Clinical anatomy of the inferior phrenic artery

Abstract

The majority of anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic artery (IPA). In the last decade, however, increased numbers of reports have appeared with reference to the arterial supply of hepatocellular carcinoma (HCC). The IPA is a major source of collateral or parasitized arterial supply to this type of carcinoma, second only to the hepatic artery. The aim of this study was to identify the origin and distribution of the IPA (right and left), in normal and pathological cases, and to apply such findings to the clinical scenario of treating hepatic cancer. We have examined 300 formalin-fixed adult cadavers lacking abdominal pathology, and 30 cadavers derived from patients with HCC. Dissections in normal cadavers showed that the right IPA originated from the: a) celiac trunk in 40% of the specimens; b) aorta in 38%; c) renal in 17%; d) left gastric in 3%; and e) hepatic artery proper in 2% of the specimens. The left IPA originated from the: a) celiac trunk in 47%; b) aorta in 45%; c) renal in 5%; d) left gastric in 2%; and e) hepatic artery proper in 1% of the specimens. The IPA gave rise to eight notable branches: ascending, descending, inferior vena cava, superior suprarenal, middle suprarenal, esophageal, diaphragmatic hiatal, and accessory splenic. The right IPA was always associated with HCC and served as the major collateral artery adjunct to the hepatic artery. These findings could have major implications in the transcatheter embolization of HCC patients.

Abdominal Aorta and Its Branches: Morphometry - Variations In Autopsy Cases

“…In a series of 330 cadavers, Loukas et al determined that right and left IPA originated from CT in 40% and 47% of the specimens, respectively (15). We observed in our series that IPA arose from CT as a common trunk in 3 cases (3.1%).…”

Origin of the Celiac and Superior Mesenteric Arteries in a Common Trunk - Description of a Rare Vessel Variation of the Celiacomesenteric Trunk with a Literature Review

“…The 2 arteries can also arise from the aorta or celiac artery as a common trunk 30,31) . The reported incidences of the right inferior phrenic originating from the aorta are 57.90% 32) and 38.00% 33) and from the celiac artery are 42.10% 32) and 40.00% 33) . The origin of the left inferior phrenic artery is from the celiac artery in 47.00% of cases, the aorta in 45.00% of cases, the renal artery in 5.00% of cases, the left gastric artery in 2.00% of cases, and the hepatic artery in 1.00% of cases 33) .…”

“…The reported incidences of the right inferior phrenic originating from the aorta are 57.90% 32) and 38.00% 33) and from the celiac artery are 42.10% 32) and 40.00% 33) . The origin of the left inferior phrenic artery is from the celiac artery in 47.00% of cases, the aorta in 45.00% of cases, the renal artery in 5.00% of cases, the left gastric artery in 2.00% of cases, and the hepatic artery in 1.00% of cases 33) . It has also been reported that the 2 arteries can arise from the left gastric (3.70%), renal (15.7%), hepatic (2.10%), or superior mesenteric (0.30%) arteries 34) .…”

Inferior Phrenic Arteries and Their Branches, Their Anatomy and Possible Clinical Importance: An Experimental Cadaver Study

“…Therefore, both RIPA and LIPA are used during transcatheter arterial chemoembolization of liver malignancies (5-7). Furthermore, LIPA gives branches that supply the stomach and esophagus and can be a source of arterial bleeding at the esophagogastric junction (8)(9)(10)(11)(12).In this study, we aimed to investigate the anatomy of the inferior phrenic arteries -with special reference to the branches of the LIPA -and to outline their clinical importance with anatomical pitfalls which we believe may help interventional radiologists.Background: Transcatheter arterial chemoembolization is a common treatment for patients with inoperable hepatocellular carcinoma. If the carcinoma is advanced or the main arterial supply, the hepatic artery, is occluded, extrahepatic collateral arteries may develop.…”

“…Therefore, both RIPA and LIPA are used during transcatheter arterial chemoembolization of liver malignancies (5-7). Furthermore, LIPA gives branches that supply the stomach and esophagus and can be a source of arterial bleeding at the esophagogastric junction (8)(9)(10)(11)(12).…”