Dm than tang

http://findarticles.com/p/articles/mi_m5EOM/is_2_25/ai_n30962009/

Anatomy and variations of the celiac trunk/Anatomia y variaciones del tronco celiacoInternational Journal of Morphology, June, 2007 by Selma Petrella, Celio Fernando de Sousa Rodriguez, Emerson Alexandre Sgrott, Geraldo Jose Medeiros Fernandes, Sergio Ricardo Marques, Jose Carlos Prates

1 2 3 4 5 6 7 8 9 10

http://findarticles.com/p/articles/mi_m5EOM/

http://findarticles.com/p/articles/mi_m5EOM/is_2_25/ai_n30962009/pg_10/










http://findarticles.com/p/search/?qa=Jose%20Carlos%20Prates


http://findarticles.com/p/search/?qa=Sergio%20Ricardo%20Marques

http://findarticles.com/p/search/?qa=Geraldo%20Jose%20Medeiros%20Fernandes


http://findarticles.com/p/search/?qa=Emerson%20Alexandre%20Sgrott


http://findarticles.com/p/search/?qa=Celio%20Fernando%20de%20Sousa%20Rodriguez


http://findarticles.com/p/search/?qa=Selma%20Petrella

http://findarticles.com/p/articles/mi_m5EOM/is_2_25/

Next

SUMMARY: The aim of this study was to analyze anatomy of theceliac trunk through its diameter, length, emission and variation of its branches. Sixty-nine cadavers fixed in 10% formalin solution were dissected in the anatomy laboratoriesof the Federal University of Sao Paulo (UNIFESP/EPM), Lusiadas of Santos University (UNILUS) and Santo Amaro University (UNISA) and 20 non-fixed cadavers from Death Verification Services, of the Sao Paulo University (USP) andFederal University of Sao Paulo (UNIFESP/EPM). Dissection ofthe trunk celiac of these cadavers was performed after opening of the peritoneal cavity. The obtained results allowed us to conclude the following: 1) Mensuration of the length from the celiac trunk up to its first branch, the left gastric and/or splenic artery in 81 cadavers with a mean length of 1.23 cm in males, and 1.18 cm in females. We verified as the first branch of the celiac trunk, the left gastric artery in 55 (67.90%), splenic artery in two (2.47%), both in six (7.41%), and in 18 (22.22%) the three arteries trifurcating at the same level, forming the Haller's tripod. 2) Mensuration of the length from the celiac trunk up to its last artery, the common hepatic and/or splenic artery in 68 cadavers, with a mean length of 1.74 cm in males, 1.74 cm in females. We verified as the last branch of the celiac trunk, the common hepatic artery in 13 (19.12%), the splenic in four (5.88%), both in 33 (48.53%) and 18 (22.22%) the three arteries trifurcating at the same level. 3) Mensuration of the celiac trunk diameter in 77 cadavers had a mean of 0.65 cm in males and 0.67 cm females. 4) Mensuration of the distance between the celiac trunk and superior mesenteric artery in 76 cadavers had a mean of 0.72 cm in males and 0.74 cm in females. 5) The celiac trunk emitted in 73 (82.02%) out of the 89 cadavers the left gastric, splenic and hepatic arteries. In the remaining 16 (17.98%) variations regarding the number of emitted arteries and their disposition in the celiac trunk were observed. The trunk celiac emitted besides the three arteries, a gastroduodenal artery in six (6.74%),


gastroduodenocolic trunk in one accessory hepatic artery in only two (2.25%). We also verified in three (3.37%) cadavers, one (1.12%) gastrosplenic trunk, in two (2.25%) one hepatosplenic trunk, in one (1.12%) the common hepatic as the only branch and in one (1.12%) absence of the celiac trunk.

Most RecentHealth Care Articles

Doctor Shortage Is Worsening, Say Hospital CEOs Interest Groups Redouble Fight on Healthcare Reform Kerry Bill Would Help Physicians Borrow Money For EHRs Provider Cost Reports Have Little Impact on Consumer

Choice Hospital Mergers Are A Major Health Cost Driver More »

KEY WORDS: Anatomy; Celiac trunk; Anatomical variations.

RESUMEN: El objetivo de este estudio fue analizar la anatomia del tronco celiaco a traves de sus diametro, longitud, origen y variacion de sus ramos. Fueron disecados 69 cadaveres fijados en formalina al 10% en los LaboratoriosAnatomia de la Universidad Federal de Sao Paulo (UNIFESP/EPM), Universidad Lusiadas de Santos y Universidad Santo Amaro (UNISA), Brasil y 20 cadaveres del Servicio de Verificacion de Obitos de la Universidad Sao Paulo (USP) y de la Universidad Federal de Sao Paulo (UNIFESP/EPM), Brasil. Las disecciones de la region del tronco celiaco fueron realizadas despues de hacerlo con la cavidad peritoneal. Los resultados obtenidos permitieron llegar a las siguientes conclusiones: 1) La longitud media del troncoceliaco hasta su primera rama, la arteria gastrica izquierday/o esplenica en 81 cadaveres fue de 1,23 cm en el sexo masculino y 1,18 cm en el femenino. Verificamos como primer ramo del tronco celiaco, la arteria gastrica izquierda en 55(67,90%), arteria esplenica en dos (2.47%), ambas en seis (7,41%), y en 18 (22,22%), las tres arterias trifurcandose en la misma altura formando el triple de Haller. 2) La medida de la longitud del tronco celiaco hasta su ultimo

http://industry.bnet.com/healthcare/

http://industry.bnet.com/healthcare/10001384/hospital-mergers-are-a-major-health-cost-driver/?tag=fa.ind5

http://industry.bnet.com/healthcare/10001386/provider-cost-reports-have-little-impact-on-consumer-choice/?tag=fa.ind4


http://industry.bnet.com/healthcare/10001389/kerry-bill-would-help-physicians-borrow-money-for-ehrs/?tag=fa.ind3

http://industry.bnet.com/healthcare/10001391/interest-groups-redouble-fight-on-healthcare-reform/?tag=fa.ind2

http://industry.bnet.com/healthcare/10001396/doctor-shortage-is-worsening-say-hospital-ceos/?tag=fa.ind1

ramo, la arteria hepatica comun y/o esplenica en 68 cadaveres, tuvo una longitud media de 1,74 cm en el sexo masculino y 1,74 cm en el femenino. Verificamos como ultimo ramo del tronco celiaco, la arteria hepatica comun en 13 (19,12%), la arteria esplenica en cuatro (5.88%), ambas en 33 (48,53%) y en 18 (22,22%), las tres arterias trifurcandose en la misma altura. 3) La medida del diametro del tronco celiaco en 77 cadaveres tuvo una mediana de 0.65 cm en el sexo masculino y 0,67 cm en el femenino. 4) La medida de la distancia entre el tronco celiaco y la arteria mesenterica superior en 76 cadaveres, tuvo una mediana de 0,72 cm en el sexo masculino y 0,74 cm en el femenino. 5) Eltronco celiaco emitio las arterias gastrica izquierda, esplenica y hepatica en 73 (82,02%) de los 89 cadaveres. En los otros 16 (17,98%) observamos variaciones en cuanto al numero de arterias emitidas y a la disposicion de estas en el tronco celiaco. Este emitio, ademas de sus tres arterias,una arteria gastroduodenal en seis (6,74%), un tronco gastroduodenocolico en uno (1,12%), una arteria hepatica accesoria en dos (2,25%). Tambien verificamos en tres (3,37%) un tronco gastroesplenico, en dos (2,5%) un tronco hepatoesplenico, en uno (1,12%) la arteria hepatica comun como unico ramo y en uno (1,12%) la ausencia del tronco celiaco.

Anatomy and variations of the celiac trunk/Anatomia y variaciones del tronco celiacoInternational Journal of Morphology, June, 2007 by Selma Petrella, Celio Fernando de Sousa Rodriguez, Emerson Alexandre Sgrott, Geraldo Jose Medeiros









Fernandes, Sergio Ricardo Marques, Jose Carlos Prates

Previous 1 2 3 4 5 6 7 8 9 10 Next

PALABRAS CLAVE: Anatomia; Trono celiaco; Variaciones anatomicas.

INTRODUCTION




The celiac trunk is the first visceral collateral branch of the abdominal part of aorta, originating at its anterior contour just below the aortic hiatus of diaphragm. It has been referred as a short and calibrous trunk, ranging from 5to 40mm in length and a mean of 10 to 25 mm (Rio Branco, 1912); 1 to 2 cm (Tandler, 1929); up to 12 mm (Orts-Llorca, 1944); 8 to 40 mm (Michels, 1951); 10 mm (Fumagalli & Cavallotti, 1983); 10 to 15 mm (Latarjet & Ruiz-Liard, 1989)
























and diameter ranging from 4 to 10 mm (Rio Branco); 3 to 12mm(Michels, 1951); 10 to 12 mm (Pignataro, 1969); 7 mm (Fumagalli & Cavallotti); 6 mm on average (Latarjet & Ruiz-Liard). It is situated between the T12-L1 vertebrae (Lipshutz, 1917; George, 1934; Anson & McVay, 1936); Cauldwell & Anson, 1943; Riva, 1967; Warter et al., 1970; Stanley & Fry, 1971; Furnemont, 1974; Warter et al., 1976) with no direct relationship with fibrous ring of the aortic hiatus, whose free anterior margin usually crosses the aortajust above the celiac trunk at the level of the T11-T12 vertebrae (Reuter, 1971; Warter et al.) or the T 12-L1 vertebrae (Stoney & Wylie, 1966). The most frequent origin of the celiac trunk is at the third superior level of the L1vertebra (George; Anson & McVay; Cauldwell & Anson) and 20% of the cases they originated higher at the T12 vertebra above the arcuate ligament (George; Cauldwell & Anson).

After a trajectory of 1.0 cm or 1.5 cm and displaying in front and above the superior margin of the pancreas, the celiac trunk is divided into two branches: one right, the hepatic artery and one at the left side, the splenic or lineal artery. Just before this division, in general its superior part, the left gastric artery is originated (Pignataro).

MATERIAL AND METHOD

Eighty nine cadavers were analyzed and came from the following Institutions: Death Verification Service of the Federal University of Sao Paulo (UNIFESP/EPM) and from the city of Sao Paulo at the Medical Faculty of Sao Paulo University (USP) and Anatomy Laboratories at the Federal University of Sao Paulo (UNIFESP/EPM), Medical Sciences Faculty of the Lusiadas University of Santos (UNILUS) and Santo Amaro University (UNISA).

Sixty-nine cadavers fixed in 10% formalin solution were dissected. Ages ranged from 21 to 82 years, of which 60 weremales and nine females. They were from the Anatomy Laboratories of the Federal University of Sao Paulo, Medical

Sciences Faculty of the Lusiadas University of Santos and Santo Amaro University.

Dissection of the celiac trunk of these cadavers was performed after opening of the peritoneal cavity during the classes of the graduation course.

Also, 20 non -fixed cadavers maintained in a frigorific chamber, of which 12 males and eight females, with ages ranging from 34 to 88 years were dissected during necropsiesat the Death Verification Service of the city of Sao Paulo, in the Medical Faculty of Sao Paulo University (USP) and in the Federal University of Sao Paulo (UNIFESP/EPM).


Previous 1 2 3 4 5 6 7 8






















9 10 Next

To dissect the celiac trunk and the superior mesenteric artery in the fixed cadavers, the pancreas was removed or had its body sectioned or divided with the aid of a scissor.In non-fixed cadavers, the celiac trunk and the superior mesenteric artery were reached by the omentum, opening the flaccid part of the lesser omentum. Ganglions and the nervous tissue of the celiac plexus, involving the initial segment of the mentioned vessels (celiac trunk and superior mesenteric artery), were withdrawn with the aid of a pincer and scissor to allow observing disposition of these arteriesfrom their origins.

To obtain measures proposed in this study, a digital pakimeter of Mitutoyo Corporation was used.




All preparations were photographed to illustrate the resultsof the present study.

Due to technical difficulties, the overall number of dissected cadavers, that is 89, could not be maintained for all the studied variables (length and diameter of the celiactrunk, distance between celiac trunk and the superior mesenteric artery).

The length of the celiac trunk was measured in 81 cadavers, from its origin up to emission of the first artery, the left











gastric and/or splenic artery and, also until emission of its last artery, the common hepatic and/or splenic in 68 cadavers. The diameter of the celiac trunk was measured in the first centimeter near its origin in 77 cadavers.

The left gastric artery, as the first branch of the celiac trunk, was observed in 55 (67.90%) out of the 81 cadavers (Fig.1). The origin of both arteries, the left gastric and splenic bifurcating as first branches was noted in six (7.41%) cadavers. In two (2.47%) the splenic artery was observed as the first branch.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

Eighteen (22.22%) cadavers with the celiac trunk presenting their three arteries trifurcating at the same level, formingthe Haller's tripod (Fig.2), were also included in this analysis.




Mensuration of the length from celiac trunk up to common hepatic and/or splenic artery. This length in male sex had amean of 1.74 cm, with minimum length of 0.35 cm and maximum 4.0 cm. In female cadavers, the mean length was 1.74 cm, theminimum 0.82 cm and maximum 2.58 cm.

The common hepatic artery was present in 13 (19.12%) cadavers as the last artery, the splenic artery in 4 (5.88%)








and both arteries at the same level, as terminal branches (Fig.1), in 33 (48.53%) out of the 68 studied cadavers.

Measures of length of the 18 (26.47%) cadavers presenting the Haller's tripod were included in this statistics.

Statistical treatment did not show statistically significantdifferences between sexes.


Previous 1 2 3 4 5 6 7 8 9 10 Next

[FIGURE 5 OMITTED]

























In three (3.37%) cadavers, a gastrosplenic trunk with the common hepatic artery, originating at the superior mesenteric artery was observed (Fig.6), in two (2.25%), a hepatosplenic trunk and the left gastric artery independently originating at the aorta (Fig.7) and in one (1.12%) the common hepatic artery originating at the celiac trunk and the left gastric and splenic arteries originating separated at the aorta. In one (1.12%) cadaver absence of the celiac trunk was observed and the left gastric, splenic and hepatic arteries were emitted separated by the aorta (Fig. 8).

[FIGURE 6 OMITTED]

[FIGURE 7 OMITTED]

[FIGURE 8 OMITTED]




DISCUSSION

As previously observed, due to technical difficulties it wasnot possible to maintain the same number of samples in all the tables.

In six (7.89%) out of the 76 cadavers, a common celiacomesenteric ostium was found. This percentage was greater than that found by Michels (1951) who reported three(1%) out of 400 dissections. However, the occurrence of a common celiacomesenteric trunk, as referred by Lipshutz;








Anson & McVay; Mincev & Baldzijski (1971) was not found in this study.

It was observed that the distance between the celiac trunk and the superior mesenteric artery, in 76 cadavers, ranged from 0.10 to 1.80 cm with a mean of 0.73 cm, differing from the findings of some authors who obtained the following measures: 1 to 11 mm with a mean of 3.88 mm in 140 cadavers (Brunet et al., 1993); 0.5 to 3.1 cm, with a mean of 1.6 cm in 38 (George); 1.0 to 2.0 cm in 70 (Anson & McVay) and a mean of 1.3 cm (Cauldwell & Anson) and in accordance with Michels (1951, 1953a,b) who reported a distance from 1 to 22mm in 200 cadavers.

The celiac trunk, according to the literature, was describedby von Haller (1803) apud Rio Branco as a trunk trifurcatingat its termination into left gastric, splenic and common hepatic arteries.

The Haller's tripod was verified in 20.22% of the 89 cadavers dissected in the present study (Fig. 2). These results are similar to the percentages of 24 up to 25% foundby Eaton (1917); Lipshutz and Michels (1953a,b) and that 33%found by Rio Branco.

Regarding the length of the Haller's tripod we obtained a mean of 1.62 cm, minimum 1.0 and maximum 2.09 cm. These results are in accordance with that of Rio Branco, who mentioned a length of up to 20 mm and Tandler, who reported 1 to 2 cm. These results differ from those found by Fumagalli & Cavallotti who mentioned 10 mm.

The classic celiac trunk that originated the three arteries (left gastric, splenic and hepatic) is also denominated complete hepatolienogastric trunk (Michels, 1951, 1953a,b). The observation of this type of normal celiac trunk found in65% out of 200 dissections carried out by Michels (1953a,b),and in 75% out of the 83 dissections performed by Lipshutz, allowed us to consider that 82.02% out of the 82 cadavers of

this study are similar to that found by Lipshutz and differ from those of Michels (1953a).

The most frequent type of celiac trunk is that originating the left gastric artery as a collateral branch before the bifurcation into hepatic and splenic artery (Eaton; Pignataro; Latarjet & Ruiz Liard).


Previous 1 2 3 4 5 6 7 8 9 10 Next

The left gastric artery, as first branch of the celiac trunkwas found in 67.90% of the cadavers analyzed in this study,

























which is in agreement with the 62.10% of Eaton and with 66.67% of Rio Branco. Lipshutz verified the splenic artery as first branch of the celiac trunk in 2.41%, and our results are in accordance with this percentage.

We consider the length of the celiac trunk from its origin up to bifurcation into the hepatic and/or splenic artery, which is in accordance with Pignatario and Rio Branco).




The length from the celiac trunk up to the splenic and/or hepatic artery ranged from 0.35 to 4.0 cm. These results arein agreement with that of the Rio Branco who reported a length from 5 to 40 mm and Michels (1951), who observed 8 to40 mm and differ from that of Orts Llorca, who found up to 12 mm, that of Latarjet & Ruiz- Liard, who observed 10 to 15mm. Also, in our study, the celiac trunk did not reach a length of 4.5 cm, as observed by Yuksel & Sargon (1992).

An explanation for length variations of the celiac trunk found in the literature was conjectured by Rio Branco and correlated with the celiac trunk division process. The celiac trunk with 20 mm or more would emit as terminal branches the hepatic and splenic arteries and as collateral branch the left gastric artery, while in those with less than 20 mm, the three branches would originate at the same level. Our results are in accordance with Rio Branco's hypothesis when we observed a Haller's tripod with 2.0 cm ormore, in only four (22.22%) out of the 18 cadavers. In the 43 cadavers with hepatic and splenic arteries ending at the apex of the celiac trunk and the left gastric as collateral,








only 12 (27.91%) had more than 2.0 cm in length, differing from Rio Branco's assumption.

In our studies, the mean diameter of the celiac trunk was 0.66 cm, minimum 0.40 cm and maximum 0.95 cm, similar to that of Rio Branco, who observed variations from 4 to 10 mm;Michels (1951) from 3 to 12 mm; Pignataro from 10 to 12 mm; Fumagalli & Cavallotti, 7 mm; Latarjet & Ruiz Liard a mean of 6 mm.

In the present study, other variations of the celiac trunk were verified. There is a great variation in origin of all visceral branches (Stoney & Wylie).

Out of the 89 dissected cadavers, 16 (17.98%) variations were observed. Among those, six (6.74%) celiac trunks, emitting as fourth branch a gastroduodenal artery (Fig. 3). Our results differ from that of Lipshutz), who observed a gastroduodenal artery originating in the celiac trunk in three (3.61%) out of the 83 cadavers and that from Michels (1953a,b), who found five (2.5%) in 200 dissections with thegastroduodenal artery originating in the celiac trunk or in the superior mesenteric artery without specifying the numberof origins of each artery.

The emission of the right hepatic artery as the fourth branch of the celiac trunk was angiographically demonstratedby Lamarque et al. in three (2%) out of the 143 observed cases. Also, Rio Branco reported one (2%) in 50 cases. A right accessory hepatic artery (Fig. 5) was observed by us in two (2.25%) out of the 89 cadavers, which is in accordance with the percentage mentioned by the addressed authors.

An observation of a gastroduodenocolic trunk (Fig 4), as we have decided to denominate it in one (1.12%) cadaver, is notmentioned in the literature, both in the treatise and specific studies on this subject. This common trunk gave origin to the middle colic and gastroduodenal.

The official anatomic terminology did not register a name todesignate the gastroduodenocolic trunk when it appears.

Rio Branco reported that the gastrosplenic trunk occurred in4% of the cadavers. Other authors observed, by a computerized tomography in 100 patients, the common hepatic originating in the superior mesenteric artery in 3% of the patients (Sponza et al., 1993). Also, was analyzed in 107 angiographs, four (3.74%) (Mincev & Baldzijski). Our resultsrevealed three (3.37%) in 89 cadavers (Fig. 6) in accordancewith the findings of the above mentioned authors. However, our results differ from the Michel's results (1951) that found three (1.5%) in 200 cadavers.




The hepatosplenic trunk variety was concluded by Rio Branco occurring in 5% of the cases. Similarly, Michels (1953) observed 3.5 % in 200 dissections, and Mincev & Baldzijski found 2% in 107 angiographs. The observation of this variation in two (2.25%) out of the 89 cadavers in the present study (Fig. 7) led us to agree with the above mentioned authors and to disagree with Lipshutz (1917), who reported this variation in 15% out of the 83 dissections.

We are in accordance with Rio Branco when he mentioned that in the hepatosplenic variation, the gastric left artery originates in the aorta just below the celiac trunk.

Olvier et al. (1970) observed a gastrosplenic trunk and the hepatic artery originating as separated branch from aorta,








being the three arteries compressed by the median arcuate ligament. In this study no similar cases could be observed.

On the other hand, in one cadaver (1.12%) the celiac trunk emitting the common hepatic artery and the left gastric and splenic arteries with independent origins in the aorta were observed by us. No similar case was observed in the researched literature.

In the literature there are rare cases of absence of celiac trunk (Yamaki et al., 1995). According to Rio Branco this variation was observed in 0.8% out of the 50 dissections. Intrasurgically, one case was observed (Morettin et al., 1995). Our results are in accordance with the literature since we could demonstrate the absence of the celiac trunk in only one case (1.12%) (Fig. 8).

Yamaki et al. observed in one case, a left gastric artery originating in the aorta anterior wall, bellow the inferior left phrenic artery, the splenic artery originating in the left side of the anterolateral wall of the aorta, 4 mm distal to the left gastric artery and the common hepatic in the right side of it, approximately 10.5 mm distal to the left gastric artery and the superior mesenteric artery at 10.4 mm distal to the common hepatic artery.

Similarly to Yamaki et al., we found one left gastric arteryoriginating in the anterior wall of aorta, the splenic artery and the common hepatic artery with proximal origins in the median portion of the aorta, approximately 0.6 cm distal from the left gastric artery and the superior mesenteric artery originating in the anterior wall of aorta at 0.75 cm of the common hepatic artery and splenic artery (Fig. 8).

Our findings are not in accordance with Augustiniak (1965), who verified in one case of absence of celiac trunk, the inferior phrenics and left gastric artery originating in thesplenic and the common hepatic in the superior mesenteric artery.

We may emphasize that authors like Michels (1951; 1953a,b) and Rio Branco found one dorsal pancreatic artery and one middle colic artery originating in the celiac trunk, this fact not found by us.

Received: 23-01-2007 Accepted: 04-03-2007

REFERENCES

Anson, B. J. & McVay, C. B. The topographical positions and the mutual relations of the visceral branches of the abdominal aorta. A study of 100 consecutive cadavers. Anat. Rec., 67: 7-15, 1936.




Augustyniak, E. A rare case of absence of the celiac artery.Folia Morphol., 24: 411-2, 1965.

Brunet, C.; Moutardier, V. & Di Marino, V. La region dite du"bouton coelio-mesenterique", etude anatomochirurgicale. J. Chir. (Paris), 2:70-3, 1993.

Cauldwell, E.W. & Anson, B. J. The visceral branches of the abdominal aorta: topographical relationships. Am. J. Anat., 73:25-57, 1943.

Eaton, P. B. The coeliac axis. Anat. Rec., 13:369-74, 1917.

Fumagalli, Z. & Cavallotti, C. Anatomia Umana Normale. Padova, Piccin Nuova libraria., S.p.A., 1983. v.1.








Furnemont, E. La stenose du tronc coeliaque par le ligament arque du diaphragme. A propos de deux observation. J. Belg. Radiol., 57:443-50, 1974.

George, R. Topography of the unpaired visceral branches of the abdominal aorta. J. Anat., 69:196-205, 1934.

Von Haller, A. apud Rio Branco, P. Anatomia et medicine operatoire du tronc coeliaque em particulier de l'artere hepatique. Paris, G. Steinheil, 1912. 818p.

Lamarque, J. L.; Senac, J. P.; Bruel, J. M.; Gau, A. & Toulza, A. Anatomie radiologique de l'artere hepatique. Ann.Radiol., 19:316-8, 1976.

Latarjet, M. & Ruiz-Liard, A. Anatomia Humana. 2 ed. Sao Paulo, Medicina Panamericana Editora do Brasil Ltda, 1989. V. 2.

Lipshutz, B. A composite study of the coeliac axis artery. Am. Surg., 65:159-69, 1917.

Michels, N.A. The hepatic, cystic and retroduodenal arteriesand their relations to the biliary ducts. Ann. Surg., 133: 503-24, 1951.

Michels, N.A. Collateral arterial pathways to the liver after ligation of the hepatic artery and removal of the celiac axis. Cancer, 6:708-24, 1953a.

Michels, N. A. Variational anatomy of the hepatic, cystic, and retroduodenal arteries. Am. Med. Assoc., 66:2034, 1953b.

Mincev, M. & Baldzijski, A. On the variability of tr. coeliacus and its ramifications according to our 107 selective angiographies. Folia Med., 23:114-21, 1971.

Morettin, L.B.; Baldwin-Price, H.K. & Schreiber, M.H. Congenital absence of the celiac axis trunk. Am. J. Roentgen., 95: 727-30, 1995.

Olivier, C.; Rettori, R. & Di Maria, G. Stenoses non atheromateuses et compressions du tronc coeliaque. Chirurgie, 96:471-82, 1970.

Orts Llorca, F. Anatomia Humana. Barcelona, La semana grafica, 1944. V. 3.

Pignataro, E. L'angiografia selettiva del tronco celiaco e dell'arteria mesenterica superiore. Min. Med., 60:236998, 1969.

Reuter, S. R. Accentuation of celiac compression by the median arcuate ligament of the diaphragm during deep expiration. Diagn. Radiol., 98:561-4, 1971.

Rio Branco, P. Anatomia et medicine operatoire du tronc coeliaque en particulier de l'artere hepatique. Paris, G.Steinheil, 1912. 818p.

Riva, D. Considerazione anatomo-chirurgiche sul tronco celiaco ed i suoi rami. Min. Chir., 22:570-9, 1967.

Siegel, S. Estadistica nao parametrica (para as ciencias do comportamento). Mc Graw - Hill Ltda. Sao Paulo, 1976. 350p.

Sponza, M.; Mucelli, R. P. & Mucelli, F. P. Anatomia arteriosa del tripode celiaco e dell'arteria mesenterica superiore con la tomografia computerizzata. Radiol. Med., 86: 260-7, 1993.











Stanley, J. C. & Fry, W. J. Median arcuate ligament syndrome. Arch. Surg., 103:252-8, 1971.

Stoney, R. J. & Wylie, E. J. Recognition and surgical management of visceral ischemia syndrome. Ann. Surg., 164: 714-22, 1966.

Tandler, J. Tratado de anatomia sistematica. Barcelona, Salvat Editores, S. A., 1929. V. 3.

Warter, J.; Storck, D.; Kieny, R. & Tongio, J. La maladie phreno-coeliaque. Ann. Radiol., 19:361-70, 1976.

Warter, J.; Storck, D.; Kieny, R. & Tongio, J. Stenoses congenitales du tronc coeliaque. Arch. Fr. Mal. Appar. Dig.,59:765-80, 1970.

Yamaki, K.; Tanaka, N.; Matsushima, T.; Miayazaki, K. & Yoshizuka, M. A rare case of absence of the celiac trunk: the left gastric, the splenic, the common hepatic and the superior mesenteric arteries arising independently from the abdominal aorta. Ann. Anat., 177:97-100, 1995.

Yuksel, M. & Sargon, M. A variation of a coeliac trunk. Okajimas Folia Anat. Jpn., 69:173-6, 1992.

PETRELLA, S.; RODRIGUES, C. F. S.; SGROTT, E. A; FERNANDEZ. G. J. M.; MARQUES, S. R. & PRATES. J. C. Anatomy and variations of the celiac trunk. Int. J. Morphol., 25(2):249-257, 2007.

PETRELLA, S.; RODRIGUES, C. F. S.; SGROTT, E. A; FERNANDEZ. G. J. M.; MARQUES, S. R. & PRATES. J. C. Anatomia y variaciones del tronco celiaco. Int. J. Morphol., 25(2):249-257, 2007.

Correspondence to:

Prof. Dra. Selma Petrella

Rua Rio Grande, 180 apto. 62

Vila Mariana

Sao Paulo CEP

04018-000

Sao Paulo

BRASIL

Email:[email protected]

* Selma Petrella; ** Celio Fernando de Sousa Rodriguez; *** Emerson Alexandre Sgrott; **** Geraldo Jose Medeiros Fernandes; ***** Sergio Ricardo Marques & ***** Jose Carlos Prates.

* Medical Biology Division, Adolfo Lutz Institute, Sao Paulo, Brazil. ** Department of Morphology, Federal University of Alagoas, Brazil. *** Descriptive and Topographic Anatomy Division, Vale do Itajai University, Santa Catarina, Brazil **** Descriptive and Topographic Anatomy Division, Alfenas University, Minas Gerais, Brazil. ***** Descriptive and Topographic Anatomy Division, Federal University of Sao Paulo, Brazil.

COPYRIGHT 2007 Universidad de La Frontera, Facultad de Medicina COPYRIGHT 2008 Gale, Cengage Learning

Bibliography for: "Anatomy andvariations of the celiac trunk/Anatomia y variaciones del tronco celiaco"Selma Petrella "Anatomy and variations of the celiac trunk/Anatomia y variaciones del tronco celiaco".



mailto:[email protected]

International Journal of Morphology. FindArticles.com. 17 Nov, 2009. http://findarticles.com/p/articles/mi_m5EOM/is_2_25/ai_n30962009/

COPYRIGHT 2007 Universidad de La Frontera, Facultadde Medicina COPYRIGHT 2008 Gale, Cengage Learning

Previous 1 2 3 4 5 6 7 8 9 10

International Journal of Morphology

View more issues:

Articles in June, 2007 issue of International Journal of Morphology

Morphometric analysis of mice testicular tubules after administration of Malathion and Maca/Analisis morfometrico de los tubulos testiculares del raton despues de la administracion de Malation y Maca by Eduardo Bustos-Obregon

Anatomy and variations of the celiac trunk/Anatomia y variaciones del tronco celiaco



http://findarticles.com/p/search/?qa=Eduardo%20Bustos-Obregon















by Selma Petrella Localization of total proteins and lactate

dehydrogenase in hamster epididymis/Localizacion de proteinas totales y LDH en el epididimo del hamster by Celia C.L. Beu

Morphometry of the parotid gland in mice infected by the RAL strain of Trypanosoma cruziin function of the sex/Morfometria de la parotida de raton infectado por la cepa RAL de Trypanosoma cruzi en funcion del sexo by Sergio de Albuquerque

Ultrastructural study of spermatogenesis in Eisenia foetida /Estudio ultraestructural de laespermatogenesis en Eisenia foetida by A. Rolando

Study of the Collo-diaphyseal Angle of the Femur of Corpses in the anatomy department of the PUC-SP medical school/Estudio del angulo del cuello del femur en cadaveres del departamento de anatomia de la facultad de medicina-PUC-SP by Edie Benedito Caetano

Analysis of the hard palate as a donor site for bone grafting/Analisis del paladar oseo como zona dadora de injerto by Catalina Martinez

Histoenzimological characterization of the masseter muscle, superficial bundle, in guinea-pigs after malocclusion induction/Caracterizacion histoenzimologica de la capa superficial del musculo masetero, en



http://findarticles.com/p/search/?qa=Catalina%20Martinez




http://findarticles.com/p/search/?qa=Edie%20Benedito%20Caetano




http://findarticles.com/p/search/?qa=A.%20Rolando




http://findarticles.com/p/search/?qa=Sergio%20de%20Albuquerque




http://findarticles.com/p/search/?qa=Celia%20C.L.%20Beu





guinea-pigs despues de maloclusion inducida by Joao Paulo Mardegan Issa

Morphometric analysis of infraorbital foramen in human fetuses/Analisis morfometrico del foramen infraorbital en fetos humanos by Ghaus Farah

Diaphyseal nutrient foramina in the femur, tibia and fibula bones/Foramenes nutricios diafisarios de los huesos femur, tibia y fibula

by Erika Collipal Decalcification dynamic of dog mineralized

tissue by microwaves/Dinamica de la descalcificacion de tejido mineralizado de perros a traves de microondas by Dimitrius Leonardo Pitol

Microscopic anatomy of the reproductive system in two sympatric species of Fissurella bruguiere, 1789 /Anatomia microscopica del sistema reproductor en dos especies simpatricasdel genero Fissurella bruguiere, 1789 by Gonzalo A. Collado

Morphological comparison between brazilian's mandibles and populations from four continents/Comparaciones morfologicas entre lasmandibulas de brasilenos y de poblaciones de otros continentes by Felippe Bevilacqua Prado

Morphogenesis of a tunica mucosa of oviduct of the hens/Morfogenesis de la tunica mucosa del oviducto de gallinas by R. YU. Khokhlov

Studies on the effects of fixatives on the staining ability of Morinda lucida extracts on



http://findarticles.com/p/search/?qa=R.%20YU.%20Khokhlov




http://findarticles.com/p/search/?qa=Felippe%20Bevilacqua%20Prado




http://findarticles.com/p/search/?qa=Gonzalo%20A.%20Collado




http://findarticles.com/p/search/?qa=Dimitrius%20Leonardo%20Pitol




http://findarticles.com/p/search/?qa=Erika%20Collipal




http://findarticles.com/p/search/?qa=Ghaus%20Farah




http://findarticles.com/p/search/?qa=Joao%20Paulo%20Mardegan%20Issa


tissue sections/Estudios en los efectos de fijadores en la capacidad de tincion de los extractos de morinda lucida en secciones de tejidos by O.G. Avwioro

Comparative bilateral bone density of the mandible angle/Densidad osea bilateral comparativa del angulo de la mandibula by Joao Paulo Mardegan Issa

Histological study on the male reproductive organs of mouse CF1 treated with boron/Estudio histologico de los organos reproductivos del raton macho CF1 tratado con boro by O. Espinoza-Navarro

Optical densitometry study of the newly formed bone using rhBMP-2 in wistar rat mandibles/Estudio densitometrico del tejido oseo neoformado por el uso de rhBMP-2 en mandibulas de ratas wistar by Joao Paulo Mardegan Issa

A Pilot study of the mandibular angle and ramus in indian population/Estudio piloto del aAnguloy rama de la mandibula en la poblacion hindu by Rajalakshmi Rai

Multiple variations in the axillary arterial tree relevant to plastic surgery: A case report/Variaciones multiples de las ramas de laarteria axilar relevantes para la cirugia plastica. Reporte de caso by Orhan Magden

Characterization of blood mononuclear phagocytes in Phrynops hilarii /Caracterizacionde los fagocitos mononucleares en la sangre de



http://findarticles.com/p/search/?qa=Orhan%20Magden




http://findarticles.com/p/search/?qa=Rajalakshmi%20Rai








http://findarticles.com/p/search/?qa=O.%20Espinoza-Navarro








http://findarticles.com/p/search/?qa=O.G.%20Avwioro



Phrynops hilarii by Dimitrius Leonardo Pitol

Learning styles and its correlation from academic Performance on Human Normal Anatomy/ Estilos de aprendizaje y su correlacion con el rendimiento academico en Anatomia Humana Normal

by Ivan Claudio Suazo Galdames Cardia: at the end of the day, what is it?

Cardia: al fin de cuentas que es? by Jose Humberto Tavares Guerreiro Fregnani

Cyamella in man—its morphology and review of literature/Cyamella en el hombre—su morfologia y revision de la literature by Sreenivasulu Reddy

Regulation of the bone healing process by hormones/Regulacion del proceso de reparacion osea por hormonas by Joao Paulo Mardegan Issa

Morphometry of vertebral pedicles: a comprehensive anatomical study in the lumbar region/Morfometria de los pediculos vertebrales: un exhautivo estudio anatomico en la region lumbar by Prakash

Osteometric studies of the skull of red sokoto goats : implications for regional anaesthesia of the head/Estudios osteometricos del craneo de las cabras rojas de sokoto : implicaciones para la anestesia regional de la cabeza by J.O. Olopade

Hashimoto's thyroiditis: lingual and labial capillary microcirculation in patients affectedby macroglossia/ Tiroiditis de hashimoto:



http://findarticles.com/p/search/?qa=J.O.%20Olopade




http://findarticles.com/p/search/?qa=Prakash








http://findarticles.com/p/search/?qa=Sreenivasulu%20Reddy




http://findarticles.com/p/search/?qa=Jose%20Humberto%20Tavares%20Guerreiro%20Fregnani



http://findarticles.com/p/search/?qa=Ivan%20Claudio%20Suazo%20Galdames




http://findarticles.com/p/search/?qa=Dimitrius%20Leonardo%20Pitol


microcirculacion lingual y labial en pacientes afectados por macroglosia by G. A. Scardina

The Studying Guide Generato . Version 1.5 "an organizer of questions of tests and generator of autoinstructive for students/El Gestor de Guias de Estudio . version 1.5 "un organizador de preguntas para pruebas y generador de autoinstructivos par by Joaquin Rivas

GGE: Gestor de Guias de estudio version 1.5 by Joaquin Rivas

Polymorphism C373G of the PECAM-1 Gene in chilean subjects with coronary disease and controls/Polimorfismo C373G del Gen PECAM-1 en individuos chilenos con enfermedad coronaria y controles by Christian L. Herrera

Spine: 15 February 2009 - Volume 34 - Issue 4 - pp E149-E152doi: 10.1097/BRS.0b013e3181918f05Case Reports

Acute Celiac Artery Compression SyndromeAfter Surgical Correction of ScheuermannKyphosis

http://findarticles.com/p/search/?qa=Christian%20L.%20Herrera




http://findarticles.com/p/search/?qa=Joaquin%20Rivas


http://findarticles.com/p/search/?qa=Joaquin%20Rivas




http://findarticles.com/p/search/?qa=G.%20A.%20Scardina



Daniels, Alan H. BA; Jurgensmeier, Darin BS; McKee, Jason MD; Harrison, Marvin W. MD; d'Amato, Charles R. MD

Abstract

Study Design. A case of acute celiac artery compression syndrome after spinal fusion in a patient with Scheuermann kyphosis is reported.

Objective. To describe the unusual complication of acute celiac artery compression after surgical kyphosis correction, to outline diagnostic methods, and to review thepertinent literature.

Summary of Background Data. Chronic celiac artery compression syndrome is well described, yet there is only 1 reported case of acute celiac artery compression after surgical correction of kyphosis. There have been no previousreports of this complication leading to foregut ischemic necrosis after correction of Scheuermann kyphosis.

Methods. Case report and literature review.

Results. After an anterior release and posterior spinal fusion for a 106° kyphotic deformity performed under 1 anesthetic, our patient developed a perforated gastric antrum on postoperative day 5, evolving to ischemic necrosisof the stomach, gallbladder, and spleen discovered on postoperative day 7. Abdominal angiography indicated that his celiac artery had been occluded at its origin. After this event, the patient required a prolonged intensive care hospital stay and required a Roux-en-Y gastro-jejeunostomy reconstruction. He is now doing well at 1-year follow-up with independent ambulation and a regular diet.

Conclusion. Acute celiac artery compression after surgical kyphosis correction is a rare but potentially serious adverse event. Spinal deformity surgeons and intensivists

javascript:showHide('ej-article-box-text1',%20'img1')

should be aware of this entity, and should have a high indexof suspicion for it if sepsis of unknown origin, an acute abdomen, or elevated liver enzymes are encountered after surgery after correction of a kyphotic deformity.

© 2009 Lippincott Williams & Wilkins, Inc.

Bµi kh¸c

The Branches of the Celiac TrunkJ.P.J. Vandamme, J. Bonte

Vesalius Institute of Anatomy, Louvain, Belgium

Address of Corresponding Author

Acta Anatomica 1985;122:110-114 (DOI: 10.1159/000145991)

Key Words

Truncus coeliacus Arteria hepatica Arteria lienalis Arteria gastrica sinistra Celiac trunk

Abstract

156 abdominal preparations were explored by arteriography, corrosion and dissection. Classification of the celiac trunkbecomes easy if one considers the trunk to be composed of three main stems: the splenic, the hepatic and the left

http://content.karger.com/ProdukteDB/produkte.asp?Doi=145991#AC

http://content.karger.com/ProdukteDB/produkte.asp?Doi=145991#OLN


gastric artery, other vessels being less important collaterals. Usually, the celiac trunk bifurcates into the splenic and the hepatic artery; the left gastric artery is amobile vessel whose origin may slide between the aorta, all over the celiac trunk up to a trifurcation. The direction ofthe celiac trunk is influenced by the topography of the pancreatic neck and by the origin of the hepatic artery: if the celiac trunk is not the origin of the hepatic artery it is not directed to the right but to the left. It is the hepatic artery that pulls the celiac trunk to the right. Variations in the origin of the splenic artery are exceptional. In contrast to adults, the diameter of the hepatic artery in young children is larger than that of the splenic artery.

Copyright © 1985 S. Karger AG, Basel

Author Contacts

Dr. J.P. Vandamme, Dept. of Surgery, Elisabeth Clinic, B-8340 Sijsele-Damme (Belgium)

Bµi kh¸c

Roberto Iezzi1 , Antonio Raffaele Cotroneo1, Daniela Giancristofaro1, Marco Santoro1 and Maria Luigia Storto1

(1)

Department of Clinical Science and Bioimaging, Section ofRadiology, University “G. D’Annunzio”, Osp. “SS. Annunziata”, Via dei Vestini, 66013 Chieti, Italy

Received: 16 August 2007 Accepted: 6 February 2008 Published online: 20 February 2008

AbstractPurpose To evaluate the ability of MDCT reformations in describing the celiac trunk vascular anatomy and variations.


http://www.springerlink.com/content/lr4227l7482431m4/#ContactOfAuthor1

Materials and methods A total of 555 MDCT angiographies of the abdominal aorta performed between January 2002 and July 2005 were retrospectively reviewed to assess the celiac trunk vascular anatomy and variations. All the patients withpathological condition likely to affect normal vascular anatomy as well as CT exams technically inadequate were excluded from our study. Results A total of 524 MDCT angiographies of abdominal aorta were included in our study. The classical configuration of the celiac trunk was detected in 72.1%. Thehepato-splenic trunk was detected in 50.4% of cases; the hepato-gastro-splenic trunk was detected in 19.4% of cases; the gastro-splenic trunk was detected in 2.3% of cases. The hepato-spleno-gastric trunk associated with hepatic arteriesvariants were found in 15.4%. The hepato-splenic trunk, the hepato-gastric trunk, the hepato-splenic-mesenteric trunk, and the spleno-gastric trunk were found in 2.7, 5, 0.4, and 3.6%, respectively. In 0.6%, we found an absent celiac trunk. Conclusion The knowledge of the type of anatomical variantsand their subtypes is fundamental for a correct pre-operative vascular planning in surgical or radiological abdominal procedures. Multidetector-row CT (MDCT) provides high-quality 3D-reconstructed images and allows non-invasiveassessment of normal anatomy and anatomic variants of celiactrunk.

Keywords Celiac trunk - Anatomy - Embryology - Variation - Computed tomography - Imaging - Three-dimensional

Bµi kh¸c

Acta Cirurgica Brasileira

Print version ISSN 0102-8650Acta Cir. Bras. vol.24 no.1 São Paulo Jan./Feb. 2009

doi: 10.1590/S0102-86502009000100009

9 - ORIGINAL ARTICLE ANATOMICAL RESEARCH

Arterial diameter of the celiac trunk and its branches. Anatomical study1

Diâmetro arterial do tronco celíaco e seus ramos. Estudo anatômico

Luís Augusto da SilveiraI; Fernando Braga Cassiano SilveiraII; Valéria Paula Sassoli FazanIII

IMS, Assistant Professor, Human Anatomy, Barao de Maua University Center, Ribeirao Preto-SP, Brazil IIGraduate Student, Department of Surgery and Anatomy, School of Medicine, USP, Ribeirao Preto-SP, Brazil IIIPhD, Assistant Professor, Human Anatomy, Department of Surgery and Anatomy, School of Medicine, USP, Ribeirao Preto-SP, Brazil

Correspondence

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502009000100009#end

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502009000100009#not01

ABSTRACT

PURPOSE: Despite the fact that anatomical variations of the celiac trunkare well explored in the literature, information on these vessels diameters is scanty. The aims of the present study were to describe the arterial diameters of the celiac trunk and its main branches, and to investigate if these diameters are altered in those cases presenting anatomical variations of these vessels. METHODS: Twenty-one formalin fixed adult male cadavers were appropriately dissected for the celiac trunk identification and arterialdiameter measurements. Arteries measured included the celiac trunk and its main branches (splenic artery, left gastric artery and common hepatic artery), as the proper hepatic artery, right gastric artery, theleft and right hepatic arteries and the gastroduodenal artery. RESULTS: From the 21 cadavers, 6 presented anatomical variations of, at least, one of the above mentioned branches. The average arterial diameter comparisons between groups (normal and variable) clearly showedsmaller diameters for variable vessels, but with no significant difference. CONCLUSION: Our data indicates the possibility of a diameter reduction of the celiac trunk main branches in the presence of anatomical variations. This should be taken into account on the selection for the liver transplantation donors.

Key words: Celiac Trunk. Celiac Artery. Anatomy. Aorta, Abdominal. Cadaver.

RESUMO

OBJETIVO: Embora as variações arteriais do tronco celíaco e seus ramos estejam bem documentadas na literatura, o mesmo não ocorre com as descrições dos diâmetros dessas artérias. O presente estudo tem por objetivo descrever os diâmetros arteriais do tronco celíaco e seus ramosem indivíduos normais, bem como investigar se esses diâmetros se apresentam alterados em indivíduos com variação anatômica desses vasos. MÉTODOS: Utilizamos 21 cadáveres adultos, do sexo masculino, previamentefixados em formol a 10% que foram dissecados apropriadamente para a exposição do tronco celíaco e seus ramos. Com o auxílio de um paquímetro

digital, foram obtidos os diâmetros externos dos seguintes vasos: troncocelíaco, artéria hepática comum, artéria gástrica direita, artéria esplênica, artéria gástrica esquerda, artéria gastroduodenal, artéria hepática própria e artérias hepáticas direita e esquerda. RESULTADOS: Dos 21 cadáveres avaliados, 6 apresentaram variação anatômica de pelo menos um dos ramos acima mencionados. Ao compararmos os diâmetros arteriais dos vasos normais com os que apresentaram variação, os variáveis apresentaram diâmetros menores, sem, entretanto alcançar níveis de significância. CONCLUSÃO: Nossos dados apontam para a possibilidade de uma diferença dediâmetros entre artérias abdominais normais e variáveis, sendo esse dadode implicância clínica para os transplantes hepáticos de doadores vivos.

Descritores: Tronco Celíaco. Artéria Celíaca. Anatomia. Aorta Abdominal.Cadaver.

Introduction

Despite that the celiac trunk anatomical variations are well explored inthe literature, information on the arterial diameter of its main branches is still scanty. Arterial diameter of celiac trunk hepatic branches has gained importance especially due to development of techniques for liver transplantation. Vascular and biliary reconstructions are technically difficult in living-related liver transplantation1 because of the use of a partial graft with small-diameter vessels and ducts. Hepatic artery trombosis is one of the most devastating postoperative living-related liver transplantation complication and this risk is related to the use of small diameter arteries (< 2 mm)1. In fact, the necessity for vascular reconstruction has led some authors to exclude donors with < 3mm arteries2. The right lobe grafts have been the main type of partial liver grafts for adult-to-adult living donor liver transplantation and the anatomy of the rightliver must be intensively investigate to assure safety to the donor and prevention of recipient complications3. However, there are only few articles dealing specifically with the right hepatic artery anatomy. As a sufficient supply of arterial blood is indispensable for survival of aright lobe graft, special attention must be paid to the anatomy of the right hepatic artery, including the number and diameter of the vessels3.Usually, based on the arterial diameters, different surgical techniques must be used and small-sized arteries discrepant from the host are

related to unfavorable outcomes3. The post-operative ischemic damage to the liver graft as a result of hepatic artery stenosis is another serious complication after liver transplantation. In these cases, surgical re-anastomosis is often difficult and the angioplasty of the stenotic artery might be an option. Nevertheless, knowledge of the arterial diameter is mandatory for the correct choice of the catheter. Another situation that involves mandatory knowledge of the hepatic arteries diameters is the hepatic arterial infusion chemotherapy for treatment of hepatic metastatic tumors4, so the correct size of the catheter can be safely chosen.

Patients with cirrhosis and portal hypertension are at risk for developing splenic artery aneurisms5 and its incidence is reported to be7 - 10% in these cases6. These patients may also be at higher risk for splenic artery aneurysm rupture in the post-transplant period5. Thus, the preoperative diagnosis of splenic artery aneurism (including the arterial diameter) is crucial because this area is not routinely explored during transplantation surgery.

For the gastric arteries diameters, information is rare and available inthe literature only for the left gastric artery. Importance of this knowledge has been associated with studies of the abdominal segment of the esophagus and the lower esophageal sphincter vascularization7, as well as on angiographic studies of the left gastric artery aneurysms8.

Despite some sparse information on the celiac trunk and its branches diameters, as well as a wide and well explored arterial variation descriptions literature, there is not, to the best of our knowledge, a study on the association between the anatomical variations and arterial diameters. Thus, the aims of the present study were to describe the arterial diameters of the celiac trunk and its main branches, and to investigate if these diameters are altered in those cases with anatomical variations of these vessels.

Methods

Male embalmed human cadavers (fixed in 10% formaldehyde solution) were included in the present study. The abdominal cavities and retroperitoneal spaces have been partially dissected by medical studentsduring the previous years and further dissections were performed by the authors, with the aid of a D. F. Vasconcellos M-90 surgical microscope. Anomalous tortuosities, dilatations, aneurisms or atheromatous/occlusivedisease tissues were discarded at the beginning of the study. A meticulous evaluation was done in each cadaver and, when arteries were

not in good condition for obtainment of accurate measurements, they werenot included in the study. The study ended up with 21 celiac trunks. An anatomically normal branching of the celiac trunk was accepted as defined by Lipert and Pabst9. Quantification and description of anatomical variations were carried out for the celiac trunk and its mainbranches (left gastric artery, splenic artery and common hepatic artery). Also, the proper hepatic artery, the right gastric artery, the left and right hepatic arteries and the gastroduodenal artery diameters were investigated. A complete diagram of the arterial arrangements was made for each sample, before measurements and photo-documentation. With the aid of an electronic digital caliper (range of 0-300 mm, resolution 0.01 mm, Gehaka, SP, Brazil), the celiac trunk and its main branches diameters were measured as previously described10, as were the proper hepatic artery, right gastric, right and left hepatic, and gastroduodenal arteries. Arterial diameter data was plotted on scatter graphs (Figure 1), so the variation between the normal and variable values are clearly represented. Mean arterial diameters were compared between normal and variable arteries. For this comparison, data were tested for normal distribution by the Kolmogorov-Smirnov normality test.If the data presented a normal distribution, comparisons were made by the unpaired Student's t-test. Otherwise, comparisons were made by the Mann-Whitney test. Differences were considered significant if P < 0.05.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502009000100009#fig01

Results

Thirty cadavers were evaluated in total. Four female cadavers, despite the presence of normal arteries, were discarded due to the small number of female samples in this study. Five other cadavers were discarded due to loss or major damage to the large arteries under investigation.

From the 21 cadavers included in this study, 6 presented anatomical variations (approximately 29 %) of, at least, one of the arteries under investigation. None of the variations presented the same pattern betweentwo or more cadavers.

Variation descriptions

Type 1: Normal origins of left gastric artery, common hepatic artery andsplenic artery from the celiac trunk. The common hepatic artery trifurcates into right and left hepatic arteries and gastroduodenal artery. No proper hepatic artery is present.

Type 2: A middle colic artery (0.26 cm in diameter) originates from the celiac trunk, together with the left gastric artery, common hepatic artery and splenic artery. Associated to this variation, the right gastric artery originated form the gastroduodenal artery.

Type 3: Origin of the left gastric artery from the abdominal aorta and the celiac trunk giving off only the common hepatic and splenic arteries(hepatosplenic trunk formation). The left gastric artery gives off the inferior phrenic artery (with 0.25 cm in diameter) and the right gastricartery originates from the gastroduodenal artery.

Type 4: The right hepatic artery originates from the superior mesentericartery. Two left hepatic arteries were observed, both originating on thecommon hepatic artery. Absence of the proper hepatic artery and the cystic artery (0.20 cm in diameter) originating from the gastroduodenal artery.

Type 5: Two separate artertial trunks comming off the abdominal aorta: agastrosplenic trunk and a hepatomesenteric trunk. The hepatomesenteric trunk gives off the common hepatic artery.

Type 6: The right hepatic artery originates from the superior mesentericartery. The proper hepatic artery is absent.

Arterial diameter

Mean arterial diameters of normal and variable arteries are shown on Table 1. Except for the splenic and common hepatic arteries, all variable arteries showed smaller mean diameter compared to normal arteries, but these differences did not reach statistical significance. Figure 1 shows a scatter plot of the normal and variable arterial diameters for all arteries included in the present study. It is evident that the variable arteries show smaller diameters than the normal ones, specially the hepatic arteries.

Discussion

In the present study, from 21 cadavers, six presented anatomical variations of the celiac trunk and its branches, being no variation with

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502009000100009#fig01

http://www.scielo.br/img/revistas/acb/v24n1/a09tab01.jpg

the same patterns in two or more cadavers. In this way, approximately 29% of our sample showed anatomical variations, being each type represented by 4.8 % individually. In spite of the relatively small sample in the present study, our data is not different from the literature that describes 70 % of normal main hepatic branches2,9.

The Type 1 variation found in the present study (absence of the proper hepatic artery) can also be considered normal by some authors9. Nevertheless, this absence can be associated to other anatomical variations, in percentages varying from 1 to 12 %9.

The Type 2 variation (middle colic artery originating from the celiac trunk) is described in the literature9 but, to the best of our knowledge, its association with a right gastric artery origin from the gastroduodenal artery was not previously reported.

The Type 3 variation (left gastric artery origin from the abdominal aorta) is described in the literature and might be present in 3 % of cases9 as we showed. The presence of an inferior phrenic artery origin from the left gastric artery is also described in the literature11 as isthe right gastric artery origin from the gastroduodenal artery11. Nevertheless, to the best of our knowledge, the combination of all thesearterial variation in one sample was not previously described.

The Type 4 variation (right hepatic artery origin from the superior mesenteric artery) was described in the literature11 but this variation is much less frequent than the left hepatic artery origin from the superior mesenteric artery9. The presence of two left hepatic arteries originating from the common hepatic artery associated to this variation was not found in the literature.

The Type 5 variation (two trunks from the abdominal aorta: a gastrosplenic and an hepatomesenteric) is described in the literature9, on a frequency similar to our results (3 %).

The Type 6 variation (the right hepatic artery origin from the superior mesenteric artery) is described in the literature and seems to be of little importance9,11.

The high incidence of anatomical variations of the celiac trunk and its branches arterial pattern was widely explored in the literature, including a more recent review12, focused on the surgical anatomy of thehepatic arteries and donor selection for liver transplantation. The celiac trunk is a main dominant vascular structure of the upper abdominal cavity, responsible not only but also for the liver arterial supply. Recent progress on the liver transplantation brought the need ofa precise knowledge of the frequency of anatomical variations on the

arteries involved. Nevertheless, very little is known about the diameterof these arteries and based on this knowledge, new surgical reconstructive techniques can be proposed. Despite that formalin fixed cadavers were used in the present study, our data is reliable since it is compatible to those obtained in fresh cadavers7 or in vivo, through noninvasive methods to access vascular caliber1,3,5.

Table 2 shows a comparison between our normal data and data obtained from the literature. In spite of some available data in the literature, it was not possible to compare all arteries investigated because vascular diameter data is rare. This is especially the case of the splenic, the right gastric and the gastroduodenal arteries, whose data presented in the present study are original to the literature. Splenic artery aneurysms are described in the literature and most of descriptions are of vessels larger than 2 cm in diameter13. Nevertheless, Sunagozaka et al.14 described saccular aneurysms measuring 0.4 to 2.2 cm in diameter. It is important to notice that the described diameters of some aneurysms are close to normal values, reinforcing the importance of the normal values knowledge. No descriptions of arterial diameter values for the right gastric artery and for the gastroduodenal artery were found in the literature. Only one reference on resonance angiography of abdominal arteries attesting that the gastroduodenal artery is too small was found15. This might also be the case for the right gastric artery.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502009000100009#tab02

The knowledge of normal arterial diameters in a specific population is of great importance in order to make correct and precise radiological diagnosis of arterial aneurysms5,8. Also, evaluation of arterial diameters is fundamental for liver transplantation follow up. Previous knowledge of the normal and expected values for a specific artery might help the early diagnosis, through radiological exams, of an arterial stenosis, even before clinical signs of low arterial flow.

It seems to be consensual from the literature that arteries with diameters < 0.3 cm are considered of high surgical risk on liver transplantation surgery1,2,5. An important consideration about our resultsis that the hepatic arteries (common and proper) had always diameters > 0.3 cm, even those with anatomical variations. Nevertheless, when considering the right and left hepatic arteries on normal celiac trunks,four cadavers presented arteries smaller than 0.3 cm. This corresponds to 40 % of normal arteries. On variable celiac trunks, three right hepatic arteries and two left hepatic arteries were less than 0.3 cm in diameters. Kostelic et al.2 found anomalous hepatic artery anatomy in 67 %of potential donors, and a left hepatic artery less than 0.2 cm in 1 % and between 0.2 and 0.3 in 5 % of potential donors. The authors mention that arteries less than 0.2 cm in diameter was an absolute exclusionary

criteria for living related liver transplant donor while arteries between 0.2 and 0.3 cm in diameter were a relative exclusionary criteria. More recently, Ishigami et al.16 demonstrated that patients with variant arterial anatomy had higher post-transplantation complication rates, compared to patients with normal anatomy. Also, this is the firstliterature report indicating that patients with variant arterial anatomyhad arteries of smaller diameters compared to those with normal anatomy16, which is similar to our results. Those authors concluded thatvariant artery anatomy in liver transplant recipient increases the risk of complications after transplantation and that the smaller caliber of the native common hepatic artery may contribute to the higher risk.

Conclusion

Our results also suggest that there is a reduction of the arterial diameters of the celiac trunk and its branches in the presence of anatomical variations of these arteries, which have direct clinical implications for liver transplantation.

Acknowledgements

The authors are thankful for the excellent technical support of Nelson Roberto da Mota, Marcelo Savoldi, Valdir Mazzucato Júnior and Waldeci Roberto Bim, from the Multidisciplinary Laboratories, School of Medicineof Ribeirao Preto, while the study was carried out.

References

1. Douard R, Ettorre GM, Chevallier JM, Delmas V, Cugnenc PH, Belghiti J. Celiac trunk compression by arcuate ligament and living-related livertransplantation: a two-step strategy for flow-induced enlargement of donor hepatic artery. Surg Radiol Anat. 2002;24:327-31.[ Links ]

2. Kostelik JK, Piper JB, Leef JA, Lu CT, Rosenblum JD, Hackworth C, Kahn J, Thistlethwaite JR, Whitington PF. Angiographic selection criteria for living related liver transplant donors. Am J Roentgenol. 1996;166:1103-8. [ Links ]

javascript:void(0);

javascript:void(0);

3. Ahn CS, Lee SG, Hwang S, Moon DB, Ha TY, Lee YJ, Park KM, Kim KH, KimYD, Kim KK. Anatomic variation of the right hepatic artery and its reconstruction for living donor liver transplantation using right lobe graft. Transplant Proc. 2005;37:1067-9. [ Links ]

4. Watanabe M, Takita W, Tsuchiya M, Otsuka Y, Tamura A, Kaneko H, Kobayashi K. Hepatic arterial cannulation using the side holed catheter.J Surg Oncol. 2005;91:145-9. [ Links ]

5. Nghiem HV, Dimas CT, McVicar JP, Perkins JD, Luna JA, Winter III TC, Harris A, Freeny PC. Impact of double helical CT and three-dimensional CT arteriography on surgical planning for hepatic transplantation. AdbomImaging. 1999;24:278-84. [ Links ]

6. Ayalon A, Wiesner R, Perkins J, Tominaga S, Hayes DH, Krom RA. Splenic artery aneurysms in liver transplant patients. Transplantation. 1988;45:386-9. [ Links ]

7. Yan Y, Chen C, Chen Y, Wu Y, Shi Z. Arterial patterns in the thoracicand abdominal segments of the esophagus: anatomy and clinical significance. Surg Radiol Anat. 1998;20:399-402. [ Links ]

8. Sasaki A, Bandoh T, Shiraishi N, Adachi Y, Kitano S, Kaketani K. Laparoscopic ligation of an aneurysm of the left gastric artery. Surg Laparosc Endosc Percutan Tech. 2001;11:225-7. [ Links ]

9. Lippert H, Pabst R. Arterial variations in man: classification and frequency. Müchen: JF. Bergmann Verlag; 1985. [ Links ]

10. Ribeiro RA, Ribeiro JAS, Rodrigues Filho OA, Caetano AG, Fazan VPS. Common carotid artery bifurcation levels related to clinical relevant anatomical landmarks. Int J Morphol. 2006;24:413-6. [ Links ]

11. McVay CB. Anson & McVay surgical anatomy. 6ed. Philadelphia: WB. Saunders Company; 1984. [ Links ]

12. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220:50-2. [ Links ]

13. Berceli SA. Hepatic and splenic artery aneurysms. Semin Vasc Surg. 2005;18:196-201. [ Links ]

14. Sunagozaka H, Tsuji H, Mizukoshi E, Arai K, Kagaya T, Yamashita T, Sakai A, Nakamoto Y, Honda M, Kaneko S. The development and clinical features of splenic aneurysm associated with liver cirrhosis. Liver Int.2006;26:291-7. [ Links ]

javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

15. Miyazaki T, Yamashita Y, Shinzato J, Kojima A, Takahashi M. Two-dimensional time-of-flight magnetic resonance angiography in the coronalplane for abdominal disease: its usefulness and comparison with conventional angiography. Br J Radiol. 1995;68:351-7. [ Links ]

16. Ishigami K, Zhang Y, Rayhill S, Katz D, Stolpen A. Does variant hepatic artery anatomy in a liver transplant recipient increase the riskof hepatic artery complications after transplantation? Am J Roentgenol. 2004;183:1577-84. [ Links ]

Correspondence: Valéria Paula Sassoli Fazan Department of Surgery and Anatomy School of Medicine of Ribeirao Preto - USP Av. Bandeirantes 3900 14049-900 Ribeirao Preto-SP Brazil Phone: (55 16)3602-2501 Fax: (55 16)3633-0017 [email protected] [email protected]

Received: August 19, 2008 Review: October 14, 2008 Accepted: November 12, 2008 Conflict of interest: none Financial source: FAPESP and CNPq

How to cite this article Silveira LA, Silveira FBC, Fazan VPS. Arterial diameter of the celiac trunk and its branches: anatomical study. Acta Cir Bras. [serial on the Internet] 2009 Jan-Feb;24(1). Available from URL: http://www.scielo.br/acb 1 Research performed at Department of Surgery and Anatomy, School of Medicine, Sao Paulo University (USP), Ribeirao Preto-SP, Brazil.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502009000100009#tit

http://www.scielo.br/acb



javascript:void(0);

javascript:void(0);

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502009000100009#tit

All the content of the journal, except where otherwise noted, is licensed under a Creative Commons License

SOBRADPEC

Al. Rio Claro, 179/14101332-010 São Paulo SP BrazilTel./Fax: +55 11 3287-8814

Bk

Ann Anat. 2009 Oct;191(4):399-407. Epub 2009 Jun 6.

Anatomic variation of the celiac trunk with special reference to hepatic artery patterns.Chen H, Yano R, Emura S, Shoumura S.

Department of Anatomy, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Japan. [email protected]

Based on a large homogeneous sample from a Japanese population, anatomic variations in the celiac trunk (CT) andthe hepatic artery were studied. Previously we analyzed the branching mode of the CT in 450 Japanese cadavers. In order to maximize the database on the CT and hepatic artery, we examined the anatomy of these arteries in 524 cadavers, a total of 974 cases. A total of 89.8% of cases showed the classical trifurcation of the CT. The typical normal patternof the CT and the hepatic artery was confirmed in 66.6% and 72.4% of the cadavers, respectively. Variant left and right

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Shoumura%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Emura%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Yano%20R%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chen%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

javascript:AL_get(this,%20'jour',%20'Ann%20Anat.');

http://creativecommons.org/licenses/by-nc/3.0/



hepatic arteries were observed in 11.0% and 4.9%, respectively. A variant anatomy involving both the left and right hepatic arteries was found in 1.5%. A common hepatosplenic trunk and a gastrohepatic trunk were seen in 4.4% and 0.3%, respectively. A common hepatic artery (CHA) arising from the superior mesenteric artery (SMA) or directly from the aorta was present in 3.5% or 0.5%, respectively. A hepatosplenomesenteric trunk and a celiomesenteric trunk were encountered in 0.7%, respectively. This anatomical update of the CT and the hepatic artery can be useful for transplantation and generalsurgeons, as well as vascular radiologists in this area.

PMID: 19540742 [PubMed - indexed for MEDLINE

Bk

J Med Assoc Thai. 2008 Nov;91(11):1748-53.

Variation of hepatic artery by3-D reconstruction MDCT scan of liver in Siriraj Hospital.Prabhasavat K, Homgade C.

Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok 10700, Thailand.

OBJECTIVE: To evaluate the prevalence of hepatic arterial variant in Siriraj Hospital. MATERIAL AND METHOD: A retrospective study that was approved by ethic committee of Siriraj Hospital. Between August and October 2006, 200 studies of abdominal MDCT were randomly sampled and multi-planar reformatted by using program Vitrea 2. Both axial, two- and three-dimensional images were evaluated for possible variants of hepatic vasculature. The results were

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Homgade%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Prabhasavat%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

javascript:AL_get(this,%20'jour',%20'J%20Med%20Assoc%20Thai.');

classified by Michel classification and analyzed in percentage. Moreover, a small group (23 studies) that had digital subtraction angiography (DSA) was compared to know accuracy and Intercorelation between the two reviewers (Kappa value). RESULTS: Of 200 studies, 83.5% had type I, 1%type II, 6% type III, 0.5% type IV, 3.5% type V, 1% type VI,0.5% type VIII, 1% type IX, 0.5% Type X, and 2.5% others type. Accuracy of MDCT for detection hepatic artery variation as compared with DSA was 78.3%. CONCLUSION: All variation is about 16%. Type III is most common variation ofpatients in Siriraj Hospital.


Bk

Morphologie. 2008 Dec;92(299):154-61. Epub 2008 Nov 12.

[Left hepatic artery: anatomical variations and clinical implications][Article in French]

Abid B, Douard R, Chevallier JM, Delmas V.

Faculté de médecine Paris-Descartes, institut d'anatomie de Paris, niversité Paris-V, 45, rue des Saints-Pères, 75005 Paris, France.

The presence of a left hepatic artery (LHA) is an anatomicalvariation related to the persistence after fetal maturation of one of the two embryonic hepatic arteries, who disappear in the modal liver arterial vascularisation (liver vascularisation by a unique hepatic artery originating from the celiac trunk). When present, LHA is originating from theleft gastric artery and runs through the pars condensa of

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Delmas%20V%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chevallier%20JM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Douard%20R%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Abid%20B%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

javascript:AL_get(this,%20'jour',%20'Morphologie.');

the lesser omentum. Its frequency is varying from 12 to 34% according to the different study methods: 14 to 27% in anatomical series, 12 to 20% in angiographic studies and 12 to 24% in liver transplantation series. Laparoscopic detection has the highest sensitivity with reported rates from 18 to 34% of cases. LHA is irrigating a variable liver territory from a part of the left lobe to the whole liver inless than 1% of cases. A satisfactory knowledge of these anatomical variations is mandatory in liver surgery and during liver transplantation but also each time the pars condensa is approached during gastric surgery, hiatal surgery for gastroesophageal reflux and for bariatric surgery. Due to existing anastomosis between liver arteries,LHA ligation is feasible in most cases with a subsequent andtransitory elevation of liver enzymes. On the contrary, in case of a unique LHA for the whole liver, the safety of its ligation is not demonstrated.


Bk

Am Surg. 2008 May;74(5):430-2.

Rare anatomic variation of left gastric artery and right hepatic artery in a female cadaver.Troupis T, Chatzikokolis S, Zachariadis M, Troupis G, Anagnostopoulou S, Skandalakis P.

Department of Anatomy, School of Medicine, University of Athens, Athens, Greece. [email protected]

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Skandalakis%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Anagnostopoulou%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Troupis%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Zachariadis%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chatzikokolis%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Troupis%20T%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

javascript:AL_get(this,%20'jour',%20'Am%20Surg.');

The present report describes a rare case in which the left gastric artery arises directly from the abdominal aorta and the right hepatic artery from the superior mesenteric artery, as observed during the dissection of a female cadaver. The left gastric artery usually rises as one of thethree branches of the celiac trunk, which was originally described by Haller in 1756, whereas the right hepatic artery usually originates from the proper hepatic artery. The knowledge of the typical anatomy of the abdominal arteries, and their variations, is especially important due to the numerous interventions performed in the abdominal area.

PMID: 18481502 [PubMed - indexed for MEDLINE]

Bk

Anat Sci Int. 2007 Mar;82(1):53-8.

A case of celiacomesenteric trunk with some other arterialanomalies in a Japanese woman.Katagiri H, Ichimura K, Sakai T.

Department of Anatomy, Juntendo University School of Medicine, Tokyo, Japan.

We found a case of multiple arterial anomalies in a Japanesefemale cadaver during a routine dissection course. In the present case, a combination of three arterial anomalies was recognized in the abdominal digestive organs: (i) a celiacomesenteric trunk; (ii) a right accessory hepatic artery; and (iii) a left colic artery arising from a portioncorresponding to the superior mesenteric artery. The typicalceliacomesenteric trunk can be regarded as a variation of the arterial convergence at its origins progressing further

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Sakai%20T%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ichimura%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Katagiri%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

javascript:AL_get(this,%20'jour',%20'Anat%20Sci%20Int.');

between the celiac trunk and the superior mesenteric artery.The celiacomesenteric trunk in the present case included theleft colic artery, which is usually one branch of the inferior mesenteric artery. Previously, a case had been reported in which all three arteries supplying the abdominaldigestive organs had converged into one trunk, the celiac-bimesenteric trunk. Therefore, the celiacomesenteric trunk in the present case showed an intermediate degree of arterial convergence between that of the typical celiacomesenteric trunk and the celiac-bimesenteric trunk.


Bk

Saudi Med J. 2006 Aug;27(8):1232-5.

Numerical variation of the celiac trunk and anatomical variation in origin and courseof the dorsal pancreatic artery.Karakose M, Peker T, Gulekon N, Yucel D, Oktem H.

Tip Fakultesi, Gazi Universitesi, Anatomi Anabilim Dali, Dekanlik Binasi 3. Kat, 06500 Besevler, Ankara, Turkey. [email protected]

A numerical anomaly of the celiac trunk and anatomical variation in origin, and course of the dorsal pancreatic artery were encountered during a routine upper abdomen dissection of a 62-year-old male cadaver. The aim of this study was to describe a rare celiac trunk and dorsal pancreatic artery variation in detail, which can be a guide

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Oktem%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Yucel%20D%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Gulekon%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Peker%20T%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Karakose%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

javascript:AL_get(this,%20'jour',%20'Saudi%20Med%20J.');

and precaution during operative procedures in this region. The abdominal aorta, its branches and the pancreas were cut and removed just above the celiac trunk and below the superior mesenteric artery to investigate the vascular distribution of the pancreas in detail. The celiac trunk divided into the left gastric, hepatic, splenic, and dorsal pancreatic arteries. The anatomical variation of the celiac trunk and splenic artery makes it vulnerable to iatrogenic surgery. Knowledge of the existing aberrations is important in planning and conducting surgical procedures.


Bk

Saudi Med J. 2005 Nov;26(11):1809-11.

Rare variation of the celiac trunk and related review.Demirtas K, Gulekon N, Kurkcuoglu A, Yildirim A, Gozil R.

Department of Anatomy, School of Medicine, Yeditepe University, Istanbul, Turkey.

In this study, we report a rare variation of the branching of the celiac trunk. During a routine abdominal dissection on a female cadaver, we found the celiac trunk to emerge from the abdominal aorta as 2 roots named hepatogastric trunk and hepatosplenic trunk. The hepatogastric trunk arises from the anterior surface of the abdominal aorta and divides into an aberrant branch to the right lobe of the liver, a branch to the right hemi diaphragm, the left hepatic and the left gastric arteries. The hepatosplenic trunk, which arises 1.5 cm below the hepatogastric trunk, gave off the common hepatic and splenic arteries. The commonhepatic artery divided into the gastroduodenal, the right branch to the hepatic and the cystic arteries. It is

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Gozil%20R%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Yildirim%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Kurkcuoglu%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Gulekon%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Demirtas%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

javascript:AL_get(this,%20'jour',%20'Saudi%20Med%20J.');

important to know the variations of hepatogastric trunk and hepatosplenic trunk for the success of surgical operations to the liver and radiological investigations of those regions.


Bk

Ann Anat. 2005 Sep;187(4):387-91.

A rare variation of the coeliac trunk.Ciçekcibaşi AE, Uysal II, Seker M, Tuncer I, Büyükmumcu M, Salbacak A.

Department of Anatomy, Meram Faculty of Medicine, Selcuk University, 42080-Konya, Turkey. [email protected]

The hepatic, splenic and Left gastric arteries are considered as the "main classic branches" of the coeliac trunk. During the routine dissections in the laboratory of the Anatomy Department in a 62-year-old male cadaver, a rarevariation, a coeliacomesenteric trunk was observed. This trunk gave rise to the left gastric, the common hepatic, thesplenic, the left gastro-epiploic, the right and left inferior phrenic arteries. The developmental and clinical significance of this anomalous vessel is discussed.


BK

Celiac Artery Compression by the Median Arcuate Ligament: A

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Salbacak%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22B%C3%BCy%C3%BCkmumcu%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Tuncer%20I%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Seker%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Uysal%20II%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ci%C3%A7ekciba%C5%9Fi%20AE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

javascript:AL_get(this,%20'jour',%20'Ann%20Anat.');

Pitfall of End-expiratory MR Imaging1

1.Vivian S. Lee , MD, PhD, 2.Joseph N. Morgan , MD, 3.Andrew G. S. Tan , MD, 4.Pari V. Pandharipande , MD, 5.Glenn A. Krinsky , MD, 6.Jonathan A. Barker , MD, 7.Calvin Lo , MD and 8.Jeffrey C. Weinreb , MD

+ Author Affiliations

1. 1From the Department of Radiology-MRI, New York University Medical Center, 530 First Ave, New York, NY 10016. Received June 9, 2002; revision requested August 14; revision received August 29; accepted October 24. Address correspondence to V.S.L. (e-mail: [email protected]).

Next Section

AbstractPURPOSE: To measure the prevalence and degree of celiac artery compression during breath-hold imaging at end inspiration and end expiration in patients referred to undergo magnetic resonance (MR) imaging of the abdomen for reasons unrelated to intestinal ischemia.

MATERIALS AND METHODS: A series of 100 patients underwent routine MR imaging of the upper abdomen at 1.5 T; imaging included multiple dynamic contrast-enhanced fat-suppressed transverse three-dimensional spoiled gradient-echo acquisitions (3.6–4.5/1.5–1.9 [repetition time msec/echo time msec], 12° flip angle). Arterial phase acquisitions were obtained during suspended respiration at end expiration

http://radiology.rsna.org/content/228/2/437.full#notes-1

http://radiology.rsna.org/content/228/2/437.full

http://radiology.rsna.org/search?author1=Jeffrey+C.+Weinreb&sortspec=date&submit=Submit

http://radiology.rsna.org/search?author1=Calvin+Lo&sortspec=date&submit=Submit

http://radiology.rsna.org/search?author1=Jonathan+A.+Barker&sortspec=date&submit=Submit

http://radiology.rsna.org/search?author1=Glenn+A.+Krinsky&sortspec=date&submit=Submit

http://radiology.rsna.org/search?author1=Pari+V.+Pandharipande&sortspec=date&submit=Submit

http://radiology.rsna.org/search?author1=Andrew+G.+S.+Tan&sortspec=date&submit=Submit

http://radiology.rsna.org/search?author1=Joseph+N.+Morgan&sortspec=date&submit=Submit

http://radiology.rsna.org/search?author1=Vivian+S.+Lee&sortspec=date&submit=Submit

http://radiology.rsna.org/content/228/2/437.full#aff-1

(n = 50) or at end inspiration (n = 50), and venous phase acquisitions were obtained at the opposite respiratory phase. Two radiologists, blinded to patient identity and thephase of respiration, independently assessed the degree of narrowing on reconstructed oblique sagittal images. Radiologists reached consensus in 97 patients, who formed the cohort for this study. The percentage of stenosis of theceliac artery relative to its origin and the angle formed bythe proximal celiac artery and the aorta were also measured in all patients. This angle and the arcsine transformation of the percentage of stenosis were compared for the two respiratory phases by using a paired Student t test. χ2 analysis was used to evaluate whether the degree of narrowing was independent of the breath-hold protocol that was used.

RESULTS: In total, 55 (57%) of 97 patients had at least mildartery narrowing at end expiration, of whom 40 (73%) had less narrowing at end inspiration and 11 (20%) had no change. The average percentage of stenosis at end expiration(21% ± 16) was significantly higher than that at end inspiration (11% ± 11; P < .001). At end expiration, the average celiac artery angle was significantly lower in patients with mild to severe narrowing (41° ± 19) than in those without narrowing (50° ± 19; P < .03).

CONCLUSION: Accentuation of celiac artery compression at endexpiration can give rise to a potential pitfall of breath-hold abdominal imaging. When compression is suspected, imaging should be performed during inspiration.

© RSNA, 2003

Arteries, celiac, 951.92 Arteries, stenosis or obstruction, 951.721 Magnetic resonance (MR), vascular studies

Previous Section Next Section

http://radiology.rsna.org/content/228/2/437.full#sec-1

http://radiology.rsna.org/content/228/2/437.full#abstract-1

http://radiology.rsna.org/search?fulltext=Magnetic+resonance+(MR),+vascular+studies&sortspec=date&submit=Submit&andorexactfulltext=phrase

http://radiology.rsna.org/search?fulltext=Arteries,+stenosis+or+obstruction,+951.721&sortspec=date&submit=Submit&andorexactfulltext=phrase

http://radiology.rsna.org/search?fulltext=Arteries,+celiac,+951.92&sortspec=date&submit=Submit&andorexactfulltext=phrase

Note in Proof© RSNA, 2003

The median arcuate ligament of the diaphragm is formed by muscular fibers that connect the right and left crura of thediaphragm, and it defines the anterior margin of the aortic hiatus. Compression of the celiac axis by this ligament is referred to as celiac artery compression syndrome or median arcuate ligament syndrome, and it has been reported to causeintestinal angina (1,2), although this diagnosis has been disputed in the surgery literature (3,4). Additionally, thisentity has been reported to predispose patients who have undergone orthotopic liver transplantation to develop hepatic artery thrombosis (5). While surgical treatment can lead to persistent clinical improvement in symptomatic patients (2), the importance of celiac artery compression inasymptomatic patients is unknown.

The character and position of the median arcuate ligament are highly variable. In an autopsy series of 75 cases, Lindner and Kemprud (6) observed that the celiac artery origin was at or above the median arcuate ligament in 33% (25 of 75) of cases. Results of conventional angiographic studies dating to the early 1970s showed that the positions of the median arcuate ligament, celiac artery, and aorta vary considerably during respiration and that median arcuateligament compression is often accentuated during expiration (7,8) (Fig 1).

http://radiology.rsna.org/content/228/2/437.full#F1

http://radiology.rsna.org/content/228/2/437.full#ref-8









http://radiology.rsna.org/content/228/2/437/F1.expansion.html

View larger version: In this page In a new window

Download as PowerPoint Slide

Figure 1. Diagram of sagittal view of abdominal aorta shows celiac artery compression by the median arcuate ligament (solid and dashed line). At expiration (Exp), the aorta and its major branches, including the celiac artery (C), move cephalad (arrow). This typically causes worsening of compression by the median arcuate ligament. (Image courtesy of Martha Helmers, BS, New York University Medical Center, New York, NY)

Abdominal imaging techniques are typically performed during suspended respiration to minimize image degradation caused by respiratory motion. By suspending respiration at end expiration, reproducibility of diaphragmatic and abdominal organ positioning can be optimized (9,10). On the basis of our clinical experience with dynamic contrast material–enhanced three-dimensional (3D) magnetic resonance (MR) imaging, we have observed that in patients who are otherwiseasymptomatic, celiac artery narrowing often manifests duringroutine MR imaging of the abdomen. The purpose of this studywas to measure the prevalence and extent of celiac artery compression during breath-hold MR imaging at end inspirationand end expiration in patients who were referred to undergo MR imaging of the abdomen for reasons unrelated to intestinal ischemia.


MATERIALS AND METHODSA series of 100 patients (54 men, 46 women; age [mean ± SD],56 years ± 13; weight, 74.7 kg ± 16.2) was evaluated by using our standard abdominal MR imaging protocol. For this study, 50 consecutive patients were initially examined by





http://radiology.rsna.org/powerpoint/228/2/437/F1



using one breath-hold protocol, and then an additional 50 consecutive subjects were examined by using the alternative breath-hold protocol. Informed consent for the administration of contrast material was obtained from each patient, and each imaging examination was performed as part of the clinical evaluation of the patient. Use of patient data for this study was granted a waiver of consent by our institutional review board. Indications for imaging includedthe following: cirrhosis (n = 26), hepatocellular carcinoma (n = 14), abnormal liver function test results (n = 5), evaluation of liver mass (n = 6), hepatitis (n = 6), biliarydisease (n = 7), metastatic disease (n = 5), pancreatic disease (n = 20), Crohn disease (n = 2), liver transplantation (n = 1), liver transplant donor (n = 1), hepatosplenomegaly (n = 1), hemochromatosis (n = 1), cholangiocarcinoma (n = 1), and gastric polyps (n = 1). In three patients, indications for imaging were unknown to us. None of the patients were suspected to have mesenteric ischemia.

MR Imaging

All patients underwent imaging at 1.5 T (Quantum or Vision; Siemens Medical Systems, Erlangen, Germany) with a torso phased-array coil. Prior to imaging, a 22-gauge intravenous catheter was placed in an arm vein and was attached to an MR-compatible power injector (Spectris; Medrad, Pittsburgh, Pa). In addition to routine breath-hold transverse T1-weighted gradient-echo imaging and short inversion time inversion-recovery fast spin-echo imaging, a series of 3D spoiled gradient-echo acquisitions was obtained in the liverand upper abdomen both before and after intravenous administration of contrast material. Evaluation of the 3D data sets formed the basis of this study.

All 3D MR imaging was performed with a transverse 3D radiofrequency-spoiled gradient-echo sequence (3.6–4.5/1.5–1.9 [repetition time msec/echo time msec], 12° flip angle) with an intermittent (once per partition loop) fat-

saturation pulse, which was modified from a sequence described in the literature (11,12). By using a field of view of 300–425 mm and an image matrix of 256 × 80–135, witha rectangular field of view optimized to patient body habitus, in-plane spatial resolution of 2.0–3.3 × 1.2–1.7 mmwas attained. Asymmetric echo sampling in the section-selectdirection was used to obtain 40–64 data points, which were then interpolated with zero filling to produce 80–128 partitions. We used slab thicknesses ranging from 160 to 260mm to ensure full coverage of the liver (including the celiac artery and superior mesenteric artery) in all cases, thereby yielding a partition thickness of 1.5–2.5 mm. Acquisition times were no more than 30 seconds (average, 21.5 seconds ± 2.1; range, 16–30 seconds).

In all patients, an unenhanced 3D acquisition was performed first and was followed by a timing examination performed according to a modification of a method described in the literature (13). In brief, a 1-mL test dose of gadopentetatedimeglumine (Magnevist; Berlex, Wayne, NJ) was administered intravenously and was followed by a 20-mL saline flush; bothwere injected at a rate of 2 mL/sec with a power injector. Repeated transverse two-dimensional magnetization-prepared spoiled gradient-echo (turbo fast low-angle shot, 5.2/3, 15°flip angle, 300-msec inversion time) imaging, which was synchronized with the injection, was performed through the aorta at a rate of one image every 2 seconds. The time to peak aortic contrast enhancement was used to determine circulation time (transit time from arm vein to aorta).

For contrast-enhanced imaging, all patients were administered 19 mL of gadopentetate dimeglumine, which resulted in an average dose of 0.12 mmol/kg (range, 0.07–0.18 mmol/kg). Four 3D acquisitions were subsequently obtained in succession; the first was timed for arterial enhancement on the basis of the test-bolus timing examination (13). Two additional 3D acquisitions were obtained, after a 45-second and an additional 90-second delay. The first three contrast-enhanced imaging sequences





were performed during suspended respiration either at end expiration (n = 50) or at end inspiration (n = 50). After anadditional 20-second delay, a fourth 3D imaging sequence wasperformed, in which the patient was instructed to suspend respiration at the opposite phase of respiration. The delaysbetween each 3D acquisition allowed patients to breathe normally and to prepare for the next breath hold. Breath-holding instructions and techniques were reviewed with each patient before the start of the examination and again duringthe examination.

Image Analysis

In all patients, the arterial phase and delayed phase volumetric 3D acquisitions were reformatted in the sagittal or oblique sagittal plane in order to view the origin and first several centimeters of the celiac artery through the midline of the vessel. This was performed by two investigators (J.N.M., A.G.S.T.) who worked together at a satellite workstation and used commercially available software (Siemens). The typically acute angle formed betweenthe aorta and the proximal celiac artery at its origin was also measured at the workstation. Reformatted images were printed on film. The craniocaudal diameter of the celiac artery was measured on the film images by using a vernier caliper (Fowler, Newton, Mass) at several locations: the origin, the narrowest point, and just beyond the narrowest point. These points were measured in all patients and at both respiratory phases. The diameter was measured orthogonal to the axis of the vessel. The window and level of film images were assigned subjectively by the two investigators. The percentage of stenosis was calculated by using the diameter at the point of greatest narrowing divided by the diameter at the celiac artery origin. If ostial stenosis was present, the percentage of stenosis was determined by using the diameter of the vessel distal to thestenosis as reference. Each of two radiologists (G.A.K., J.A.B.), who were blinded to patient identity and to the phase of respiration, graded the degree of narrowing on the

following scale: none, minimal, mild, mild to moderate, moderate, and severe. Graders were instructed that the five abnormal grades should reflect quintiles of stenosis (1%–20%, 20%–40%, 40%–60%, 60%–80%, >80%). Prior to grading, thetwo radiologists also reviewed a range of clinical studies together to reach agreement on definitions of each grading category. Once independent grading was performed, discrepancies were resolved by consensus, and consensus readings were used for data analysis.

The following additional findings were also considered by the two graders, and consensus observations were used: poststenotic dilatation in the celiac artery, presence of collateral vessels, presence of atheromatous plaque of the aorta, and stenosis of the superior mesenteric artery.

Data Analysis

Of the 100 patients who underwent imaging, three were excluded from analysis for reasons that included inability of the patient to suspend respiration (n = 1) and inability of the graders to reach consensus in interpretation of the images (n = 2). Results from the remaining 97 patients (51 men, 46 women; average age, 56 years ± 13) were used for analysis. The prevalence of celiac artery narrowing at end-inspiratory and end-expiratory imaging was calculated. The celiac artery-aorta angles for the two phases of respirationwere compared by using a paired Student t test. The distribution of data on the percentage of stenosis was skewed and therefore subject to arcsine transformation in order to approximate a normal distribution before application of a paired Student t test to compare the stenosis for the two phases of respiration. Patients were also assigned to one of two subgroups: those with at least mild celiac artery narrowing during end expiration and thosewith minimal or no narrowing. Patient age and weight and theceliac artery-aorta angle were compared between the two groups by using a Student t test. In 49 of the 97 patients, end-expiratory imaging was performed during arterial phase

enhancement; this was followed by end-inspiratory imaging performed during delayed venous phase enhancement. In the remaining 48 patients, this protocol was reversed. To evaluate whether observations of celiac artery narrowing (subjective categories) were independent of the protocol used, a χ2 analysis was performed.


RESULTSThe prevalence of celiac artery narrowing in our population is given in Table 1. Of the 97 patients in whom consensus readings were reached, 55 (57%) had at least mild celiac artery narrowing on end-expiratory imaging; 16 patients (16%) had moderate or severe narrowing. When measured at endinspiration, 39 (40%) of all patients had at least mild celiac artery narrowing. Of the 55 patients with at least mild narrowing at end expiration, 40 (73%) demonstrated lessnarrowing at end inspiration (Figs 2, 3) and 11 (20%) demonstrated no change.

View this table: In this window In a new window

TABLE 1. Degree of Celiac Artery Narrowing at Breath-hold MRImaging

http://radiology.rsna.org/content/228/2/437/T1.expansion.html




http://radiology.rsna.org/content/228/2/437.full#T1






Figure 2a. Sagittal reconstructions of contrast-enhanced 3D MR angiograms (4.5/1.9, 12° flip angle) show moderate celiacartery narrowing in a 52-year-old man suspected of having hepatocellular carcinoma. Images obtained during suspended respiration at (a) end expiration (arterial phase acquisition) and (b) end inspiration (venous phase acquisition) show that focal narrowing at the origin of the celiac artery (arrow, a) is seen only at end expiration (a).



Figure 2b. Sagittal reconstructions of contrast-enhanced 3D MR angiograms (4.5/1.9, 12° flip angle) show moderate celiacartery narrowing in a 52-year-old man suspected of having hepatocellular carcinoma. Images obtained during suspended respiration at (a) end expiration (arterial phase acquisition) and (b) end inspiration (venous phase acquisition) show that focal narrowing at the origin of the celiac artery (arrow, a) is seen only at end expiration (a).










Figure 3a. Sagittal reconstructions of contrast-enhanced 3D MR angiograms (4.5/1.9, 12° flip angle) show mild to moderate celiac artery narrowing in a 65-year-old man with hepatocellular carcinoma. Images obtained during suspended respiration at (a) end expiration (venous phase) and (b) endinspiration (arterial phase) show narrowing of the origin ofthe celiac artery (arrowheads, a) at end expiration, which is improved at end inspiration.











Figure 3b. Sagittal reconstructions of contrast-enhanced 3D MR angiograms (4.5/1.9, 12° flip angle) show mild to moderate celiac artery narrowing in a 65-year-old man with hepatocellular carcinoma. Images obtained during suspended respiration at (a) end expiration (venous phase) and (b) endinspiration (arterial phase) show narrowing of the origin ofthe celiac artery (arrowheads, a) at end expiration, which is improved at end inspiration.

Approximately half of all patients underwent end-expiratory imaging during the arterial phase of contrast enhancement and end-inspiratory imaging during the venous phase (n = 49), while the remaining patients (n = 48) underwent the reverse protocol. In total, 30 (61%) of 49 patients who underwent arterial phase end-expiratory imaging had at leastmild narrowing, and 19 (63%) of these 30 demonstrated less narrowing at venous phase end-inspiratory imaging (Fig 2). Of the 48 patients who underwent venous phase end-expiratoryimaging, 25 (52%) had at least mild celiac narrowing, and, of these, 21 (84%) demonstrated less narrowing at arterial phase end-inspiratory imaging (Fig 3). By using χ2 analysis,the presence of celiac artery narrowing during end-expiratory imaging was determined to be independent of the phase of vascular enhancement (P > .2).

The percentage of celiac artery stenosis, which was measuredrelative to the diameter of the celiac artery origin, averaged 21% ± 16 during end expiration. During end inspiration, the percentage of celiac artery stenosis was significantly lower and averaged 11% ± 11 (P < .001). Imagesin a total of 22 patients (23%) demonstrated a change in thepercentage of stenosis between inspiratory and expiratory imaging that measured greater than or equal to 20%; in only three of these patients was the degree of stenosis greater at end inspiration than at end expiration (Fig 4).






Figure 4. Change in percentage of celiac artery stenosis between end expiration and end inspiration among subset of 22 patients who had at least 20% change. In three patients ( ), the degree of stenosis increased at end inspiration, ♦while the remaining 19 patients (▪) had markedly less stenosis at end inspiration.

The angle between the celiac artery and the aorta did not differ significantly between end expiration (45° ± 19) and end inspiration (40° ± 15, P > .05). At end expiration, however, the average celiac artery angle was significantly lower in those patients with mild to severe celiac artery narrowing (41° ± 19) than in those with minimal or no narrowing (50° ± 19, P = .02).

The data were further analyzed by assigning patients to one of two groups: those with at least mild celiac artery narrowing during end expiration (n = 55, 27 men and 28 women) and those with minimal or no narrowing (n = 42, 24 men and 18 women). In those with at least mild narrowing, the average percentage of celiac artery stenosis was significantly higher at end expiration than at end inspiration (P < .01) (Table 2). There was no significant difference between average age of the two groups: 56.2 years± 12.0 for those with narrowing versus 55.4 years ± 14.6 forthose without narrowing (P = .8). Those patients with at least mild narrowing weighed on average slightly less (73.9 kg ± 17.3, versus 75.9 kg ± 14.7 for those with minimal or

http://radiology.rsna.org/content/228/2/437.full#T2





no narrowing), although this difference did not achieve statistical significance (P > .1).

View this table: In this window In a new window

TABLE 2. Percentage of Celiac Artery Stenosis at Breath-holdMR Imaging

There were 14 patients (14%) who demonstrated greater celiacartery narrowing at inspiratory imaging than at expiratory imaging: seven with mild narrowing at end inspiration versusno narrowing at end expiration, three with at least mild to moderate narrowing versus no narrowing, and four with moderate narrowing versus mild narrowing.

Additional findings were uncommon. Poststenotic dilatation was recorded in three patients: two with severe narrowing atend expiratory imaging and one with moderate narrowing. In all, the dilatation persisted at end-inspiratory imaging. Inone patient, the severe narrowing remained unchanged at inspiratory imaging. In the remaining two patients, the narrowing decreased to mild narrowing at inspiration. Collateral vessels were not identified in any patients. Atheromatous plaque in the aorta was noted in five patients;in one, the plaque extended into the orifice of the celiac artery and resulted in fixed severe narrowing at end-inspiratory and end-expiratory imaging. The superior mesenteric artery was without stenosis in all patients.


DISCUSSIONCompression of the celiac artery by the median arcuate ligament is a well-documented anatomic variant, reportedly seen in 12.5%–49.7% of patients (4,14). The compression is thought to be due in part to the variable migration of the







celiac trunk origin during embryogenesis, and patients with celiac artery narrowing tend to be thinner than those without stenosis (6). The clinical manifestations of celiac artery compression syndrome are often vague and may include postprandial pain and an abdominal bruit. The diagnosis may rely on findings at imaging; however, differentiation between clinically relevant celiac artery compression and incidental narrowing may be difficult (4). When additional findings such as poststenotic dilatation are present at imaging, it can be strongly suggestive of true celiac arterycompression syndrome.

The accentuation of celiac artery compression during deep expiration has been identified at lateral angiography performed in patients with abdominal bruit or abdominal symptoms (7). In one case, Erden et al (15) used Doppler sonography to document increases in flow velocities during end expiration. In 1973, Reuter and Bernstein (8) studied eight patients in whom surgical clips had been placed along the free edge of the median arcuate ligament during abdominal operations. By observing the respiratory motion ofthe clips at fluoroscopy, the investigators found that the ligament, aorta, and celiac artery moved caudad during inspiration and cephalad during expiration in all patients (Fig 1). The relative motion of each structure caused the celiac artery and median arcuate ligament to move toward each other during expiration, which accentuated celiac artery compression in most cases.

To achieve improved reproducibility, MR imaging of the chestand abdomen and MR angiography of the torso are frequently performed during suspended respiration at end expiration (9,10). Reproducibility may be important in several clinicalscenarios. In the evaluation of renal masses, for example, the detection of enhancing components may depend on accuratesubtraction if the lesions are small or already hyperintenseon unenhanced images (16). MR angiographic images are typically reconstructed by using maximum intensity projection reconstructions of subtracted data sets;










subtraction improves image quality by minimizing signal contributions from background tissues (17). Although patients are typically able to suspend respiration for a shorter duration at end expiration, the improved consistencyof end-expiratory imaging has been thought to outweigh this disadvantage.

The results of our study suggest an additional disadvantage to end-expiratory imaging of the abdomen. In 97 patients whowere referred to undergo abdominal MR imaging for reasons other than suspected mesenteric ischemia, 46 (46%) were found to have mild to moderate celiac artery narrowing and nine (9%) were found to have severe narrowing at MR imaging during suspended respiration at end expiration; the degree of narrowing lessened considerably in the majority of patients (40 of 55, 73%) when imaging was performed at end inspiration. It is possible that some of these patients withsubstantial compression had unreported clinical symptoms attributable to celiac insufficiency, but for the majority of patients, the celiac artery compression should be considered a false-positive finding. The paucity of additional findings such as poststenotic dilatation (n = 3, 3%) supports this assessment.

There are recognized limitations to our study. First, our study was performed retrospectively, which introduces possible bias in the interpretation. To minimize this effect, the two independent readers were blinded to the phase of respiration and to patient identity. Second, to assess the caliber of the celiac artery, we performed sagittal or oblique sagittal reconstructions of transverse 3D source data. The near isotropic pixels achieved with interpolation allowed for reconstructed images with comparable apparent in-plane resolution (11,12). Third, to compare different phases of respiration, we used the first and fourth contrast-enhanced acquisitions, which resulted ina decline in contrast enhancement on the latter acquisitions. However, because the order of breath holding was reversed for the second group of 50 patients in this




study, the effects of reduced image quality did not bias ourresults. Fourth, we were unable to verify the degree of cooperation with breath-holding instructions that patients were able to achieve. Our technologists are skilled in instructing and practicing breath-holding techniques with patients, and in all cases, breath-holding instructions werereviewed both before and during the examination. As discussed previously, although we excluded patients known tohave or suspected of having mesenteric ischemia, patients with occult cases may have inadvertently been included in this series. If this occurred, the number of patients would likely be small, and the effects on our results would be negligible. Last, conventional contrast-enhanced angiography, which is considered a reference standard for vascular disease, was not available in this population.

We conclude that when celiac artery compression syndrome is suspected on the basis of end-expiratory imaging, findings should be correlated with clinical history and results of physical examination and, if clinically indicated, confirmedwith imaging at end inspiration. In patients suspected of having mesenteric ischemia, imaging of the abdominal aorta should be performed exclusively at end inspiration. Techniques such as MR image measurements of blood-oxygen saturation in mesenteric veins may be useful as a means of determining the physiologic significance of celiac artery narrowing, and these techniques deserve further investigation (18).

Previous Section Next Section Previous Section Next Section

Note in Proof© RSNA, 2003


Footnotes

http://radiology.rsna.org/content/228/2/437.full#ref-list-1


http://radiology.rsna.org/content/228/2/437.full#fn-group-1





Abbreviation: 3D = three-dimensional Author contributions: Guarantor of integrity of entire

study, V.S.L.; study concepts and design, V.S.L., J.N.M., A.G.S.T.; literature research, J.N.M., V.S.L.; clinical studies, J.N.M., A.G.S.T., P.V.P., J.A.B.; statistical analysis, V.S.L.; manuscript definition of intellectual content, V.S.L., J.C.W.; data acquisition and analysis/interpretation, all authors; manuscript preparation, editing, revision/review, and final version approval, all authors

Previous Section

References1.↵

Dunbar JD, Molnar W, Beman FF, Marable SA. Compression of the celiac trunk and abdominal angina: preliminary report of 15 cases. AJR Am J Roentgenol 1966; 95:731-744.

2.↵

Reilly LM, Ammar AD, Stoney RJ, Ehrenfeld WK. Late results following operative repair for celiac artery compression syndrome. J Vasc Surg 1985; 2:79-91.

CrossRef Medline Web of Science

3.↵

Cornell SH. Severe stenosis of the celiac artery. Analysis of patients with and without symptoms. Radiology 1971; 99:311-316.

Medline Web of Science

http://radiology.rsna.org/external-ref?access_num=A1971I949000009&link_type=ISI

http://radiology.rsna.org/external-ref?access_num=5553563&link_type=MED

http://radiology.rsna.org/content/228/2/437.full#xref-ref-3-1

http://radiology.rsna.org/external-ref?access_num=A1985AAR0800009&link_type=ISI


http://radiology.rsna.org/external-ref?access_num=10.1067/mva.1985.avs0020079&link_type=DOI



http://radiology.rsna.org/content/228/2/437.full#fn-group-1

4.↵

Szilagyi DE, Rian RL, Elliott JP, Smith RF. The celiac artery compression syndrome: does it exist? Surgery 1972; 72:849-863.


5.↵

Jurim O, Shaked A, Kiai K, Millis JM, Colquhoun SD, Busuttil RW. Celiac compression syndrome and liver transplantation. Ann Surg 1993; 218:10-12.

Medline

6.↵

Lindner HH, Kemprud E. A clinicoanatomical study of the arcuate ligament of the diaphragm. Arch Surg 1971; 103:600-605.

Abstract / FREE Full Text

7.↵

Reuter SR. Accentuation of celiac compression by the median arcuate ligament of the diaphragm during deep expiration. Radiology 1971; 98:561-564.

Medline

8.↵

Reuter SR, Bernstein EF. The anatomic basis for respiratory variation in median arcuate ligament compression of the celiac artery. Surgery 1973; 73:381-385.




http://radiology.rsna.org/cgi/ijlink?linkType=ABST&journalCode=archsurg&resid=103/5/600




http://radiology.rsna.org/external-ref?access_num=A1972O158100004&link_type=ISI




9.↵

Holland AE, Goldfarb JW, Edelman RR. Diaphragmatic and cardiac motion during suspended breathing: preliminary experience and implications for breath-hold MR imaging. Radiology 1998; 209:483-489.


10. ↵

Katsuda T, Kuroda C, Fujita M. Reducing misregistration of mask image in hepatic DSA. Radiol Technol 1997; 68:487-490.

11. ↵

Rofsky NM, Lee VS, Laub G, et al. Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology 1999; 212:876-884.


12. ↵

Lee VS, Lavelle MT, Rofsky NM, et al. Hepatic MR imaging with adynamic contrast-enhanced isotropic volumetric interpolated breath-hold examination: feasibility, reproducibility, and technical quality. Radiology 2000; 215:365-372.


13. ↵

Earls JP, Rofsky NM, DeCorato DR, Krinsky GA, Weinreb JC. Hepatic arterial-phase dynamic gadolinium-enhanced MR


http://radiology.rsna.org/cgi/ijlink?linkType=ABST&journalCode=radiology&resid=215/2/365







http://radiology.rsna.org/external-ref?access_num=A1973O969100009&link_type=ISI


imaging: optimization with a test examination and a power injector. Radiology 1997; 202:268-273.


14. ↵

Bron KM, Redman HC. Splanchnic artery stenosis and occlusion:incidence, arteriographic and clinical manifestations. Radiology1969; 92:323-328.


15. ↵

Erden A, Yurdakul M, Cumhur T. Marked increase in flow velocities during deep expiration: a duplex Doppler sign of celiac artery compression syndrome. Cardiovasc Intervent Radiol 1999; 22:331-332.


16. ↵

Lee VS, Flyer MC, Weinreb JC, Krinsky GA, Rofsky NM. Image subtraction in gadolinium-enhanced magnetic resonance imaging. AJR Am J Roentgenol 1996; 167:1427-1432.


17. ↵

Adamis MK, Li W, Wielopolski PA, et al. Dynamic contrast-enhanced subtraction MR angiography of the lower extremities:initial evaluation with a multisection two-dimensional time-of-flight sequence. Radiology 1995; 196:689-695.


http://radiology.rsna.org/cgi/ijlink?linkType=ABST&journalCode=ajronline&resid=167/6/1427


http://radiology.rsna.org/external-ref?access_num=000081733100013&link_type=ISI



http://radiology.rsna.org/external-ref?access_num=A1969C780000018&link_type=ISI





18. ↵

Li KC, Dalman RL, Ch’en IY, et al. Chronic mesenteric ischemia: use of in vivo MR imaging measurements of blood oxygen saturation in the superior mesenteric vein for diagnosis. Radiology 1997; 204:71-77.



Dm than tang

Text of Dm than tang

1993b-Dia tang Devon Tong Vai - Ban Thang

Lap terapi dm

DM 181, S. 2020-4o8s7zrwr48s55l.pdf - DepEd Quezon

Track2 - 1620 DM-AM Tips n Tricks AW

DYNASERV - DD Servo-Actuator DM/SD Series - Yokogawa

dm 704-21.pdf - DepEd Quezon

STT theo DM của BYT

A Religious Leader in the Tang: Chengguan’s Biography

POO DM *** * -****** * - ERIC

BEIJING TONG REN TANG CHINESE MEDICINE COMPANY

More Different than Life, Less Different than Death

dm{f H ”{VdoXZ Annual Report - krishi icar

DM-45 Digital Multimeter Multímetro digital Multimètre

DOMITOP F24 D (3 stelle) - DM Guimur

I (M + dM) ⋅ S Iz ∫ y ⋅ dA = I I (M + dM) ⋅ S Iz

276,41 dm 319,94 dm 350,31 dm 275,44 dm , , AA AB AD

Interactive BIOS simulator HP ProDesk 600 G6 DM

DM-TX-200-2G/400-3G - Crestron

BAB 1-2 DM

THAN ANY RADIO

DM 204, S. 2022 - DepEd Quezon

DM-4000A - ECM Industries

Tang Junyi and Nishitani keiji between Philosophy and religion

Final Result DM-July-18-NET.pdf - AIIMS

DM No. 114 s. 2020 - DepEd Sagay City

Hegazy DM - University of Plymouth PEARL

LAPORAN PENDAHULUAN DM GERONTIK

Digital Microscope OPTIKA DM-25

RESOLUCION MINISTERIAL N° 000164-2022-DM/MC

2 Kamarkhanda Upazila DM Plan

Documents

Dm than tang

Text of Dm than tang