Department of General Surgery, Trakya University Medical Faculty, 22030, Edirne, Turkey.
Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey.
Surg Radiol Anat. 2023 Aug;45(8):1037-1047. doi: 10.1007/s00276-023-03180-1. Epub 2023 Jun 20.
Knowledge of anatomical variations is important in all interventional procedures. This study aims to evaluate the variations and prevalence of celiac trunk (CeT) and its branches.
The computerized tomography-angiography (CT-A) findings of 941 adult patients were evaluated retrospectively. Variations of the CeT and common hepatic artery (CHA) were evaluated according to the number of branches and their origin. Findings were compared with classical classification methods. A new classification model has been defined.
Normal (complete) trifurcation was detected in 856 (90.9%) of them, where left gastric artery (LGA), splenic artery (SpA) and CHA branches were derived from the CeT. Among 856 complete trifurcation cases, 773 (90.3%) had non-classical trifurcation patterns. The rate of classic trifurcation was 8.8%, while non-classic trifurcation was 82.1% in all cases. In one case (0.1%), LGA and left hepatic artery together and right hepatic artery and SpA together appeared as a double bifurcation. Complete celiacomesenteric trunk was observed only in 4 (0.42%) cases. In seven cases (0.7%), LGA, SpA and CHA were coming out of abdominal aorta (AAo) independently. CHA normal anatomy (Michels Type I) was detected in 618 (65.5%) patients. We found that 49 (5.2%) of our cases were ambiguous according to the Michels Classification. We have described five different variations of hepatic arteries directly arising from the AAo.
Preoperative recognition of anatomical variations of CeT, superior mesenteric artery and CHA is of primary importance in both surgical and radiological procedures. With careful evaluation of CT-angiographies, it is possible to detect rare variations.
在所有介入性操作中，了解解剖学变异非常重要。本研究旨在评估腹腔干（CeT）及其分支的变异和发生率。
回顾性评估了 941 例成年患者的计算机断层血管造影（CTA）检查结果。根据分支数量及其起源评估 CeT 和肝总动脉（CHA）的变异。将发现与经典分类方法进行比较。定义了一种新的分类模型。
在 856 例（90.9%）中检测到正常（完全）三分叉，其中左胃动脉（LGA）、脾动脉（SpA）和 CHA 分支来自 CeT。在 856 例完全三分叉病例中，773 例（90.3%）存在非经典三分叉模式。经典三分叉的发生率为 8.8%，而所有病例中非经典三分叉的发生率为 82.1%。在 1 例（0.1%）中，LGA 和左肝动脉一起，右肝动脉和 SpA 一起出现双分叉。仅在 4 例（0.42%）中观察到完全腹腔干肠系膜干。在 7 例（0.7%）中，LGA、SpA 和 CHA 分别从腹主动脉（AAo）独立发出。在 618 例（65.5%）患者中发现 CHA 正常解剖结构（Michels Ⅰ型）。我们发现，根据 Michels 分类，我们的 49 例（5.2%）病例存在模棱两可的情况。我们描述了从 AAo 直接发出的五种不同的肝动脉变异。
术前识别 CeT、肠系膜上动脉和 CHA 的解剖变异在外科和放射学操作中均具有重要意义。通过仔细评估 CT 血管造影，可发现罕见的变异。
