Defining Measurements of the Ileocolic and Inferior Mesenteric Vessels By Contrast-enhanced CT: Implications for Vascular Pedicle Ligation During Colectomy

Introduction: Recent technical refinements in laparoscopic colectomy include widespread use of energy devices to control the mesenteric vascular pedicle instead of sutures, clips or staplers. Available devices are approved to seal a variety of vessel sizes, but none is approved for vessels over 7mm, and the actual diameter of these vessels has not been well-defined in the literature. The aim of this study is to define diameters of vessels routinely divided during colectomy and evaluate patient characteristics that predictlarger vessels.

Methods and Procedures: Measurements of the ileocolic artery (ICA), ileocolic vein (ICV), inferior mesenteric artery (IMA) and inferior mesenteric vein (IMV) were performed in 100 adult patients undergoing consecutive contrast-enhanced abdominopelvic CT scans in 2009. Age, sex, body mass index (BMI) and indication for CT (acute vs. elective) were recorded. A backwards stepwise logistic regression analysis was performed to determine factors that predict vessel size > 7mm.

Results: Mean age was 52 and median BMI was 25.Thirty-two percent of scans were done acutely versus 68% elective. Mean diameters and ranges in millimeters were: ICA 4.0±0.89 (2.4 – 7.0), ICV 6.2±1.4 (2.3–11), IMA 4.2±1.0 (2.5 –8.4), IMV 5.8±1.4 (2.2 –11.5). Twenty-four percent of patients had ICV diameters > 7mm, 13% had IMV diameters > 7mm. There were no ICA diameters > 7mm. Two patients’ IMA diameters were > 7mm. In the regression model, no variables were predictive of diameter > 7mm.

Conclusions: Reference values for ICA, ICV, IMA, and IMV diameters by CT are established and may guide decision-making forpedicle ligation technique. Arterial pedicle ligation can generally be done if the energy device is approved to 7 mm.

Session: Poster

Program Number: P114

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