Accessory Left Gastric Artery Arising from Inferior Phrenic Artery: Angiographic Findings in 5 Patients

2019 ◽  
Vol 30 (10) ◽  
pp. 1687-1689
Author(s):  
Gabriel Heymann ◽  
David S. Shin ◽  
Guy E. Johnson
Keyword(s):  
Left Gastric Artery ◽  
Gastric Artery ◽  
Inferior Phrenic Artery ◽  
Phrenic Artery ◽  
Angiographic Findings

Analysis of the origin of the right inferior phrenic artery in 178 patients with hepatocellular carcinoma treated by chemoembolization via the right inferior phrenic artery

2007 ◽  
Vol 48 (7) ◽  
pp. 728-733 ◽  
Author(s):  
S. Kimura ◽  
M. Okazaki ◽  
H. Higashihara ◽  
Y. Nozaki ◽  
M. Haruno ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Left Gastric Artery ◽  
Celiac Artery ◽  
Gastric Artery ◽  
Inferior Phrenic Artery ◽  
Pancreatic Artery ◽  
Phrenic Artery ◽  
The Right ◽  
Angiographic Findings ◽  
Arterial Chemoembolization

Background: No previous report has described the level of the origin of the right inferior phrenic artery (RIPA) based on an analysis of the relationships between the level of the RIPA, the celiac artery (CA), the superior mesenteric artery (SMA), and the right renal artery (RRA) in a series of cases. Purpose: To evaluate the origin of the RIPA by retrospectively analyzing angiographic findings in 178 patients with hepatocellular carcinoma (HCC) who underwent transcatheter arterial chemoembolization (TACE) via the RIPA. Material and Methods: In patients treated with intraarterial chemoembolization for HCC, additional superselective chemoembolization of the RIPA branches was necessary in 178 cases. We analyzed the level of the origin of the RIPA in these patients according to the relationships between the level of the origin of the RIPA, the CA, the SMA, and the RRA on angiography. Results: Among the 178 cases, the RIPA arose from 1) the aorta directly in 102 cases (57%), 2) the CA in 53 (30%), 3) the left gastric artery (LGA) in three (2%), 4) the dorsal pancreatic artery (DPA) in one (1%), and 5) the RRA in 19 (11%). The level of the origin of the RIPA that originated directly from the aorta was supraceliac in 56 cases (32%), between the CA and the SMA in 31 (17%), and between the SMA and the RRA in 15 (8%). Conclusion: In our study, the RIPA originated from the aorta between the CA and the SMA directly in 17% of cases. When it is difficult to identify the origin of the RIPA, we must keep in mind that the RIPA may originate from the right part of the aorta within the small distance between the SMA and the CA.

scholarly journals Rare Anatomic Variation: The Hepatosplenomesentericophrenic Trunk

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 170
Author(s):  
Bogdan Gheorghe Hogea ◽  
Mugurel Constantin Rusu ◽  
Adelina Maria Jianu ◽  
Bogdan Adrian Manta ◽  
Adrian Cosmin Ilie
Keyword(s):  
Anatomic Variation ◽  
Celiac Trunk ◽  
Left Gastric Artery ◽  
Gastric Artery ◽  
Inferior Phrenic Artery ◽  
Phrenic Artery ◽  
Anatomic Variants ◽  
The Right ◽  
Rare Anatomic Variant ◽  
Anatomic Feature

The rare anatomic variants of the celiac trunk and superior mesenteric artery include the hepatosplenic, hepatosplenomesenteric (HSMT), celiacomesenteric, hepatomesenteric and gastrosplenic trunks. We report a 72-year-old female patient whose computed tomography angiograms indicated a rare anatomic feature whereby the right inferior phrenic artery was inserted in the origin of an HSMT, thus modifying it into a hepatosplenomesentericophrenic trunk (HSMPT). Above the HSMPT, the insertion of the left inferior phrenic artery in the origin of the left gastric artery determined a left gastrophrenic trunk (GPT). Proper identification of this type of rare anatomic variant is of utmost importance prior to different surgical procedures. For example, an HSMT origin of the right inferior phrenic artery is surgically relevant if this artery is an extrinsic pedicle of a hepatocellular carcinoma and is used for embolization of the tumor.

scholarly journals Unraveling Variations in Celiac Trunk and Hepatic Artery by CT Angiography to Aid in Surgeries of Upper Abdominal Region

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2262
Author(s):  
Kapil Kumar Malviya ◽  
Ashish Verma ◽  
Amit Kumar Nayak ◽  
Anand Mishra ◽  
Raghunath Shahaji More
Keyword(s):  
Superior Mesenteric Artery ◽  
Hepatic Artery ◽  
Mesenteric Artery ◽  
Celiac Trunk ◽  
Left Gastric Artery ◽  
Gastric Artery ◽  
Inferior Phrenic Artery ◽  
Abdominal Region ◽  
Phrenic Artery ◽  
Upper Abdominal

Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region.

Transarterial embolisation for gastroduodenal bleeding following endoscopic resection

2021 ◽  
pp. 20210062
Author(s):  
Suyoung Park ◽  
Boryeong Jeong ◽  
Ji Hoon Shin ◽  
Eun Ho Jang ◽  
Jung Han Hwang ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Clinical Success ◽  
Vital Signs ◽  
Left Gastric Artery ◽  
Gelatin Sponge ◽  
Success Rates ◽  
Gastric Artery ◽  
Delayed Bleeding ◽  
Transcatheter Arterial Embolisation ◽  
Angiographic Findings

Objectives: Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. Methods: Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed. Results: Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1–30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. Conclusions: TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures. Advances in knowledge: This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.

scholarly journals The origin of the inferior phrenic artery: a study in 32 South Indian cadavers with a review of the literature

2007 ◽  
Vol 6 (3) ◽  
pp. 225-230 ◽  
Author(s):  
Thejodhar Pulakunta ◽  
Bhagath Kumar Potu ◽  
Vasavi Rakesh Gorantla ◽  
Muddanna S. Rao ◽  
Sampath Madhyastha ◽  
...  
Keyword(s):  
Additional Data ◽  
Gross Anatomy ◽  
Celiac Trunk ◽  
Left Gastric Artery ◽  
Celiac Artery ◽  
Inferior Phrenic Artery ◽  
Medical College ◽  
South Indian ◽  
Phrenic Artery ◽  
The Right

BACKGROUND: Considering the paucity of information presently available concerning inferior phrenic arteries, a more definitive study seemed appropriate and necessary, both for its potential clinical applications and to provide additional data to contemporary anatomical literature. OBJECTIVE: Most anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic artery (IPA). For that reason, the origin of the IPA has been studied and the available literature has been reviewed. METHODS: Thirty-two human adult cadavers preserved in formalin obtained from the departments of Anatomy, Kasturba Medical College, Manipal and Mangalore were dissected and the origin of the IPA was studied. RESULTS: The IPA had its usual origin from the abdominal aorta in 28 cases but in the remaining four cases, two were arising from the celiac trunk, one from the left gastric artery and one from the right renal artery. CONCLUSION: The IPA usually originates from the aorta or celiac artery, and less frequently from the renal, hepatic or left gastric arteries. The IPA is a major source of collateral or parasitized arterial supply to hepatocellular carcinoma, second only to the hepatic artery. Literature on the IPA origin and clinical implications of variation in its origin have been reviewed in this article.

scholarly journals A Study of Anatomical Pattern of Inferior Phrenic Artery using Multidetector CT

2021 ◽  
Author(s):  
Anil Kumar Singh ◽  
Archna Gupta ◽  
Zafar Neyaz ◽  
Prabhakar Mishra
Keyword(s):  
Ct Angiography ◽  
Multidetector Ct ◽  
Uttar Pradesh ◽  
Celiac Trunk ◽  
Left Gastric Artery ◽  
Cross Sectional Study ◽  
Arterial Phase ◽  
Cross Sectional ◽  
Inferior Phrenic Artery ◽  
Phrenic Artery

Introduction: Inferior Phrenic Artery (IPA), though a small artery, is important from several points of view. Apart from being arterial supply to normal structures, it is also involved in many pathological conditions such as tumours, haemoptysis, gastroesophageal bleeding and traumatic conditions where interventional radiology or surgery play an important role in management. A preprocedure idea about variations in its anatomical pattern may help better treatment planning and minimise morbidity. Aim: To study variations in anatomical pattern of IPA in terms of vessel of origin, vertebral level of origin and diameter of IPA using Multidetector Computed Tomography (MDCT). Materials and Methods: The present study was a cross-sectional study conducted in Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. A retrospective analysis of CT angiography or Triple phase CT abdomen studies of 200 adult patients (M:F 119:81) performed during December 2020 to April 2021 was done to look for anatomical pattern variations in IPA. Vessel of origin and level of origin were recorded. Diameters of IPAs were also recorded and statistical analysis was done. Results: Common Inferior Phrenic Artery (CIPA) was seen in 23% cases, with independent Right and Left Inferior Phrenic artery (RIPA and LIPA) in remaining 77%. Vessels of origin for CIPA were aorta (n=27; 58.7%), celiac trunk (n=16; 34.8%) and right Main Renal Artery (right MRA) (n=3; 6.5%); for RIPA, celiac trunk (n=69; 44.8%), aorta (n=57; 37.01%), right MRA (n=23;14.94%), Left Gastric Artery (LGA) (n=5; 3.25%), and for LIPA, celiac trunk (n=97; 63%), aorta (n=53; 34.4%), left MRA (n=2; 1.3%) and LGA (n=2; 1.3%), respectively. Level of origin from aorta for RIPA was L1>T12>T12/L1 disc>others; LIPA, T12>T12/L1>L1>others; celiac trunk, T12>L1>T12/L1 disc>others. Mean diameters of apparently normal RIPA and LIPA were 1.75 mm and 1.76 mm, respectively. Conclusion: The most common vessels of origin for CIPA, RIPA and LIPA were abdominal aorta (58.7%), celiac trunk (44.8%) and celiac trunk (63%), respectively. The predominant vertebral levels of origin for CIPA, RIPA and LIPA arising from aorta were T12, L1, and T12 respectively, and for celiac trunk T12. The mean diameter of IPA was found to be greatest in cirrhotic group followed by chronic pancreatitis and apparently normal IPA group, but not statistically significant. These can be efficiently and readily demonstrated by CT angiography or arterial phase of multiphasic CT study.

Transcatheter Chemoembolization of a Hepatocellular Carcinoma Utilizing Lipiodol through the Pancreaticoduodenal Arcade: A Case Report

2018 ◽  
Vol 2 ◽  
pp. 5
Author(s):  
Scott P Patterson ◽  
Richard G Foster
Keyword(s):  
Hepatocellular Carcinoma ◽  
Case Report ◽  
Vascular Anatomy ◽  
Left Gastric Artery ◽  
Target Lesion ◽  
Celiac Artery ◽  
Small Hepatocellular Carcinoma ◽  
Gastric Artery ◽  
Variant Anatomy ◽  
Pancreaticoduodenal Arcade

This case report describes the chemoembolization of a small hepatocellular carcinoma employing a lipiodol drug delivery system utilizing a novel arterial pathway. Because the target lesion was precariously located adjacent to the inferior heart border and the diaphragm, it was unsuitable for imaging-guided microwave ablation. To achieve chemoembolization, several intraprocedural adaptations were necessary, given the variant anatomy encountered and difficulty accessing the left gastric artery through a celiac artery approach. The left gastric artery was selected from a superior mesenteric artery approach through the pancreaticoduodenal arcade (Rio Branco’s arcade). This case illustrates the importance of a mastery of the vascular anatomy and variants of hepatic arterial flow.

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