Celiac axis

Watson, W.C., Williams, P.B., Duffy, G. Epigastric bruits in patients with and without celiac axis compression. A phonoarteriographic study. Ann. Intern. Med. 1973 79 211-215... 

The stomach and proximal duodenum are derived from the embryonic foregut and will therefore receive their blood supply from the celiac axis. Part... 

Michels NA (1953) Collateral arterial pathways to the liver after ligation of the hepatic artery and removal of the celiac axis. Cancer 6 708-724... 

Abdominal aorta - Injection of 15 cc/s for 30 cc (pigtail catheter). This step allows for identification and assessment of patency of the celiac axis and SM A, and it helps guide proper visceral catheter selection. For SMA and celiac vessels that have acute angles, reverse curve catheters such as the Sos-Omni (Angiodynamics, Queensbury, NY) or Simmons (Cook, Bloomington, IN) can be utilized. Otherwise, C-shaped catheters may be routinely used. 

Crawford ES, Morris GC, Myhre HO, Roehm JO (1977) Celiac axis, superior mesenteric artery, and inferior mesenteric artery oedusion surgical considerations. Surgery 82 856-866... 

Fig. 20.3a,b. Hepatic arterial anatomy according to Hiatt. aMIP reconstruction of Hiatt s type 1 anatomy i.e., conventional anatomy with the common hepatic artery arising from the celiac axis to the gastroduodenal and proper hepatic arteries. The proper hepatic artery divides distally into right and left branches, b MIP reconstruction of Hiatt s type 3 anatomy i.e., a replaced right hepatic artery originating from the superior mesenteric artery... 

Type 1 the common HA arising from the celiac axis to form the gastroduodenal and proper hepatic arteries the proper HA dividing distally into right and left branches... 

In the setting of cadaveric liver transplantation it is more important to identify vascular anomalies of the celiac axis than hepatic artery variations. Indeed, celiac axis anomalies, such as atheromatous celiac-trunk stenosis or diaphragmatic arcuate ligament, could necessitate celiac axis revasculariza-... 

Fig. 20.7a-c. Celiac axis stenosis. a,b MIP images in different planes of the severe stenosis of the celiac axis, c VR image gives a panoramic view of the collateral arterial pathways... 

In 1999 Beger et al. published the results of a phase 11 trial of intra-arterial chemotherapy applied via an angiographically placed celiac axis catheter in 26 patients with locally advanced and inoperable pancreatic cancer. As cytostatics they used a combination of mitoxantrone, CDDP and 5-fluorouracil. Compared to historical controls patients treated with intra-arterial chemotherapy survived longer, with a median of 23 months compared to 10.5 months. 

Proximal Embolization In the absence of active contrast extravasation, the splenic artery is proximally embolized. We typically utilize either a 5F Cobra catheter or a 5F Omni-2 catheter to catheterize the celiac axis. Depending on the tortuosity of the vessel, we then either use the Cobra catheter or a microcatheter with a 0.021 inner luminal diameter for more selective catheterization. Once the catheter is in place, just distal to the dorsal pancreatic artery, coils are deposited. The size of the coils chosen depends on the size of the vessel. 

The hepatic and splenic arteries typically arise from the celiac axis, which has its origin at the T12/ LI level of the abdominal aorta. The three main branches of the celiac include the splenic, left gastric, and common hepatic arteries. The splenic artery is typically large and tortuous and supplies small branches to the pancreas. The common hepatic branches into the gastroduodenal and proper hepatic arteries. There is significant variant anatomy of the hepatic arteries Aat the interventionist should be aware of. The most common variation is the replaced right hepatic artery, which arises from the superior mesenteric artery (SMA). This occurs in 12%-15% of the population. Other less frequent variations include the replaced left hepatic from the left gastric artery (11%) and the completely replaced common hepatic from the SMA (2%). 

Typically, the celiac axis is selected with either a Sos or Cobra catheter from the groin and nonselec-... 

The splenic artery arises from the celiac axis and is often tortuous. Therefore, glide wires and hydrophilic catheters are helpful in gaining peripheral access to this vessel. It has a long course from the aorta to the splenic hilum, making it one of the most amenable arteries for stent graft placement. It supplies branches to the body and tail of the pancreas. If necessary, complete occlusion of the main splenic artery distal and proximal to the aneurysm neck can be performed. If the artery is completely thrombosed, collaterals can be parasitized resulting in a splenic remnant or even hypertrophy of splenules after an embolization. 

Typically a groin approach is used and the celiac axis is selected with a Sos catheter. Selective angiography is performed to lay out the splenic artery. A glidewire is then passed distally and either the Sos or a Cobra catheter is advanced. Embolization can be performed through the 5 French catheter at this point. If too tortuous, then a microcatheter can be passed coaxially. (Fig. 8.4) We use either a Mass Transit (Cordis, Miami, FL) or Renegade (Boston Scientific, Boston, MA) microcatheter. These catheters can withstand a power injection of 2-3 cc per second if needed. 

Step 3-Abdominal aortogram. (Optional). A flush aortogram via a multisideholed, pig-tailed catheter at the level of the celiac artery will delineate the vascular anatomy, tumor supply and provide a road-map for more selective access. For the most part this step can be skipped. In rare cases and after failing to easily select the SMA and celiac axis with a selective catheter (see step 4), which may suggest variant anatomy, one may revert to an abdominal aortogram. If performed, a 15 cc per second injection for a total of 50 cc (15/50) is adequate. 

Fig. 6.1.15a,b. Lymph node metastases from gastric carcinoma demonstrated in the left gastric and celiac axis territory (a) and para-aortic (b)... 

Fig. 14.5. Median arcuate ligament compression. Lateral abdominal aortogram showing compression of the celiac axis (arrow) by the median arcuate ligament of the diaphragm...

Park CM, Chung JW, Kim HB, Shin SJ, Park JH (2001) Celiac axis stenosis incidence and etiologies in asymptomatic individuals. Korean J Radiol 2 8-13... 

Fig. 4.2.2. Volume-rendered CT image of conventional hepatic arterial anatomy. The common hepatic artery (t) originates from the celiac axis and, after the origin of the gastroduodenal artery (5), becomes the proper hepatic artery (2). The proper hepatic artery divides into the left (3) and right (4) hepatic artery...

Fig. 4.2.10. Axial MIP rendering of CT angiogram shows an accessory right hepatic artery (arrows) originating from the celiac axis (arrowhead)...

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