Systemic Review and Meta-Analysis of Vascular Positional Relationships of the Superior Mesenteric Vessels
Location
D.P. Culp Center Ballroom
Start Date
4-5-2024 9:00 AM
End Date
4-5-2024 11:30 AM
Poster Number
67
Name of Project's Faculty Sponsor
Tiffany Carpenetti
Faculty Sponsor's Department
Biomedical Sciences
Competition Type
Competitive
Type
Poster Presentation
Presentation Category
Health
Abstract or Artist's Statement
INTRODUCTION: There have been well-documented anatomical variations involving the positional relationship of the superior mesenteric artery (SMA) to the superior mesenteric vein (SMV) structures. The SMA typically arises from the abdominal aorta inferior to the origin of the celiac trunk and courses anteromedially to the SMV to supply the midgut structures. Both the right colic artery (RCA) and ileocolic artery (ICA) are largely retroperitoneal as they travel to the right side of the large bowel. Awareness of vascular variations should be considered in mesenteric dissection, bowel resection, and procedures within the retroperitoneal space. The present systematic review and meta-analysis aimed to compile current data surrounding the prevalence of the anterior/posterior (A-P) relationships of the RCA and ICA in relation to SMV structures to investigate potential trends. METHODS: A systemic review and meta-analysis adhering to PRISMA guidelines was carried out, encompassing searches on PubMed as well as a thorough exploration of gray literature sources. The search term ““ileocolic artery” OR “right colic artery”” was used to search articles indexed in PubMed. A title and abstract sweep was performed to assess the suitability of each article. Gross anatomical, radiological, and clinical reports were included in the final analysis. RStudio (v.2023.09.0) packages “meta” and “haven” were used to meta-analyze the data and produce forest and funnel plots to summarize the findings. Cochrane’s Q and I2 values were calculated to assess heterogeneity in the sample. RESULTS: The PubMed search yielded a total of 261 indexed articles. Following a title and abstract sweep, 30 PubMed articles were deemed relevant for the study. Ten of these were excluded due to missing data, inability to locate sources, or being a review/meta-analysis. The gray literature review yielded a total of four sources, and two were excluded due to lack of relevance. After screening, 22 eligible articles yielded full text reviews for data extraction and analysis. The meta-analysis revealed the ICA passed anteriorly to the SMV structures in 47% of the 2,837 analyzed samples (95% CI 0.42; 0.53). Out of the 703 analyzed RCA samples, 81% coursed anterior to the SMV (95% CI 0.71; 0.91). The I2 values for ICA and RCA samples were 80% and 91%, respectively. The ICA funnel plot resulted in clustering of studies around the mean proportion (47%) with low standard error (SE). The RCA funnel plot revealed more diffuse data points with higher SE within the low anterior passage studies. CONCLUSIONS: The results demonstrate considerable variation in vascular relationships reported throughout the literature. Positional pattern of the ICA was notably variable (anterior proportion = .47) when compared to the RCA patterning (anterior proportion = .81). Elevated heterogeneity within both the RCA and ICA forest plots suggests interesting differences in the included studies, possibly attributed to population differences (sex, ethnicity, region, etc.). RCA studies with lower rates of anterior passage tended to have greater SE, reflecting small sample sizes. Future research should investigate vascular relationships in different populations, as recognition in demographic differences could improve clinical outcomes and reduce iatrogenic injuries.
Systemic Review and Meta-Analysis of Vascular Positional Relationships of the Superior Mesenteric Vessels
D.P. Culp Center Ballroom
INTRODUCTION: There have been well-documented anatomical variations involving the positional relationship of the superior mesenteric artery (SMA) to the superior mesenteric vein (SMV) structures. The SMA typically arises from the abdominal aorta inferior to the origin of the celiac trunk and courses anteromedially to the SMV to supply the midgut structures. Both the right colic artery (RCA) and ileocolic artery (ICA) are largely retroperitoneal as they travel to the right side of the large bowel. Awareness of vascular variations should be considered in mesenteric dissection, bowel resection, and procedures within the retroperitoneal space. The present systematic review and meta-analysis aimed to compile current data surrounding the prevalence of the anterior/posterior (A-P) relationships of the RCA and ICA in relation to SMV structures to investigate potential trends. METHODS: A systemic review and meta-analysis adhering to PRISMA guidelines was carried out, encompassing searches on PubMed as well as a thorough exploration of gray literature sources. The search term ““ileocolic artery” OR “right colic artery”” was used to search articles indexed in PubMed. A title and abstract sweep was performed to assess the suitability of each article. Gross anatomical, radiological, and clinical reports were included in the final analysis. RStudio (v.2023.09.0) packages “meta” and “haven” were used to meta-analyze the data and produce forest and funnel plots to summarize the findings. Cochrane’s Q and I2 values were calculated to assess heterogeneity in the sample. RESULTS: The PubMed search yielded a total of 261 indexed articles. Following a title and abstract sweep, 30 PubMed articles were deemed relevant for the study. Ten of these were excluded due to missing data, inability to locate sources, or being a review/meta-analysis. The gray literature review yielded a total of four sources, and two were excluded due to lack of relevance. After screening, 22 eligible articles yielded full text reviews for data extraction and analysis. The meta-analysis revealed the ICA passed anteriorly to the SMV structures in 47% of the 2,837 analyzed samples (95% CI 0.42; 0.53). Out of the 703 analyzed RCA samples, 81% coursed anterior to the SMV (95% CI 0.71; 0.91). The I2 values for ICA and RCA samples were 80% and 91%, respectively. The ICA funnel plot resulted in clustering of studies around the mean proportion (47%) with low standard error (SE). The RCA funnel plot revealed more diffuse data points with higher SE within the low anterior passage studies. CONCLUSIONS: The results demonstrate considerable variation in vascular relationships reported throughout the literature. Positional pattern of the ICA was notably variable (anterior proportion = .47) when compared to the RCA patterning (anterior proportion = .81). Elevated heterogeneity within both the RCA and ICA forest plots suggests interesting differences in the included studies, possibly attributed to population differences (sex, ethnicity, region, etc.). RCA studies with lower rates of anterior passage tended to have greater SE, reflecting small sample sizes. Future research should investigate vascular relationships in different populations, as recognition in demographic differences could improve clinical outcomes and reduce iatrogenic injuries.