Anatomical variations of the coeliac trunk in the homogeneous Polish population

Prevalence of coeliac trunk variants: A systematic review with meta-analysis

BACKGROUND

The coeliac trunk (CoT) is an important branch of the abdominal aorta, that typically gives off the left gastric artery (LGA), the splenic artery (SA) and the common hepatic artery (CHA). Variations of the CoT are of great importance in clinical practice. The aim of the current systematic review with meta-analysis is to investigate the prevalence of these variants.

MATERIAL

A systematic review was performed in four online databases to identify studies referring to CoT variants prevalence. A meta-analysis was conducted by using the R programming software to calculate the pooled prevalence of the variants, and to detect possible parameters affecting them by using subgroup analysis.

RESULTS

The typical anatomy was considered the CoT with three branches (type 3) with a pooled prevalence of 83.39 %. The most common variation was the CoT with two branches (type 2) identified in 10.53 %. Rarest types were considered the CoT with four branches (type 4-1.80 %) and the CoT absence (type 1-0.43 %). A statistically significant difference according to the type of study (imaging or cadaveric) was identified for CoT type 1 and type 4. Overall, the most common variation was the hepato-splenic trunk calculated with a pooled prevalence of 6.68 %.

CONCLUSIONS

The current systematic review with meta-analysis investigated the CoT variants and proposed a classification system based on the number of branches emanating from the trunk. Knowledge of these variations is of paramount importance for anatomists, radiologists and surgeons frequently operating the abdominal organs.

Challenging arterial pattern of foregut and its potential impact on surgery

Anticipating a wide range of morphological variations of arterial anatomy of foregut derivatives beyond the classical pattern, a precise understanding is pertinent to preoperative diagnosis, operative procedure and to avoid potentially devastating post-operative outcome during various traumatic and non-traumatic vascular insult of foregut. The study aimed to revisit the morphological details and update unusual configurations of arteries of foregut to establish clinico-anatomical correlations. This study described the detailed branching pattern of coeliac trunk (CT) as principal artery of foregut with source & course of hepatic, gastric, duodenal and pancreatic branches in 58 cadaveric dissections. Based on morphology, different types and subtypes were made. The descriptions were explained using figures and pertinent tables. Among classical branches of CT, splenic artery was found as most stable whereas other two branches were found to be most variable with missing common hepatic artery in 11 cases. In addition to classical trifurcation (65.52%), different types of bifurcation (12.07%) and tetrafurcations (22.41%) of CT were observed. Regarding variations of hepatic arteries (27.59%), both non-classical origin and accessory hepatic branches were found. In case of gastric branches, more variant origins were seen with right gastric (50%) as compared to left gastric artery (34.48%). Other morphological variations included non-classical origin of gastro-duodenal artery (18.96%) along with presence of accessory pancreatic (17.13%) and duodenal arteries (6.38%). Awareness of anatomical variations regarding circulatory dynamics of foregut is worth knowing in order to facilitate successful planning of surgery involving upper abdominal organs with least complications.

Evaluation of the celiac trunk and its branching pattern by magnetic resonance angiography

OBJECTIVE

The study aimed to examine the celiac trunk (CT) in detail by magnetic resonance angiography, to determine the locations, positions and variations of the CT, to provide detailed information for surgeons and interventional radiologists, and to reduce the time spent in the catheter angiography.

MATERIAL AND METHODS

MR angiography images of 185 patients with abdominal imaging in PACS (Picture Archiving Communication Systems) were retrospectively analyzed. The level of origin of CT, according to the vertebral column, angle of origin, distance between CT and branches of the abdominal aorta (AA), and the branching pattern of CT were evaluated. Parameters were evaluated according to gender and age.

RESULTS

The most common origin site for CT, according to the vertebral column, was found to be at T12-L1 in both genders. There was a low, positive correlation between age and CT-Sagittal angle (SA) in the whole study group (p<0.05). The most common CT branching pattern was the hepatogastrosplenic trunk in both genders, according to Adachi and Uflkacker's classification. The distance between CT and the inferior mesenteric artery (IMA) and CT and the aortic bifurcation (AB) of males was greater than in females, and the differences were statistically significant (p<0.05).

CONCLUSION

Knowledge of the locations, positions, and variations of CT is essential in the diagnosis, differential diagnosis and decision-making mechanisms regarding the type of intervention to be performed for this vessel and related structures. In addition, the fact that data on these vessels can be obtained by MR angiography due to the improved image quality will prevent patients and physicians from the problems caused by the ionizing radiation of computed tomography. The data presented will constitute a basis for detailed and individualized interpretation and evaluation of each patient, as they provide important details about the configuration of the CT concerning gender and age using MRA.

A Comparison of the Celiacomesenteric Trunk in the Caribbean with Global Prevalence Calculated by a Systematic Review

Background

Typically, the celiac trunk and superior mesenteric artery branch off separately from the anterior aspect of the abdominal aorta. The celiacomesenteric trunk (CMT) is a rare variant in which those arteries share a common origin. We sought to compare the prevalence of CMT in the Caribbean with the global prevalence as calculated by a systematic review.

Methods

In this study, we evaluated all consecutive patients who had multiphase contrast-enhanced CT scans at two major referral centres in the Caribbean from August 30, 2017, to September 1, 2019. In patients with a CMT, we recorded demographic and anatomic details. We then conducted a systematic literature search and retrieved raw data to calculate the global prevalence (number of individuals with a CMT divided by the sum total of study samples). We compared CMT prevalence in our sample with the global prevalence using Pearson's chi-square and Fisher's exact tests. Statistical significance was considered to be present when the P value was <0.05.

Results

From 832 CTs, 665 scans met the inclusion criteria. There were 16 (2.41%) CMTs: 3 (0.45%) classic CMTs, 12 (1.8%) hepato-mesenteric trunks, and 1 (0.15%) hepato-spleno-mesenteric trunk. Forty-two studies reported on CMTs in a total of 74,320 persons. The global CMT prevalence was comparable (3.88%; P = 0.054), but the incidence of hepato-mesenteric variants was significantly lower in our sample (1.8% vs. 3.24%; P = 0.0352).

Conclusion

There was no difference in the prevalence of a classic CMT in the Caribbean compared to the global prevalence. However, the hepato-mesenteric trunk (incomplete CMT variant) was significantly less prevalent in the Caribbean. Advances in Knowledge: Healthcare professionals performing hepatobiliary interventions must be aware of these differences in order to minimize morbidity during their interventions.

The prevalence of anatomical variants of the coeliac trunk and renal arteries on contrast-enhanced abdominal computed tomography scans at Dr George Mukhari Academic Hospital

Background

Anatomical variations of the coeliac trunk and renal arteries should be radiologically reported as they affect the surgical approach and subsequent outcome in patients.

Objectives

The aim of this study was to determine the prevalence of anatomical variations of the coeliac trunk and renal arteries and whether there is a relationship between the occurrence of these variations at Dr George Mukhari Academic Hospital.

Method

Arterial phase abdominal computed tomography (CT) or CT abdominal angiograms performed during January and December 2017 were analysed. The variations of the coeliac trunk and renal arteries were classified according to accepted classification systems and expressed as a percentage of the study population.

Results

A normal classical coeliac trunk was present in 82.2% and a non-classical pattern was present in 9.7%. The most common variation of the coeliac trunk other than the non-classical pattern was a hepatosplenic trunk, which was present in 3% of the study population. A normal right and left renal artery was present in 88.2% and 83.7%, respectively. The most common variations of the renal arteries were bilateral hilar arteries seen in 3.4% on the right and 9.1% on the left. Renal artery variations were more prevalent on the left than on the right. Concurrent variations of both the right and the left renal arteries were present in 2.4% and variations of both the coeliac trunk and renal arteries were present in 5% of the study population.

Conclusion

The most common variation of the coeliac trunk in this study is comparable to other studies in non-African populations. Concurrent vascular variations between the renal arteries and between the coeliac trunk and renal arteries may co-exist.

Anatomical variants of the celiac trunk

AIM OF THE STUDY

Determine the anatomical variants of the celiac trunk and describe it in its modal form using a scanner.

PATIENTS

In total, 200 patients were included in this study.

MATERIAL AND METHODS

The study was carried out using a multi-detector scanner (SIEMENS Somatom Emotion Excel Edition, 16 bars). The two-dimensional and three-dimensional reconstructions by volume were made with the OSIRIX software. It was a retrospective study. The study had taken into account the result of the abdominal scanners injected carried out from December 15, 2018 to February 15, 2019 i.e. 14 months (1 year 2 months).

RESULTS

A predominance of type I of UFLACKER is 93.50% with a rate of change from normal of 6.50%. A vertebral projection of the origin of the celiac trunk at the level of the T12-L1 intervertebral disc was observed in 52.80%. An existence of collateral branches in 7.5% of cases. Other terminal branches apart from the three classics were found in 8.5% of the cases.

CONCLUSION

These variants deserve special attention in the case of a pre-therapeutic vascular assessment for the surgical or interventional management of tumors and trauma of the supra-meso-colic viscera or even for organ transplantation.

Variations of the celiac trunk investigated by multidetector computed tomography: Systematic review and meta-analysis with clinical correlations

In recent years multidetector computed tomography (MDCT) has been used to investigate vascular anatomy for scientific and diagnostic purposes. These studies allow for much larger sample sizes than traditional cadaveric studies. The aim of this research was to perform a systematic review and meta-analysis on studies investigating the variations of the celiac trunk using MDCT. Major medical databases were used to find studies investigating celiac trunk anatomy using MDCT. Extracted information included demographic details, number of normal celiac trunks, and number of each variant celiac trunk. Using a random effects meta-analysis the pooled prevalence of each variation was calculated. A total of 36 studies from 14 countries and four continents were included in the meta-analysis. The total number of subjects included was 17,391. The total prevalence of variant celiac trunks was 10.85%. The different types of celiac trunk variations with their prevalences were: gastrosplenic trunk (3.46%), hepatosplenic trunk (3.88%), hepatogastric trunk (0.24%), absent celiac trunk (0.28%), celiacomesenteric trunk (0.46%), hepatosplenomesenteric trunk (0.26%), gastrosplenomesenteric trunk (0.07%), and celiacomesenteric anastomosis (0.09%). A total of 61 cases (0.19%) were either not described or not described adequately to be included in our classification. Major variations of the celiac trunk are not uncommon and should be anticipated before radiological and surgical interventions. Knowledge of celiac trunk anatomy is important in hepatopancreatobiliary surgery, transplantology, and interventional radiology.

Awareness of hepatic arterial variants is required in surgical oncology decision making strategy: Case report and review of literature

Surgery for the treatment of pancreatic cancer remains the gold standard, however, the identification of the vascular supply of the pancreas and the nearby organs remains a crucial difficulties in a curative resection. During pancreatic head resection for carcinoma dissection of regional arterial vasculature is mandatory. Normal coeliac and hepatic arterial anatomy occurs in ~50-70% of patients and multiple variations have been described. Knowledge of multiple arterial anomalies is essential in hepato-pancreatico-billary surgery to avoid unnecessary complications. The present study presents coeliac trunk and common hepatic artery (CHA) anomalies along with their clinical importance, as reviewed according to the available literature. Patients diagnosed with cancer of the pancreatic head were hospitalized for staging and planning of radical surgical therapy. Computed tomography (CT) revealed a large tumour mass in the head of the pancreas and CHA, which branched directly from the superior mesenteric artery. A three-dimensional CT reconstruction revealed a demonstrative vascular anomaly, which was confirmed during an operation. Despite the anomalous origin of the CHA, pylorus preserving pancreatoduodenectomy and regional lymph node dissection without intraoperative complications was performed in each case. The patient's postoperative clinical course was uneventful and adjuvant chemotherapy could be administered without delay. In the multidisciplinary treatment of pancreatic carcinoma the surgeon and radiologist must be aware of the aberrant anatomy in order to avoid potential complications. As CT scans used for the preoperative staging are of diagnostic value for vascular anomaly, it is required for appropriate surgical decision making.