OBJECTIVE: To examine the specific characteristics of ICG-angiography during various bariatric interventions.
METHODS: The study included 329 patients, with 105 (32%) undergoing sleeve gastrectomy (LSG), 98 (30%) undergoing mini-gastricbypass (MGB), 126 (38%) undergoing Roux-en-Y gastric bypass (RGB). Intraoperative ICG angiography was perfomed on all patients at \'control points\', the perfusion of the gastric stump was qualitatively and quantitatively assessed.
RESULTS: Intraoperative ICG angiography shows that during LSG the angioarchitectonics in the area of the His angle are crucial. The presence of the posterior gastric artery of the gastric main type is a prognostically unfavorable risk factor for the development of ischemic complications. Therefore, to expand the gastric stump it is necessary to suture a 40Fr nasogastric tube and perform peritonization of the staple line. Statistical difference in blood supply at three points were found between and within the two groups of patients (Gis angle area, gastric body, pyloric region) with a p-value <0.001. During MGB, one of the important stages is applying the first (transverse) stapler cassette between the branches of the right and left gastric arteries. This maintains blood supply in anastomosis area, preventing immediate complications such as GEA failure, as well as long-term complications like atrophic gastritis, peptic ulcers, and GEA stenosis.
CONCLUSIONS: ICG angiography is a useful method for intraoperative assessment of angioarchitecture and perfusion of the gastric stump during bariatric surgery. This helps prevent tissue ischemia and reduce the risk of early and late postoperative complications.
UNASSIGNED: Изучить особенности проведения ангиографии с индоцианином зеленым (ICG-ангиографии) при выполнении бариатрических вмешательств.
UNASSIGNED: В исследование включено 329 человек, в 105 (32%) случаях выполнена лапароскопическая продольная резекция желудка (ЛПРЖ), в 98 (30%) случаях — минигастрошунтирование (МГШ), в 126 (38%) случаях — гастрошунтирование по Ру. Всем пациентам проведена интраоперационная ICG-ангиография в «контрольных точках», осуществлена качественная и количественная оценка перфузии культи желудка.
UNASSIGNED: В результате применения интраоперационной ICG-ангиографии выявлены следующие закономерности. Так, при проведении ЛПРЖ наибольшее значение имеет ангиоархитектоника в области угла Гиса. Наличие задней желудочной артерии магистрального типа является прогностически неблагоприятным фактором риска развития ишемических осложнений, что связано с необходимостью некоторого расширения культи желудка (прошивание при использовании назогастрального зонда 40Fr) и перитонизации линии степлерного шва. При сравнении двух групп пациентов выявлены статистически значимые различия кровоснабжения в трех точках как между группами, так и внутри групп (область угла Гиса, угол желудка, пилорический отдел), p<0,001. При МГШ одним из важных этапов операции является наложение первой (поперечной) степлерной кассеты, которая должна располагаться между ветвями правой и левой желудочных артерий. Это позволяет сохранить кровоснабжение в области анастомоза, что предотвращает как ближайшие осложнения (несостоятельность гастроэнтероанастомоза), так и отдаленные — атрофический гастрит, пептические язвы и стеноз гастроэнтероанастомоза.
UNASSIGNED: Ангиография с индоцианином зеленым является перспективным методом интраоперационной оценки ангиоархитектоники и перфузии культи желудка во время бариатрических хирургических вмешательств, позволяет предотвратить ишемию тканей и, соответственно, ранние и поздние послеоперационные осложнения.

An arterial aneurysm is a localized weakening of the artery wall that results in pathological dilatation. All intra-abdominal artery aneurysms are labeled as visceral artery aneurysms (VAA), apart from the aorto-iliac artery aneurysms. VAA´s are rare, gastroduodenal artery aneurysms (GDAA), constituting 1.5% of visceral artery aneurysms. A woman in her early 80s´ presented with chronic epigastric pain, weight loss, and nausea. Conservative management was unsuccessful. Imaging revealed a GDAA, prompting endovascular coil embolization. Subsequent evaluation confirmed Polyarteritis Nodosa (PAN), treated with rituximab. The report underscores the diagnostic challenges, emphasizing the need for a multidisciplinary approach using imaging and angiography. GDAA\'s potential life-threatening rupture necessitates prompt intervention, as illustrated in this case. The rare association with PAN, although infrequent, underscores the importance of considering underlying etiologies in multiple visceral aneurysms. Early diagnosis and intervention are pivotal for this uncommon yet potentially lethal condition.

OBJECTIVE: This study assessed the safety and effectiveness of a technical modification that involves adding short gastric artery (SGA) embolization to left gastric artery (LGA) embolization.
METHODS: This retrospective single-center study analyzed twenty obese patients (median age of 53.5 (30-73)) who were not eligible for bariatric surgery and underwent bariatric embolization with 300-500-µm microspheres in addition to a lifestyle counseling program between March 2021 and July 2022. Eight patients had LGA + SGA embolization, and twelve had LGA embolization alone. The primary outcome measure was total body weight loss (TBWL) at 6 months in the SGA + LGA and the LGA-only cohorts. Safety was assessed, defined as the 30-day adverse events rate according to the SIR classification.
RESULTS: The mean 6-month post-embolization TBWL in the SGA + LGA cohort was 7.3 kg (95%CI 2.1-12.4; p = .01) and 4.1 kg (95%CI 0.4-8.6; p = 0.034) in the LGA-only cohort (mean difference - 3.1 kg ± 2.8; 95%CI (- 9.1-2.8); p = .28). The mean 6-month post-embolization TBWL in the entire cohort was 5.3 kg (p < .01). The rate of complications was similar between the two groups.
CONCLUSIONS: Combined SGA and LGA embolization is safe and effective to treat obesity. Larger studies are needed to determine whether SGA + LGA embolization results in more significant weight loss than LGA embolization alone.

OBJECTIVE: This study aims to gather and analyze the anatomical characteristics of the posterior gastric artery (PGA), investigate the presence and metastasis of lymph nodes around the PGA in patients with gastric cancer. Additionally, the study aims to analyze the relationship between the PGA and its surrounding lymph nodes and the clinicopathological features of patients with gastric cancer.
METHODS: This study consisted of a cross-sectional analysis of data from 52 patients with gastric cancer who underwent total or proximal gastrectomy at the Department of Gastrointestinal Surgery, First Affiliated Hospital of Dalian Medical University, between January 2020 and November 2022. Intraoperative exploration was performed to determine the presence of the PGA, and patients with the PGA were assessed for relevant anatomical characteristics, including the length of the PGA and the distance from the root of the PGA to the celiac trunk. Dissection of lymph nodes around the PGA was also performed. Statistical methods were employed to describe and analyze the data regarding the presence of the PGA, as well as the presence and metastasis of the lymph nodes around the PGA. Additionally, the study identified clinicopathological factors associated with these conditions.
RESULTS: The PGA was identified in 39 (75.0%) out of 52 patients with gastric cancer, exhibiting a mean PGA length of 3.5 ± 0.8 cm and a mean distance from the root of the PGA to the celiac trunk of 6.7 ± 1.7 cm. Among the 39 patients who underwent dissection of lymph nodes around the PGA, 36 lymph nodes around the PGA were detected in 20 patients. Analysis of factors associated with the presence of lymph nodes around the PGA revealed a significant correlation with the macroscopic type of the tumor and the total number of dissected lymph nodes (P = 0.007 and P = 0.022, respectively), with a larger number of total dissected lymph nodes being an independent factor (OR = 1.105, 95%CI: 1.019-1.199, P = 0.016). Furthermore, analysis of risk factors for metastasis of the lymph nodes around the PGA demonstrated that the total number of metastatic lymph nodes, No.3 lymph node metastasis, and No.11 lymph node metastasis were associated with metastasis of the lymph nodes around the PGA (P = 0.043, P = 0.028, and P = 0.020, respectively).
CONCLUSIONS: The PGA exhibits a high incidence. It is essential to carefully identify the PGA during procedures involving the PGA and consider appropriate preservation or disconnection of this vessel. The presence of lymph nodes around the PGA is not an isolated occurrence. Gastric cancer can result in metastasis of the lymph nodes around the PGA. Although the overall risk of metastasis of the lymph nodes around the PGA is low in patients with gastric cancer, it increases in the presence of conditions such as No.3 lymph node metastasis, No.11 lymph node metastasis, advanced tumor stage, and extensive metastases in other regional lymph nodes.

OBJECTIVE: Knowing the anatomical variation of the coeliac trunk (CT) and its detailed interpretation in the preoperative period is important for the prevention of iatrogenic injury during liver surgery or endovascular intervention on the coeliac trunk and its branches.
METHODS: A diagnostic abdominal computed tomography angiography (CTA) was performed in a 61-year-old male patient, who was investigated for a liver cancer and chemoembolization was planned.
RESULTS: CTA reveals that right hepatic artery (RHA) arises directly from the abdominal aorta, at the level of CT. This vessel coursing to the right hepatic lobe, functioning therefore as a replaced right hepatic artery (RRHA). Also, the left gastric artery (LGA) arises directly from the abdominal aorta. This patient successfully underwent chemoembolization from RRHA.
CONCLUSIONS: We presented a case of new anatomical variation involving the origination of RRHA and LGA from the abdominal aorta.

Gastric artery injury resulting from blunt abdominal trauma is rare, with only eight previous cases documented in the published literature. Our report describes a case involving an injury to the right gastric artery with concomitant injuries to the liver and spleen, for which arterial embolization targeting the right gastric artery was performed. The patient, a 66-year-old woman without any remarkable medical history, was involved in a motor vehicle accident. She was brought to the hospital in a state of shock and complaining of upper abdominal pain. Contrast-enhanced CT indicated hepatic and splenic injuries, intra-abdominal hemorrhaging, and effusion of contrast medium, suggesting involvement of the right gastric artery. Subsequent angiography confirmed irregularities in the diameter of the right gastric artery, prompting coil embolization. A conservative therapeutic approach was selected due to the absence of evidence regarding active hemorrhage or vascular injury within the hepatic or splenic regions. The patient remained clinically stable following the embolization, without any sequelae. Arterial embolization is warranted if preoperative contrast CT indicates signs of hemorrhage, even if hemostasis is ostensibly attained during angiography. Our findings allude to the feasibility of non-operative management (NOM) rather than laparotomy for cases of gastric artery injury.

The coeliac trunk, the first anterior branch, often originates at the level of the T12 vertebral body, right below the aortic hiatus, as the first ventral branch of the abdominal aorta. It commonly divides into the left gastric, common hepatic, and splenic arteries. We report a rare variation in the branching pattern and course of branches of the coeliac trunk in two donated female cadavers during routine abdominal dissection. It is essential to understand the coeliac trunk and the distinctions in its origin and branching pattern to perform efficient upper abdominal surgical and radiological procedures and to adopt novel interventional and treatment options for hepatic cancers. As anatomists, we are also attempting to link our study\'s variations to their embryological genesis.
İlk ön dal olan çölyak trunkus, abdominal aortanın ilk ventral dalı olarak genellikle T12 vertebral cisim seviyesinde, aortik hiatusun hemen altından çıkar. Genellikle sol gastrik, ortak hepatik ve splenik arterlere ayrılır. Bu yazıda, bağışlanan iki kadın kadavrada, rutin abdominal diseksiyon sırasında çölyak trunkusun dallanma paterninde ve seyrinde görülen nadir bir varyasyon sunulmaktadır. Etkin üst abdominal cerrahi ve radyolojik prosedürler gerçekleştirmek ve karaciğer kanserleri için yeni girişimsel ve tedavi seçeneklerini benimsemek için çölyak trunkusu ve kökenindeki ve dallanma paternindeki farklılıkları anlamak çok önemlidir. Anatomi uzmanları olarak biz de çalışmamızdaki varyasyonları embriyolojik oluşumlarıyla ilişkilendirmeye çalışmaktayız.

OBJECTIVE: The current report describes the combined unusual origin of the left inferior phrenic and left gastric arteries observed during a routine dissection of the upper abdominal region.
BACKGROUND: The branches of the abdominal aorta are important vessels that supply blood to various organs and structures in the abdominal cavity. While there is typically a common pattern of branching, anatomical variations can occur, leading to differences in the branching patterns of the abdominal aorta.
METHODS: An accidental finding in an 80-year-old male cadaver within anatomical dissection was assessed.
RESULTS: We observed that the left inferior phrenic artery originated from the celiac trunk and gives off middle and superior suprarenal arteries, while the left gastric artery arose from the abdominal aorta independently.
CONCLUSIONS: The identification of anatomic vascular abnormalities of the abdominal aorta and its branches is clinically important in surgical and invasive arterial procedures and preoperative knowledge of vascular anomalies should prevent iatrogenic vascular trauma and complications during surgery (Fig. 3, Ref. 14).

Gastric cancer is the most common type of gastrointestinal cancer in China which about 80% of patients are locally advanced or advanced when diagnosed. Surgery along brings high recurrence rate for locally advanced gastric cancer (LAGC), and neoadjuvant therapies are needed. The use of programmed cell death-1 (PD-1)/programmed death-ligand 1 inhibitor nowadays improved the disease-free survival for LAGC, however, only <35% of patients achieved pathologic complete response (pCR) after neoadjuvant therapy nowadays. Therefore, new regimens are needed to be investigated. Gastric artery chemoembolization is applied to metastasis gastric cancer and researches showed interventional therapy can enhance the antitumor effect of PD-1 inhibitor. Here, for the first time, we combined gastric artery chemoembolization with tislelizumab (a PD-1 inhibitor) for neoadjuvant therapy of a patient with LAGC. The patient achieved pCR after a D2 resection and tumor regression grade score was 1. After surgery, the patient received tislelizumab 200 mg per 3 weeks, and showed no sign of recurrence after 6 months of follow-up. The study indicated the use of tislelizumab and gastric artery chemoembolization for neoadjuvant therapy may bring a better pCR rate and prognosis of LAGC.

Left gastric artery embolisation (LGAE) is a well-established treatment for major upper gastrointestinal (GI) bleeding when control is not established via upper GI endoscopy and recently has shown promising results for weight loss in small single arm studies. LGAE could be a treatment option in between our current tier-3 and tier-4 services for obesity. EMBIO is a National Institute for Health Research funded trial, a multicentre double-blinded randomised controlled trial between Imperial College National Health Service Trust and University College London Hospital, comparing LGAE versus Placebo procedure. The key aims of the trial is to evaluate LGAE efficacy on weight loss, its mechanism of action, safety profile and obesity-related comorbidities.
76 participants will be recruited from the existing tier-3 database after providing informed consent. Key inclusion criteria include adults aged 18-70 with a body mass index 35-50 kg/m2 and appropriate anatomy of the left gastric artery and coeliac plexus on CT Angiogram. Key exclusion criteria included previous major abdominal and bariatric surgery, weight >150 kg, type 2 diabetes on any medications other than metformin and the use of weight modifying medications. Participants will undergo mechanistic visits 1 week prior to the intervention and 3, 6 and 12 months postintervention. Informed consent will be received from each participant and they will be randomised in a 1:1 ratio to left gastric artery embolisation and placebo treatment. Blinding strategies include the use of moderate doses of sedation, visual and auditory isolation. All participants will enter a tier-3 weight management programme postintervention. The primary analysis will estimate the difference between the groups in the mean per cent weight loss at 12 months.
This trial shall be conducted in full conformity with the 1964 Declaration of Helsinki and all subsequent revisions. Local research ethics approval was granted by London-Central Research Ethics Committee, (Reference 19/LO/0509) on 11 October 2019. The Medicines and Healthcare products Regulatory Agency (MHRA) issued the Letter of No Objection on 8 April 2022 (Reference CI/2022/0008/GB). The trial\'s development and progress are monitored by an independent trial steering committee and data monitoring and ethics committee. The researchers plan to disseminate results at conferences, in peer- reviewed journals as well as lay media and to patient organisations.
ISRCTN16158402.