Division of Anatomy, Department 1, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Department of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
Ann Vasc Surg. 2021 May;73:303-313. doi: 10.1016/j.avsg.2020.11.016. Epub 2020 Dec 24.
The celiac trunk (CT) commonly trifurcates into the left gastric artery, common hepatic artery (CHA), and splenic artery (SA). The CHA then sends off the proper hepatic artery and gastroduodenal artery (GDA). The arcades of the head of the pancreas are celiacomesenteric anastomoses between branches of the GDA and the superior mesenteric artery. A quadrifurcation of the CT commonly occurs when a different branch is added to the 3 normal ones. An uncommon quadrifurcation of the CT occurs when only one or 2 of the normal branches of the CT participate.
The CT quadrifurcations were documented on 112 computed tomography angiograms.
Five different types of CT quadrifurcation-3 uncommon (types 1-3) and 2 common (types 4-5)-were found in 15/112 cases (13.39%). A marginal significant association was found between the presence of quadrifurcations and male gender (P = 0.05; Fisher's exact test). Type 1 showed a hepatogastric trunk+SA + right hepatic artery+GDA pattern, type 2 had an HGT + right inferior phrenic artery + CHA + SA pattern, type 3 had a gastrophrenic trunk + left inferior phrenic artery+CHA + SA pattern, type 4 showed an left gastric artery + CHA + SA + left inferior phrenic artery combination, and type 5 had an additional common inferior phrenic trunk. One of the type 4 cases showed a buildup of a mesentericomesenteric anastomotic pancreatic arcade between the inferior pancreaticoduodenal arteries, rather than a celiacomesenteric one.
Anatomic variation of the celiacomesenteric axis is important during hepatobiliary and duodenopancreatic approaches. Therefore, preoperative evaluation is essential because theoretical anatomic possibilities could be real arterial variants.
腹腔干（CT）通常分为三支，分别为胃左动脉、肝总动脉（CHA）和脾动脉（SA）。CH A 然后发出肝固有动脉和胃十二指肠动脉（GDA）。胰腺头部的弓状动脉是 GDA 和肠系膜上动脉分支之间的腹腔肠系膜吻合。当在 3 个正常分支之外增加一个不同的分支时，CT 常发生四叉。当只有 CT 的一个或两个正常分支参与时，会发生不常见的 CT 四叉。
在 112 例 CT 血管造影中记录 CT 四叉。
在 15/112 例（13.39%）中发现了 5 种不同类型的 CT 四叉——3 种不常见（类型 1-3）和 2 种常见（类型 4-5）。在存在四叉的情况下，发现与男性性别存在显著相关性（P=0.05；Fisher 确切检验）。类型 1 表现为肝胃干+SA+右肝动脉+GDA 模式，类型 2 为 HGT+右膈下动脉+CHA+SA 模式，类型 3 为胃膈干+左膈下动脉+CHA+SA 模式，类型 4 显示左胃动脉+CHA+SA+左膈下动脉组合，类型 5 有一个额外的普通膈下干。在一个 4 型病例中，在胰下十二指肠动脉之间出现肠系膜肠系膜吻合的胰腺弓状动脉，而不是腹腔肠系膜吻合。
肝胆胰十二指肠入路时腹腔肠系膜轴的解剖变异很重要。因此，术前评估是必要的，因为理论上的解剖可能性可能是真正的动脉变异。
