Features of catheterization of the inferior mesenteric artery and its architecture in patients with colorectal cancer according to X-ray contrast angiography data

INTRODUCTION: The anatomy of the celiac trunk and superior mesenteric artery, due to their clinical significance, has been studied quite well both in abdominal surgery and oncology. At the same time, there is much less information about peculiarities of the structure and catheterization of the inferior mesenteric artery (IMA) in angiographic operations, which was the reason for studying this issue. AIM: To study the architecture of the IMA and the peculiarities of its catheterization based on X-ray contrast angiography data. MATERIALS AND METHODS: The study included 20 patients (13 men, 7 women; mean age (56.0 ± 7.0) years) with colorectal cancer and colorectal cancer metastases to regional lymph nodes, who underwent intra-arterial neoadjuvant/adjuvant therapy. X-ray endovascular intervention was performed using a Siemens Artis Zee device. In 10 patients, angiography was performed through the femoral access, in 10 patients — through a puncture of the brachial artery. The identified features of the structure of the IMA, were structured using a modified classification of H. Yada. RESULTS: Type I of the IMA structure according to H. Yada was detected in 70%; type II — in 15%; type III — in 10%; type IV — in 5%. Basic morphometric parameters of the IMA were: diameter — (2.90 ± 0.67) mm, length to the level of separation of the first branch — (29.8 ± 15.9) mm, separation angle — (32.0 ± 7.4)°. The revealed structural features of the inferior mesenteric artery make access through the upper limb using an MPA catheter preferable. CONCLUSION: Four variants of the structure of the IMA circulation according to H. Yada’s classification were confirmed, and its main morphometric parameters were established based on our clinical material. Access through the upper limb using an MPA catheter with the primary visualization of the IMA at the level of the fifth lumbar vertebra with subsequent pulling up and orientating the catheter tip toward the anterior wall of the left semicircle of the aorta is optimal for catheterization of the IMA and its branches.