Variations of celiac axis, common hepatic artery and its branches in 600 patients

Abstract

Purpose: To evaluate the spectrum of celiac axis, common hepatic artery (CHA), right, left, middle hepatic artery and gastroduodenal artery variations by using spiral computed tomography (CT). Materials and Methods: A retrospective review of Multidetector CT (MDCT) abdominal angiography scans was performed in patients sent for various liver and other abdominal pathologies between January 2012 and February 2013. A total of 600 patients were evaluated. Definitions of CHA, ambiguous celiac axis, course and division patterns of CHA, replaced hepatic artery, accessory hepatic artery and middle hepatic artery were used as proposed by Song et al., Covey et al., and Wang et al. The pattern of the aortic origin of branches of celiac axis, common hepatic artery and its branches was analyzed. Results: Six types of celiac axis anatomic variations were identified in our study. A total of 546 of the 600 patients had a normal celiac axis anatomy. Anatomic variations were seen in 5.5% of patients. Ambiguous anatomy was seen in 3.5% of the patients. CHA originated from celiac axis in 95.83% of the patients. Variations in anatomic origin of CHA were seen in 8 patients. Ambiguous dual pathway was seen in 4 patients. Normal Sp-preportal course of CHA was identified in 97.78% of cases, Sp-retroportal course in 7 patients, Tp-preportal course in 2, Tp-retroportal in 1, Ip-preportal in 1 and through Ligamentum venosum in 2 patients. Normal origin of RHA from HAP was seen in 79.6% patients. Replaced origin of RHA was seen in 15.16% cases and Accessory origin of RHA was seen in 5.16% cases. LHA originated from HAP in 81.5% patients. Replaced LHA origin was seen in 10.8% cases and Accessory LHA origin seen in 7.6% cases. MHA originated from RHA in 41.3% patients, LHA in 27.83% and from CHA in 4.5% cases. Origin of MHA could not be defined in 26.3% of patients. GDA originated from CHA in 97.6% of patients, from celiac axis in 1.6%, from RHA in 0.33% in patients. Trifurcation of CHA was seen in 7.16% and quadrifurcation of CHA in 2.16%. Conclusion: CT Angiography is a safe and highly sensitive and accurate modality for evaluation of arterial anatomy and its variants.

Keywords

Abdominal angiography - accessory - ambiguous celiac axis - celiac axis - common hepatic artery - replaced hepatic artery

• References

• 1 Michel NA. Observatons on the blood supply of the liver and gallbladder (200 dissections). Blood supply and anatomy of the upper abdominal organs, with a descriptive atlas. Philadelphia, Pa: Lippincott;1955. p. 64-9.
• 2 Vandamme JP, Bonte J, Van der Scheueren G. A reevaluation of hepatic and cystic arteries: The importance of aberrant hepatic branches. ActaAnat 1969;73:192-209.
• 3 Suzuki T, Nakayasu A, Kawabe K, Takeda H, Honjo I.Surgical significance of anatomic variations of the hepatic artery. Am J Surg 1971;122:505-12.
• 4 Song SY, Chung JW, Yin YH, Jae HJ, Kim HC, Jeon UB, et al. Celiac axis and common hepatic artery variations in 5002 patients: Systematic analysis with spiral CT and DSA.Radiology 2010;255:278-88.
• 5 Catalano OA, Singh AH, Uppot RN, Hahn PF, Ferrone CR, Sahani DV. Vascular and biliary variants in the liver: Implications for liver surgeryRadioGraphics 2008;28:359-78.
• 6 Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial anatomy revisited: Digital subtraction angiography performed in 600 patients.Radiology 2002;224:542-7.
• 7 Wang S, He X, Li Z, Peng Z, Tam NL, Sun C, et al. Characterization of the middle hepatic artery and its relevance to living donor liver transplantation. Liver Transpl 2010;16:736-41.
• 8 Tandler J. Über die Varietäten der Arteria coeliaca und deren Entwickelung. AnatHefte 1904;25:473-500.
• 9 Morita M. Reports and conception of three anomalous cases in the area of the celiac and superior mesenteric arteries [in Japanese]. Igaku Kenkyu 1935;9:1993-2006.
• 10 Nebesar RA, Kornblith PL, Pollard JJ, Michels NA. Celiac and superior mesenteric arteries: A correlation of angiograms with dissections Boston Little, Brown ; 1969.
• 11 Gordon DH, Martin EC, Kim YH, Kutcher R. Accessory blood supply to the liver from the dorsal pancreatic artery: an unusual anatomic variant. Cardiovasc Radiol 1978;1:199-201.
• 12 Browne EZ. Variations in origin and course of the hepatic artery and its branches. Surgery 1940;8:424-45.
• 13 Daseler EH, Anson BJ, Hambley WC, Reimann AF. The cystic artery and constituents of the hepatic pedicle: A study of 500 specimens. Surg Gynecol Obstet 1947;85:47-63.
• 14 Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1966;112:337-47.
• 15 Zanon C, Grosso M, Clara R, et al. Percutaneous implantation of arterial port-acath via trans-subclavian access. Anticancer Res 1999;19:5667-71.
• 16 Blumgart L, Fong Y. Surgery of the liver and biliary tract. New York, NY: Saunders; 2000. p. 1625-8.
• 17 Ishigami K, Zhang Y, Rayhill S, Katz D, Stolpen A. Does variant hepatic artery anatomy in a liver transplant recipient increase the risk of hepatic artery complications after transplantation? AJR Am J Roentgenol2004;183:1577-84.
• 18 Thomas PG, Baer HU, Matthews JB, Gertsch P, Blumgart LH. Post-operative hepatic necrosis due to reduction in hepatic arterial blood flow during surgery for chronic biliary obstruction. Dig Surg1990;7:31-5.