Anatomic variations of the celiac trunk and hepatic arterial system with digital subtraction angiography

Abstract

Background/Aims: Anatomical variation of the abdominal arteries is important. Historic and modern anatomists, radiologists, as well as surgeons have reported and accumulated anatomical variations with a morphological and clinical interest. During graft procurement and reconstruction, accidental injury of the hepatic artery is more likely in the presence of hepatic arterial variation, which can be a common clinical entity. During cadaveric dissection and diagnostic radiological imaging, various types of vascular anomalies are frequently found in human abdominal viscera, especially the celiac trunk. The aim of the present study is to determine anatomical variations in the celiac trunk and hepatic arterial system. Materials and Methods: Digital subtraction angiography data were collected from 152 consecutive donor patients (103 males and 49 females, aged between 6 and 77 years) who underwent orthotopic liver transplantation. Results: We examined the anatomy of the celiac trunk in a total of 152 consecutive patients. In total, 62.5% (95/152) of patients showed the classical trifurcation of the celiac trunk. Variant right hepatic arteries arising from the superior mesenteric artery were observed in 17.8% (27/152), the hepatic arteries arising from the left gastric artery were found in 13.1% (20/152), and common hepatic arteries arising from the superior mesenteric artery were observed in 6.6% (10/152) of patients. Conclusion: These data are useful for planning and performing surgical and radiological procedures of the upper abdomen.

Co-existence of the double inferior vena cava with complex interiliac venous communication and aberrant common hepatic artery arising from superior mesenteric artery: a case report

“…The origin of the CHA from the SMA belonged to type 9 with a prevalence of 2.5%. Later, a modification of Michels' classification scheme into six types or Hiatt's classification was widely used [9,28,37]. The CHA from SMA was classified as type 5 with a prevalence of 1.5%.…”

“…Variation of its origin from the superior mesenteric artery (SMA) has been reported in several articles. The prevalence ranged 0.5-6.6% [1,5,9,17,20,23,28,29,31,33,37]. This variation has an important clinical significance in liver transplantation, abdominal laparoscopy and radiological abdominal intervention [19].…”

Absence of the celiac trunk in a rectal cancer patient: case report

“…Studies have shown that the CT can divide into from two to five or even six different branches in very rare cases; furthermore, all three components branch from the AA independently, so the trunk itself may be absent, described as 'agenesis of celiac trunk'. [3,14,15] The anatomical variations of CT are due to developmental changes in the ventral splanchnic arteries. [15] Anatomical variations of the CT, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA) have a considerable input in the diversity of the abdominal arterial supply and several branching patterns at this level have been described; yet, the most important one is the congenital absence of the CT, where the LGA, SA, and CHA arise directly from the AA.…”

“…[3,14,15] The anatomical variations of CT are due to developmental changes in the ventral splanchnic arteries. [15] Anatomical variations of the CT, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA) have a considerable input in the diversity of the abdominal arterial supply and several branching patterns at this level have been described; yet, the most important one is the congenital absence of the CT, where the LGA, SA, and CHA arise directly from the AA. [12] In 1935, Morita [16] described the first classification system that included an absent CT as a morphological type and the variational pattern of the arteries.…”

“…According to this classification, the present anomalous case belongs to Type 5 (Typus primitivus), a result of the absence or disappearance of the longitudinal anastomotic channels during the embryonic period, and the four ventral splanchnic arteries grew independently. [17] In the article by Zagyapan et al, [15] digital subtraction angiography data were collected from 152 consecutive donor patients who underwent orthopotic liver transplantation; there was no absence of the CT amongst these cases.…”