Celiac trunk

Deeg KH, Rupprecht T, Schmid E (1993) Doppler sonographic detection of increased flow velocities in the celiac trunk and superior mesenteric artery in infants with necrotizing enterocolitis. Pediatr Radiol 23 578-582 del Pozo G (2005) Intussusception still work in progress. Pediatr Radiol 35 92-94... 

In the classical description of the arterial anatomy, the celiac trunk trifurcates into the left gastric, splenic, and common hepatic arteries. The common... 

Quite often the hepatic artery has an incomplete set of branches because one or the other of its usual branches arises from a source other than the proper hepatic artery from the celiac trunk. Such a vessel if from an outside source is spoken of as aberrant ... 

An aberrant hepatic artery refers to a branch that does not arise from its usual source (i.e. proper hepatic artery from the celiac trunk). This type of artery may be a substitute for the usual hepatic artery that is absent, in which case it is referred to as an aberrant replaced hepatic artery. In other cases there may be an additional artery to the one normally present hence the term aberrant accessory artery. 

Fig. 4.4. A rare anatomical variant consisting in the origin of the right hepatic artery (arrow) from the celiac trunk...

CHA, common hepatic artery LHA, left hepatic artery LGA, left gastric artery RHA, right hepatic artery SMA, superior mesenteric artery GDA, gastroduodenal artery CT, celiac trunk... 

Fig. 4. 7a,b. Patient with a stenosis of the celiac trunk, a Superior mesenteric angiography demonstrates reversed flow through the pancreatoduodenal arcade (arrow) with opacification of the hepatic artery (arrowhead), b Tumour was treated after selective catheterization of the right hepatic artery through the collateral network... 

Fig. 5.1. DSA of celiac trunk with a 5-F Cobra catheter. Left gastric artery (white arrow), splenic artery (arrowheads), common hepatic artery (white arrowhead), gastroduodenal artery (small white arrow), right gastroepiploic artery (small white arrowheads), left (small arrow) and right (double small arrow) hepatic artery...

The gastrointestinal tract is supplied by the unpaired visceral arteries branching from the abdominal aorta the celiac trunk (Fig. 5.1), superior and inferior mesenteric artery. 

In stable and cooperative patients, the diagnostic arteriography is performed under local anesthesia via a transfemoral access and in the classical Seldinger technique. Celiac trunk and the superior mesenteric artery (SMA) are catheterized with preshaped single-use 4- or 5-F catheters of the Cobra or side-winder type. lodinated nonionic iso-osmolar contrast medium (25-35 ml at a rate of 4-6 ml/s) is injected by a power injector into the celiac trunk and SMA. In patients with renal insufficiency, contrast allergy or hyperthyroidism gadolinium chelates (MRI contrast medium) have been suggested as a substitute for iodinated contrast medium [53], but reports on its use in the visceral arteries are still awaited. 

The arteriograms of the celiac trunk and superior mesenteric artery should completely map the gastroduodenal blood supply. Anatomical variants should be searched for (esophageal, phrenic, hepatic arteries branching from the aorta, direct origin of the left gastric from the aorta, etc.). If all territories are visualized and no bleeding source... 

Devascularization of the target area, confirmed by angiographic cessation of extravasation or flow arrest in the vessel believed to supply the bleeding source, is achieved in 90%-95 % of cases [6-9, 58]. In 15%-25% of primary vessel occlusions, major collateral flow to the bleeding site will persist, requiring a second or third vessel embolization [6-8, 49]. Proximal anatomical obstacles, such as celiac trunk stenosis or occlusion, may be the cause of technical failures. 

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. 21.2. Sagittal oblique MIP image showing the celiac trunk and the vessels around a neuroendocrine pancreatic neoplasm the spatial relationship of the vessel is not maintained...

Invasion into peripancreatic arteries celiac trunk, hepatic artery, superior mesenteric artery (T4)... 

Fig. 30.6a-c. Extensive vascular involvement superior demonstration by CPR and VRT. a The axial image demonstrates a large cancer in the body and tail, with compression of the venous confluence, b The CPR image demonstrates the whole tumor (arrows) involving the celiac trunk and a thrombus (arrowhead) in the portal vein, c The volume-rendered image delineates extensive compression of the venous confluence (arrowhead) with subsequent thrombosis of the portal vein... 

The celiac trunk and hepatic artery are usually catheterized by 4-F or 5-F catheters (cobra or sidewinder configuration), while the tumor-bearing target vessels should be approached by 2.7- to 3-F coaxial micro-catheters. The advantages of a microcatheter system are the increased injection resistance, which reduces the risk of microsphere reflux, and the smaller likelihood of vascular spasms. 

Celiac trunk catheterization Hook (Cook) (RIM - second choice)... 

The spleen is the largest of all lymphatic tissues and rests against the lower ribs (nine through eleven), the diaphragm, the stomach, and the left kidney in the left hypochondral region. A parenchyma of red and white pulp is surrounded by a capsule of fibrous connective tissue that contains efferent lymphatics, blood vessels, nerves, and some smooth muscle. The red pulp is a cordal and sinusoidal system concerned primarily with the production of blood products. The while pulp, which is lymphoid tissue, produces ihymus-dependent T lymphocytes and B lymphocytes and plasma cells. The latter components produce the humeral antibody component of the immune system, and the T-lymphocytes are involved in the cell-mediated arm of the system. The vasculature consists of the splenic artery, the largest branch from the celiac trunk, and the splenic vein, which unites with the mesenteric vein to form the portal vein. 

Fig. 2.6. Volume-rendered 3D reconstruction of celiac trunk and superior mesenteric artery. Anomalous origin of right hepatic artery from superior mesenteric artery is demonstrated (arrow). Left hepatic artery has a normal origin from common hepatic artery (arrowhead)...

In the conventional arterial anatomy of the liver, the common hepatic artery originates from the celiac trunk (Fig. 4.2.2). From the common hepatic artery arise the left gastric, gastroduodenal and proper hepatic arteries. The hepatic artery divides at the hepatic hilum into the right and left branches. The middle hepatic artery supplies the medial seg-... 

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