Anat Cell Biol.  2024 Sep;57(3):353-362. 10.5115/acb.23.316.

Prevalence of anatomical variants in the branches of celiac and superior mesenteric arteries among Egyptians

• Sheta AA

• KMID: 2559748
• DOI: http://doi.org/10.5115/acb.23.316

Abstract

Celiac trunk and superior mesenteric artery (SMA) are the main blood supply to the liver and pancreas. The data of anatomical variations in these arteries or their branches are very important clinically and surgically. The aim of this study was to describe the different variants in these arteries through the examination of the angiographs of a large series of Egyptian individuals. This research involved 389 selective angiographies to celiac artery, its branches, and the SMA. Anatomy of the target arteries of people who experienced visceral angiograph was reviewed and the data were recorded. From the total available angiograms in this work, 286 patients (73.52%) had the standard anatomy of celiac trunk and superior mesenteric arteries, and 103 patients (26.47%) had a single or multiple vessel variation. The inferior phrenic artery originates from celiac trunk in 2.05% of patients, while quadrifurcation of the celiac trunk was noticed in only 0.51% of patients. Absence of celiac trunk is also found in 0.51% of patients. Left gastric artery showed an abnormal origin from the splenic artery in 0.51% of patients. Quadrifurcation of common hepatic artery was also noticed. Variant anatomy of the left hepatic artery (LHA) was seen in 9.51% of patients, while variations of the right hepatic artery (RHA) were 14.13%. With the different origin of hepatic arteries, the gastroduodenal artery arose either from the LHA (2.82%), RHA (2.31%) or even from the celiac trunk (1.79%).

Keyword

Celiac trunk; Superior mesenteric artery; Common hepatic artery; Anatomical variants

Figure

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  Fig. 1 Anteroposterior angiogram (A) showing the standard anatomy of the celiac axis. The celiac trunk gives splenic artery (S), the CHA and the LGA. Notice the GDA, proper hepatic artery that divides into RHA and LHA. Sub image (B) is a schematic diagram showing the standard anatomy of the celiac axis. Ao, aorta; LGA, left gastric artery; GDA, gastroduodenal artery; RHA, right hepatic artery; LHA, left hepatic artery; CHA, common hepatic artery.

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  Fig. 2 (A) Anteroposterior angiogram of celiac axis showing the splenic artery (S), the CHA, the LGA, and the right inferior phrenic artery (Inf) branching from celiac trunk. Notice the GDA, the dorsal pancreatic branch (DP) of the splenic artery and an MHA branching from the RHA. Sub image (B) is a schematic diagram showing the anatomical variants. CHA, common hepatic artery; LGA, left gastric artery; GDA, gastroduodenal artery; MHA, middle hepatic artery; RHA, right hepatic artery; LHA, left hepatic artery; Ao, aorta.

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  Fig. 3 (A) Anteroposterior angiogram of the celiac axis showing quadrifurcation of the celiac trunk into RHA, common origin of LHA, LGA, GDA, and splenic artery (S). Notice the MHA originating from the GDA. Sub image (B) is a schematic diagram showing the anatomical variants. RHA, right hepatic artery; LHA, left hepatic artery; LGA, left gastric artery; GDA, gastroduodenal artery; MHA, middle hepatic artery; Ao, aorta.

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  Fig. 4 Anteroposterior angiograms of the same patient showing absence of celiac trunk with separate origin of the splenic artery (S) from aorta (A), and replaced RHA to the SMA (B). Sub image (C) is a schematic diagram showing the anatomical variants. RHA, right hepatic artery; SMA, superior mesenteric artery; Ao, aorta.

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  Fig. 5 (A) Anteroposterior angiograms of the same patient showing separate origin of splenic artery (S) from aorta, the common origin of CHA and SMA forming a hepatomesenteric trunk (B); and quadrifurcation of the CHA into RHA, LHA, MHA, and GDA (C). Sub image (D) is a schematic diagram showing the anatomical variants. CHA, common hepatic artery; SMA, superior mesenteric artery; RHA, right hepatic artery; LHA, left hepatic artery; MHA, middle hepatic artery; GDA, gastroduodenal artery; Ao, aorta.

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  Fig. 6 (A) Anteroposterior angiograms of the same patient showing replacement of the PHA to the SMA and its division into RHA and LHA. The celiac axis gives GDA from which a small MHA arises (B). Sub image (C) is a schematic diagram showing the anatomical variants. PHA, proper hepatic artery; SMA, superior mesenteric artery; RHA, right hepatic artery; LHA, left hepatic artery; GDA, gastroduodenal artery; MHA, middle hepatic artery; S, splenic artery.

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  Fig. 7 (A) Anteroposterior angiogram of the celiac axis showing replacement of the LHA to the LGA. The RHA arises from the celiac trunk and gives the GDA branch. Sub image (B) is a schematic diagram showing the anatomical variants. LHA, left hepatic artery; LGA, left gastric artery; RHA, right hepatic artery; GDA, gastroduodenal artery; Ao, aorta; S, splenic artery.

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  Fig. 8 (A) Anteroposterior angiograms of the same patient showing replacement of the LHA to the LGA with the GDA arising from the celiac trunk and giving the MHA. Replacement of the RHA to the SMA is also seen (B). Sub image (C) is a schematic diagram showing the anatomical variants. LHA, left hepatic artery; LGA, left gastric artery; GDA, gastroduodenal artery; MHA, middle hepatic artery; RHA, right hepatic artery; SMA, superior mesenteric artery; Ao, aorta; S, splenic artery.

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  Fig. 9 (A) Anteroposterior angiograms of the same patient showing the LHA originating from the celiac trunk and giving GDA branch, while the RHA is replaced to the aorta (B). Sub image (C) is a schematic diagram showing the anatomical variants. LHA, left hepatic artery; GDA, gastroduodenal artery; RHA, right hepatic artery; LGA, left gastric artery; Ao, aorta; S, splenic artery.

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  Fig. 10 (A) Anteroposterior angiogram showing the RHA and the LHA originating from celiac trunk (double hepatic artery). Notice the GDA branching from the LHA. Sub image (B) is a schematic diagram showing the anatomical variants. RHA, right hepatic artery; LHA, left hepatic artery; GDA, gastroduodenal artery; Ao, aorta; S, splenic artery.

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  Fig. 11 (A) Anteroposterior angiograms of the same patient showing RHA and the LHA originating from the celiac trunk (double hepatic) with the GDA arising from the RHA. An accessory RHA is seen originating from the SMA (B). Sub image (C) is a schematic diagram showing the anatomical variants. RHA, right hepatic artery; LHA, left hepatic artery; GDA, gastroduodenal artery; SMA, superior mesenteric artery; S, splenic artery.

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  Fig. 12 (A) Anteroposterior angiograms of the same patient showing the LHA giving GDA and a small accessory RHA. Another accessory RHA is seen originating from the SMA (B). Sub image (C) is a schematic diagram showing the anatomical variants. LHA, left hepatic artery; GDA, gastroduodenal artery; RHA, right hepatic artery; SMA, superior mesenteric artery.

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  Fig. 13 Anteroposterior angiograms of the same patient showing the LHA arising from the celiac trunk and giving the GDA. The LGA appeared arising from the splenic artery (S) while the RHA was not depicted (A). The RHA was replaced to the SMA (B). Sub image (C) is a schematic diagram showing the anatomical variants. LHA, left hepatic artery; GDA, gastroduodenal artery; LGA, left gastric artery; RHA, right hepatic artery; SMA, superior mesenteric artery.

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  Fig. 14 (A) Anteroposterior angiogram showing the late origin of GDA arising just distal to the origin of LHA. Sub image (B) is a schematic diagram showing the anatomical variants. RHA, right hepatic artery; GDA, gastroduodenal artery; LHA, left hepatic artery; CHA, common hepatic artery.

Reference

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