic results seen in small carcinomas of the tail of the pancreas. In contrast, the high visibility index of the hepatic artery makes hepatic angiography a reliable diagnostic procedure. The visibility indices of all of the major vessels supplying the upper abdominal organs are listed in the appendix. This entire concept appears to be helpful; however, the authors themselves point out that one of the factors that influence the visibility index relates to the resolution of the image of an artery on the arteriogram. This is, among other things, dependent on the kVp and rnA used, film and screen quality, and also the catheter position at the time the contrast material is injected as well as the pressure of the injection itself. The visibility indices, therefore, will be different in celiac arteriography as compared to "superselective studies." The transverse pancreatic artery was seen in 60 per cent of patients who had the dorsal pancreatic or arteria pancreatica magna visualized. What would the visibility index of the same vessel be if the dorsal pancreatic artery was selectively catheterized? The book reads easily and the quality of the illustrations is excellent. Wide margins, generous use of blank space, and large type face, however, uneconomic ally increase the size of the book in relation to the amount of material covered in the text. This reviewer finds this type of format acceptable, but one of his older colleagues remarked that under wartime economy restrictions this book would shrink to less than 100 pages. The authors are to be congratulated on making a valuable contribution to the rapidly growing field of vascular radiology. The excellent correlation of the anatomy with the arteriogram make the book unique. It is recommended to all those involved in performing or interpreting celiac and superior mesenteric arteriograms. STANLEY BAUM, M.D.

Journal

Radiology – Radiological Society of North America, Inc.

Published: Aug 1, 1969

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