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Terminal reaches of the branches from middle colic artery (MCA) vary a lot and were rarely reported. This leads to the anatomical ambiguity of whether middle colic artery right branch feeds the ascending colon and needs to be divided in cecal tumor surgery. Ultra-thin abdominal CT images (0.5-mm thickness) from January 2017 to December 2017 were prospectively collected and analyzed. Bifurcation pattern and terminal reaches of the middle colic artery branches and right colic artery and the distances from the root of ileocolic artery to middle colic artery were examined. A total of 231 patients were included in this study. Middle colic artery bifurcated into two branches in 74.0% of the cases. Middle colic artery right branch supplied the ascending colon in 13.4% and the proximal third of transverse colon in 53.7% of the cases. Right colic artery was found in 29.9%, and its presence was strongly associated with the feeding areas of middle colic artery branches. When right colic artery was present, middle colic artery right branch rarely reached the ascending colon (1.5% vs. 18.5%, p < 0.001), and fewer chance that middle colic artery left branch supplied the proximal third of transverse colon (17.0% vs. 44.4%, p = 0.004), and the distance from ileocolic artery root and middle colic artery root was longer (30.72 SD19.72 vs. 21.46 SD9.24 mm, p < 0.001). The terminal reaches of middle colic artery right branch at ascending or transverse colon were closely correlated with the presence of right colic artery. This could help provide anatomical basis for individualized vessel management for cecal cancer surgery and reduce the operational difficulty. [ABSTRACT FROM AUTHOR]

Background: Variations of the vasculature at splenic flexure by left colic artery (LCA) and middle colic artery (MCA) remain ambiguous. Objectives: This study aim to investigate the anatomical variations of the branches from LCA and MCA at splenic flexure area. Methods: Using ultra-thin CT images (0.5-mm thickness), we traced LCA and MCA till their merging site with paracolic marginal arteries through maximum intensity projection (MIP) reconstruction and computed tomography angiography (3D-CTA). Results: A total of 229 cases were retrospectively enrolled. LCA ascending branch approached upwards till the distal third of the transverse colon in 37.6%, reached the splenic flexure in 37.6%, and reached the lower descending colon in 23.1%, and absent in 1.7% of the cases. Areas supplied by MCA left branch and aMCA were 33.2%, 44.5% and 22.3% in the proximal, middle and distal third of transverse colon of the cases, respectively. The accessory MCA separately originated from the superior mesenteric artery was found in 17.9% of the cases. Mutual correlation was found that, when the LCA ascending branch supplied the distal transverse colon, MCA left branch tended to feed the proximal transverse colon; when the LCA ascending branch supplied the lower part of descending colon, MCA left branch was more likely to feed the distal third of transverse colon. Conclusions: Vasculature at splenic flexure by LCA and MCA varied at specific pattern. This study could add more anatomical details for vessel management in surgeries for left-sided colon cancer. [ABSTRACT FROM AUTHOR]