Celiac Axis, Common Hepatic and Hepatic Artery Variants as Evidenced on MDCT Angiography in South Indian Population

Abstract

Introduction: With the increase in the hepatobiliary, pancreatic surgeries and liver transplantation, being aware of the anatomic variations of the celiac axis and the hepatic arteries is of paramount importance.

Aim: To illustrate the normal anatomy and variants of the celiac axis and the hepatic arteries with multidetector computed tomographic (MDCT) angiography in South Indian population and determine the potential variations in the celiac axis anatomy and the hepatic arteries, thus assisting the hepatobiliary surgeon and the interventional radiologist in avoiding iatrogenic injury to the arteries.

Materials and methods: Two hundred patients undergoing abdominal CT angiography from July 2014 till July 2015 were retrospectively studied for hepatic arterial and celiac axis anatomical variation. The anatomic variations in our study were correlated with other studies.

Results: The celiac axis (CA) and the hepatic artery (HA) variations were analysed as per criteria laid by Song et al., and Michel. Out of 15 possible CA variations, 5 types of celiac artery variations were seen in 14 patients. A normal CA was seen in 179(89.5%) patients of the 200 patients. In the remaining 7 patients, the CA anatomy was classified as ambiguous since there was separate origin of the right and left hepatic arteries from the CA with absent common hepatic artery (CHA). The CHA originated normally from the celiac axis in 94% of the cases. Variation of CHA origin was seen in 5 patients. Normal HA anatomy was seen in 114 (57%) patients. Variation in HA anatomy was seen in 86 (43%) patients. Origin of the right hepatic artery (RHA) from the hepatic artery proper was seen in 182 (91%) patients and replaced origin of RHA from the superior mesenteric artery (SMA) was seen in 18 (9%) of the cases. Accessory RHA was seen in 7(3.5%) patients. The left hepatic artery (LHA) originated from the hepatic artery proper in 186 (93%) patients and replaced origin of LHA from the left gastric artery (LGA) was found in 14 (7%) patients. Accessory left hepatic artery was found in 22(11%) cases. Double hepatic artery seen in 7(3.5%) patients. CHA replaced to LGA was seen in 1 patient (0.5%). CHA trifurcation was seen in 11 (5.5%) patients. CHA was replaced to SMA in 4 (2%) cases.

Conclusion: Our study identified the normal anatomy and variations in celiac axis and hepatic arterial anatomy in South Indian population, which correlated well with studies in other populations.

Keywords: Potential variations; Vascular anatomy.

[Table/Fig-6]:

CT angio VRT image showing normal anatomy of celiac axis and CHA.

[Table/Fig-7]:

CT angio VRT image showing the separate origin of LGA (double arrow) from aorta and the hepatosplenic trunk (black arrow).

[Table/Fig-8]:

CT angio volume rendered image showing hepatomesenteric trunk /common hepatic artery arising from the superior mesenteric artery (horizontal black arrow) and gastrosplenic trunk (vertical black arrow).

[Table/Fig-9]:

CT angio volume rendered reconstructed image showing the hepatomesenteric trunk/common origin of common hepatic artery and superior mesenteric artery (large black arrow) with separate origin of splenic artery and left gastric artery(small black arrow).

[Table/Fig-10]:

(a) CT angio reconstructed sagiital maximum intensity projection showing a rare celiac axis variant hepatosplenomesenteric trunk(black arrow) with separate origin of left gastric artery(white arrow). (b) Reconstructed volume rendered saggital section showing the same-hepatosplenomesentric trunk (black arrow) with separate origin of left gastric artery (white arrow).

[Table/Fig-11a & b]:

CT angio VRT image showing a rare variant where left gastric artery is arising (black arrow) from aorta and giving rise to hepatosplenic trunk (white arrow).

[Table/Fig-12]:

CT angio maximum intensity projection axial image showing celiac artery trifurcation with direct early origin of right and left hepatic artery (vertical black arrow) from the celiac axis.

[Table/Fig-13]:

CT angio volume rendered reconstructed image showing the common hepatic artery trifurcating into gastroduodenal, right and left hepatic arteries.

[Table/Fig-14]:

CT angio volume rendered reconstructed image showing accessory left hepatic artery(white arrow) arising from the left gastric artery and the common hepatic artery (red arrow) dividing into right, middle and left hepatic arteries(blue arrow) after giving rise to gastroduodenal artery(arrow head).

[Table/Fig-15]:

CT angio volume rendered image showing replaced right hepatic artery (pink arrow) from the superior mesenteric artery (black arrow).

[Table/Fig-16]:

CT angio volume rendered reconstructed image showing replaced left hepatic artery (red arrow) arising from the left gastric artery and the common hepatic artery (white arrow) bifurcating into right hepatic artery (arrow head) and gastroduodenal artery (blue arrow).