ANATOMICAL VARIANTS OF CELIAC TRUNK, HEPATIC AND RENAL ARTERIES IN A POPULATION OF DEVELOPING COUNTRY USING MULTIDETECTOR COMPUTED TOMOGRAPHY ANGIOGRAPHY
AbstractBackground: Multidetector Computed Tomography (MDCT)s has become a major part in evaluation of hepatic and renal tumours. With improvements in MDCT, CT angiography has also improved and normal anatomy and its variants in patients undergoing operative or interventional procedures can be effectively studied. The purpose of this study was to evaluate the frequency of anatomical variation of celiac trunk, hepatic and renal arterial systems in patients undergoing multidetector CT (MDCT) angiography of the abdominal aorta. Methods: A descriptive, retrospective cross-sectional study was carried out on CT angiographies performed during the months of October till December 2015. Hepatic and renal arteries and celiac trunk were studied and normal and anatomical variations were noted. All patients with abnormalities affecting the vessels or a history of any vascular abnormality were excluded from the study. Results: Out of total 110 patients, 69.1% had normal and 30.9% had variant hepatic artery with Michel Type IV being the most common variant whereas 88.2% had normal celiac trunk and 8.2% had gastrosplenic trunk variant. Variation in renal arterial system was observed in 15.5% of the patients with two renal arteries on right and two on left being the most common type. Multiple variants were identified in 11.8% of the patients. Conclusion: The type and knowledge of anatomy is of prime importance for an optimum preoperative planning in surgical or radiological procedure. MDCT allows minimally invasive assessment of arterial anatomy with high quality 3D reconstruction images.Keywords: Hepatic artery variant; Renal artery variant; Celiac trunk; Variations; Multidetector Computed tomography; MDCT
Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1996;112(3):337–47.
Uflacker R. Atlas of vascular anatomy. An angiographic approach. Philadelphia. PA: Lippincott Williams; 1997.
Rela M, McCall JL, Karani J, Heaton ND. Accessory right hepatic artery arising from the left: implications for split liver transplantation. Transplantation 1998;66(6):792–4.
Catalano OA, Singh AH, Uppot RN, Hahn PF, Ferrone CR, Sahani DV. Vascular and Biliary Variants in the Liver: Implications for Liver Surgery. Radiographics 2008;28(2):359–78.
Malnar D, Klasan GS, Miletic D, Bajek S, Vranić TS, Arbanas J, et al. Properties of the celiac trunk– anatomical study. Coll Antropol 2010;34(3):917–21.
Chen H, Yano R, Emura S, Shoumura S. Anatomic variation of the celiac trunk with special reference to hepatic artery patterns. Ann Anat 2009;191(4):399–407.
Prakash, Rajini T, Mokhasi V, Geethanjali BS, Sivacharan PV, Shashirekha M. Coeliac trunk and its branches: anatomical variations and clinical implications. Singapore Med J 2012;53(5):329–31.
Willmann JK, Baumert B, Schertler T, Wildermuth S, Pfammatter T, Verdun FR, et al. Aortoiliac and Lower Extremity Arteries Assessed with 16–Detector Row CT Angiography: Prospective Comparison with Digital Subtraction Angiography. Radiology 2005;236(3):1083–93.
Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, et al. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol 2010;83(992):661–7.
Winston CB, Lee NA, Jarnagin WR, Teitcher J, DeMatteo RP, Fong Y, et al. CT angiography for delineation of celiac and superior mesenteric artery variants in patients undergoing hepatobiliary and pancreatic surgery. AJR Am J Roentgenol 2007;189(1):W13–9.
De Cecco CN, Ferrari R, Rengo M, Paolantonio P, Vecchietti F, Laghi A. Anatomic variations of the hepatic arteries in 250 patients studied with 64-row CT angiography. Eur Radiol 2009;19(11):2765–70.
Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 1994;220(1):50–2.
Arjhansiri K, Charoenrat P, Kitsukjit W. Anatomic variations of the hepatic arteries in 200 patients done by angiography. J Med Assoc Thai 2006;89(Suppl 3):S161–8.
Saba L, Mallarini G. Anatomic variations of arterial liver vascularization: an analysis by using MDCTA. Surg Radiol Anat 2011;33(7):559–68.
Daly JM, Kemeny N, Oderman P, Botet J. Long-term hepatic arterial infusion chemotherapy. Anatomic consideration, operative technique, and treatment morbidity. Arch Surg 1984;119(8):936–41.
De Santis M, Ariosi P, Calo GF, Romagnoli R. Hepatic arterial vascular anatomay and its variants. Radiol Med 2000;100(3):145–51.
Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G. Anatomic variations of the hepatic arteries in 604 selective coeliac and superior mesenteric angiographies. Surg Radiol Anat 2004;26(3):239–44.
Araujo Neto SA, Franca HA, de Mello Júnior CF, Silva Neto EJ, Negromonte GR, Duarte CM, et al. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography. Radiolo Bras 2015;48(6):358–62.
Özbülbül NI. CT angiography of the celiac trunk: anatomy, variants and pathologic findings. Diagn Interven Radiol 2011;17(2):150–7.
Bergman R, Afifi A, Miyauchi R. Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax: Costocervical Trunk Arteries [Internet]. [cited 2016 May 2]. Available from: http://www.anatomyatlases.org/AnatomicVariants/Cardiovascular/Text/Arteries/CostocervicalTrunk.shtml
Matoba M, Tonami H, Kuginuki M, Yokota H, Takashima S, Yamamoto I. Comparison of high-resolution contrastenhanced 3D MRA with digital subtraction angiography in the evaluation of hepatic arterial anatomy. Clin Radiol 2003;58(6):463–8.
Iezzi R, Cotroneo AR, Giancristofaro D, Santoro M, Storto ML. Multidetector-row CT angiographic imaging of the celiac trunk: anatomy and normal variants. Surg Radiol Anat 2008;30(4):303–10.
Türkvatan A, Özdemir M, Cumhur T, Ölçer T. Multidetector CT angiography of renal vasculature: normal anatomy and variants. Eur Radiol 2009;19(1):236–44.
Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surg Radiol Anat 2001;23(1):33–8.
Natsis K, Paraskevas G, Panagouli E, Tsaraklis A, Lolis E, Piagkou M, et al. A morphometric study of multiple renal arteries in Greek population and a systematic review. Rom J Morphol Embryol 2014;55(3 Suppl):1111–22.
Ozkan U, Oğuzkurt L, Tercan F, Kizilkiliç O, Koç Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol 2006;12(4):183–6.