Vascular Surgery — MCQs

Q: Among the following arteries, which is dissected most frequently during angiography performed via the femoral route?

Celiac trunk. ***Celiac trunk*** - The **celiac trunk** is the **most frequently dissected artery** during femoral route angiography due to its **challenging anatomical characteristics**. - It arises at a **steep downward angle** (typically 45-90°) from the anterior aorta, requiring significant **catheter manipulation and torque** to engage the orifice. - The acute angulation increases the risk of **subintimal catheter passage** during selective cannulation attempts, leading to iatrogenic dissection. - The need for **repeated attempts** and catheter repositioning when engaging the celiac trunk further elevates dissection risk. *Superior mesenteric artery* - While the **SMA** is frequently cannulated during abdominal angiography, it has a **more favorable anatomy** for catheter engagement. - Its **less acute angle** of origin (typically 30-45° caudally) and more anterior takeoff make it **easier to cannulate** with less manipulation. - Easier cannulation translates to **lower dissection risk** compared to the celiac trunk, despite being commonly studied. *Inferior mesenteric artery* - The **IMA** is a smaller vessel with lower flow, originating from the lower abdominal aorta. - It is **less frequently cannulated** in routine angiography due to its small caliber and distal location. - Lower frequency of selective cannulation means fewer opportunities for dissection. *Gastroduodenal artery* - The **GDA** is a **secondary branch** arising from the hepatic artery (itself a celiac trunk branch). - Due to its **distal location** and smaller size, selective GDA catheterization is uncommon in routine angiography. - Its infrequent selective cannulation makes dissection during femoral angiography extremely rare.

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