Giriş ve Amaç: Mezenterik arteriyel varyasyonlar toplumda oldukça sıktır. Çölyak arter, hepatik arter ve süperior mezenterik arter ile ilgi- li bu varyasyonların majör abdominal cerrahi öncesi bilinmesi oldukça önemlidir. Çalışmamızın amacı abdominal multi dedektör bilgisayarlı tomografi incelemesi yapılan geniş bir hasta popülasyonunda çölyak arter, hepatik arter, süperior mezenterik arter ve inferior mezenterik arter anatomisindeki varyasyonları saptamaktır. Gereç ve Yöntem: Çeşitli nedenlerle abdominal multi dedektör bilgisayarlı tomografi ince- lemesi yapılan toplam 587 hasta geriye dönük olarak değerlendirilmiş ve çölyak arter, hepatik arter, süperior mezenterik arter ve inferior me- zenterik arter varyasyonlarının prevalansı belirlenmiştir. Bulgular: 500 vakanın 443'ünde (%88.6) normal çölyak arter anatomisi ve 57'sinde (%11.4) çölyak arter varyasyonları izlenmiştir. En sık rastlanan çölyak arter varyasyonu hepato-gastrik trunkus olarak belirlenmiştir (%3.8). Çölyak arter anatomisinde izlenen varyasyonlar şu şekildedir (n=57): 19 vakada (%3.8) hepato-gastrik trunkus, 17 vakada (%3.4) gastro-splenik trunkus, 13 vakada (%2.6) hepato-splenik trunkus, 3 vakada (%0.6) gastro-splenik-mezenterik trunkus ve 3 vakada (%0.6) çölyak-mezente- rik trunkus olup, 2 vakada (%0.4) çölyak trunkus izlenmemiş; ikisinde de ana hepatik arterin abdominal aortadan çıktığı görülmüştür. 500 vakanın 364'ünde (%72.8) normal hepatik arter anatomisi ve 136'sında (%27.2) hepatik arter varyasyonları izlenmiştir. En sık rastlanan hepa- tik arter varyasyonu (%8.6), süperior mezenterik arterden kaynaklanan replase sağ hepatik arter varyasyonu olmuştur. 500 vakanın 423'ünde (%84.6) normal süperior mezenterik arter anatomisi ve 77'sinde (%15.4) süperior mezenterik arter varyasyonları izlenmiştir. En sık rast- lanan varyasyon ise 51 vakada (%10.2) saptanan süperior mezenterik arterden kaynaklanan replase sağ hepatik arter varyasyonudur. Çalış- mamızda inferior mezenterik arter varyasyonu saptanmamıştır. Sonuç: Multi dedektör bilgisayarlı tomografik anjiyografi mezenterik vasküler anatomi ve varyasyonların değerlendirilmesinde kullanılacak oldukça güvenilir ve invaziv olmayan bir görüntüleme metodudur.

Background and Aims: Mesenteric arterial variations are frequently observed in the population. Being aware of the variations related to the celiac artery, hepatic artery, and superior mesenteric artery is very important in cases that undergo major abdominal surgery. The aim of this study was to determine the prevalence of variations observed in the anatomy of the celiac artery, hepatic artery, superior mesenteric ar- tery, and inferior mesenteric artery by screening a large patient popula- tion who underwent abdominal multi-detector computed tomography angiography. Materials and Methods: A total of 587 patients who underwent abdominal multi-detector computed tomography angiogra- phy for various reasons were analyzed retrospectively and the prev- alence of the variations observed in the celiac artery, hepatic artery, superior mesenteric artery, and inferior mesenteric artery were deter- mined. Results: A normal anatomy of the celiac artery was determined in 443 of the 500 cases (88.6%), and 57 cases occurred with celiac artery variations (11.4%). The most common celiac artery variation was hepato-gastric trunk (3.8%). Variations in celiac artery anatomy were determined to be as follows (n=57): hepato-gastric trunk in 19 cases (3.8%), gastro-splenic trunk in 17 cases (3.4%), hepato-splenic trunk in 13 cases (2.6%), hepato-splenic-mesenteric trunk in 3 cases (0.6%), and celiac-mesenteric trunk in 3 cases (0.6%). The celiac trunk was not visualized in 2 cases (0.4%); the main hepatic artery originated directly from the abdominal aorta in both of them. We determined that 364 of the 500 cases (72.8%) occurred with normal hepatic artery anatomy and 136 cases had variations (27.2%). The most common hepatic artery variation in our study group was replaced right hepatic artery originating from the superior mesenteric artery (8.6%). We de- termined a normal superior mesenteric artery anatomy in 423 of the total 500 cases (84.6%); 77 cases had superior mesenteric artery vari- ations (15.4%), and the most common variation was a replaced right hepatic artery originating from the superior mesenteric artery in 51 cases (10.2%). We could not detect inferior mesenteric artery variations in our study group. Conclusion: Multi-detector computed tomography angiography is a highly reliable, noninvasive imaging method for the evaluation of mesenteric vascular anatomy and its variations.

Transcatheter aortic valve implantation (TAVI) is more reliable than surgical valve replacement for high-risk or inoperable aortic stenosis patients. In this study, we aimed to investigate the effects of different femoral access methods on the development of vascular complications and contrast-induced nephropathy (CIN) after transfemoral (TF)-TAVI. Patients and Methods: In total, 110 patients (aged 78.9 ± 12.2 years; 55 females) who underwent aortic valve replacement by TF-TAVI between June 2013 and April 2015 were included in the study. CIN was defi ned as an absolute increase in serum creatinine level of > 0.5 mg/dL or a relative increase of > 25% within 48-72 h after TF-TAVI. The patients were classifi ed into two groups according to the femoral access methods: surgical cut-down (SCD) and vascular closure device (VCD) groups. Results: The amount of contrast medium (CM; p< 0.001) and the incidence of CIN (p= 0.038) were higher in the VCD group. Baseline glomerular fi ltration rate (GFR), baseline creatinine, Mehran score and CM were determined as the predictive factors of CIN development. Receiver operating characteristic analysis revealed that CM, which may predict the development of CIN, was determined as 178.5 mL, and GFR, which may predict the development of CIN, was determined as 48.9 mL/dk/1.73 m2 . Conclusion: It may be preferred to perform the femoral arterial procedure using the SCD method instead of VCD in TAVI patients whose GFR is < 48.9; the use of CM may increase due to various reasons