Common and separate origins of the left and right inferior phrenic artery with a review of the literature.

To determine the ability to visualize the origin of the right inferior phrenic artery (RIPA) and the left inferior phrenic artery (LIPA) by multidetector row computed tomography (MDCT) in a population without disease of the liver. The origin of the RIPAs and the LIPAs were evaluated using arterial-phase MDCT images in 200 patients. The RIPA origin was detected in all cases, while LIPA origin was detected in 193 (96.5%) cases. RIPA and LIPA originate as a common trunk from the aorta (16%) and celiac trunk (20%). RIPAs originated separately from the aorta (29%), celiac artery (19.5%), right renal artery (10.5%), left gastric artery (3%), and proper hepatic artery (0.5%). LIPAs originated separately from the celiac artery (38.5%), aorta (16%), left renal artery (0.5%), left gastric artery (2.5%). Arterial-phase images of MDCT could demonstrate the origin of the non-dilated IPAs in a population without the disease of the liver.

The diaphragm is supplied by the superior and inferior phrenic arteries. This present study focusses on the latter. The inferior phrenic arteries (IPA) usually originate from the abdominal aorta. The two arteries have different origins, and knowledge of these is important when performing related surgical interventions and interventional radiological procedures. The aim of this study was to identify variations in the origin of the IPA and conduct relevant morphometric analyses. The anatomical variations in the origins of the left inferior phrenic artery (LIPA) and the right inferior phrenic artery (RIPA) were examined in 48 cadavers fixed in 10% formalin solution. A dissection of the abdominal region of the cadavers was performed according to a pre-established protocol using traditional techniques. Morphometric measurements were then taken twice by two of the researchers. In the cadavers, six types of origin were observed. In type 1, the most common type, the RIPA and LIPA originate from the abdominal aorta (AA) (14 = 29.12%). In type 2, the RIPA and the LIPA originate from the coeliac trunk (CT) (12 = 24.96%). In type 3, the RIPA and the LIPA originate from the left gastric artery, with no CT observed (3 = 6.24%). Type 4 has two subtypes: 4A, in which the LIPA originates from the AA and the RIPA originates from the CT (9 = 18.72%) and 4B, in which the RIPA originates from the AA and the LIPA originates from the CT (6 = 12.48%). In type 5, the LIPA originates from the AA and the RIPA originates from the AA (1 = 2.08%). Type 6 is characterised by the RIPA and LIPA forming a common trunk originating from the CT (3 = 6.24%). Our findings suggest the presence of six different types of LIPA and RIPA origin. The most common form is type 1, characterised by an IPA originating from the abdominal aorta, while the second most common is type 2, in which the IPA originates from the AA by a common trunk. The diversity of other types of origin is associated with the occurrence of coeliac trunk variation (type 3). No significant differences in RIPA diameter could be found, whereas LIPA diameter could vary significantly. No significant differences in RIPA and the LIPA diameter could be found according to sex.

We describe in this paper a rare case of a 45-year-old male with a common stem origin of the left gastric artery (LGA), right inferior phrenic artery (RIPA), and left inferior phrenic artery (LIPA), in association with the presence of a hepatosplenomesenteric trunk (HSMT) arising from the abdominal aorta (AA), as revealed by routine multidetector computed tomography (MDCT) angiography. The common stem origin of the LGA, RIPA, and LIPA had an endoluminal diameter of 3.3 mm, the LGA of 2.8 mm. The endoluminal diameter of the RIPA and LIPA was at the origin of approximately 1 mm, complicating selective chemoembolization of the liver parenchyma.

BackgroundEndovascular therapy (ET) for delayed hepatic artery post-pancreatectomy hemorrhage (HA-PPH) may require complete hepatic artery occlusion (HAO). Nonetheless, the development of extrahepatic collateral circulation (EHC) and the relationship between radiological factors (EHC, portal vein stenosis, and HAO) and adverse hepatic events after ET remain unclear. This study aimed to evaluate the efficacy and safety of ET for delayed PPH and examine the development of EHC.MethodsA total of 19 ET cases for delayed HA-PPH were reviewed. Hepatic adverse events, portal vein stenosis, HAO, and mortality rate after ET were evaluated. Moreover, EHC from the left gastric artery (LGA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), right internal thoracic artery (RITA), left internal thoracic artery (LITA), renal artery (RA), omental artery (OA), intercostal artery (IA), and branch of superior mesenteric artery (BSMA) was assessed using angiogram and computed tomography angiography (CTA).ResultsAll cases were successfully treated using transcatheter arterial embolization (n = 17) and stent-graft placement (n = 2) without mortality. EHC from the LGA (8/19), RIPA (10/19), LIPA (4/19), and RITA (3/19) was observed on post-ET CTA. The incidence of hepatic adverse events was significant in the group with both HAO and portal vein stenosis (p < 0.001) and absence of EHC from LIPA and RITA (p < 0.05).ConclusionET for delayed HA-PPH might be effective and safe. While avoiding both HAO and portal vein stenosis is important, the development of EHCs from LIPA and RITA may prevent hepatic adverse events after ET.

No. 196: Transcatheter arterial chemoembolization for hepatocellular carcinoma fed by the right inferior phrenic artery: Clinical outcomes and rare pulmonary complications

To evaluate routes of potential extrahepatic arterial supply to the liver. Twenty-three patients with liver tumors underwent computed tomographic (CT) arteriography of extrahepatic arteries before and after temporary balloon occlusion of the proper hepatic artery. The right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), superior mesenteric artery (SMA), celiac axis, and left gastric artery (LGA) were evaluated. During temporary balloon occlusion of the proper hepatic artery, extrahepatic arterial supply was immediately evident in 22 of 23 patients (96%). The liver was supplied by the RIPA in 17 of 20 patients (85%), by the LIPA in five of six (83%), by the SMA in eight of 16 (50%), by the celiac axis in two of 10 (20%), and by the LGA in one of six (17%). There was no apparent relationship between the enhanced zones supplied by extrahepatic arteries and the presence or absence of nearby tumors. Extrahepatic arterial supply to the liver was readily evident in a large proportion of patients during temporary balloon occlusion of the proper hepatic artery. This finding suggests a need for consideration of extrahepatic arterial supply when angiographic intervention for liver tumors is contemplated.

The inferior phrenic arteries: A systematic review and meta-analysis

To investigate whether the right inferior phrenic artery (RIPA) has a role in supplying the liver in cirrhotic patients without hepatocellular carcinoma (HCC) using 64-slice computed tomography (CT). Fifty-eight consecutive cirrhotic patients were categorized into two groups in regard to the absence (group 1, n=33) or presence of portal vein thrombosis (group 2, n=25). In addition, 35 patients without liver disease were included as a control group (group 0). The diameters of the RIPA and left inferior phrenic artery (LIPA) were measured in the ascending portion of these vessels using arterial-phase CT images. The discrepancy between the diameters of the RIPA and LIPA were calculated. The diameters of the RIPA and LIPA and the discrepancy between the diameters of the RIPA and LIPA were then compared. The characteristics of all RIPA and LIPA were visualized. The diameter of the LIPA among the three groups was not significantly different (P = 0.363). The mean diameters of the LIPA were 1.8±0.19, 1.8±0.22, and 1.7±0.38 mm for groups 0, 1, and 2, respectively. The diameter of the RIPA was significantly greater (2.1±0.54 mm) in groups 1 and 2 (1.9±0.19 mm) than in group 0 (1.8±0.18 mm). There was significantly difference between groups 0 and 2 (P = 0.003), and groups 1 and 2 (P = 0.01) with regard to the discrepancy of the diameters of RIPA and LIPA. The RIPA may contribute to the blood supply of the liver in cirrhotic patients, especially those with portal venous thrombosis.

Aim To evaluate the frequency and pattern of variations in the origins of right inferior phrenic artery (RIPA) and left inferior phrenic artery (LIPA) on 256 slice multidetector computed tomography (MDCT). Materials and Methods MDCT abdominal images of 600 patients (male: 344, female: 256; mean age 56.45 ± 12.96 years) who underwent technically successful multiphase computed tomography were assessed for IPA variations with emphasis on their origins and results analyzed. Results Both IPA origins were documented in all patients. Both RIPA and LIPA originated from the common trunk in 128 (21.3%) patients. IPAs with common trunk most commonly originated from the aorta (68, 11.3%). Without common trunk RIPA most commonly originated from the aorta (225, 37.5%) and LIPA from the celiac artery (278, 46.3%). The least frequently detected IPA variations were RIPA originating from the common hepatic artery (1, 0.2%), superior mesenteric artery (1, 0.2%), and common truncus originating from left renal artery (1, 0.2%). Conclusion MDCT demonstrates the IPA origins very well, enabling planning of interventional procedures related to IPA. Without common trunk RIPA most commonly originates from aorta and LIPA from the celiac artery. IPAs with common trunk most commonly originate from aorta.

Artery divestment for artery involved pancreatic cancer: A retrospective study

The current report describes the combined unusual origin of the left inferior phrenic and left gastric arteries observed during a routine dissection of the upper abdominal region. The branches of the abdominal aorta are important vessels that supply blood to various organs and structures in the abdominal cavity. While there is typically a common pattern of branching, anatomical variations can occur, leading to differences in the branching patterns of the abdominal aorta. An accidental finding in an 80-year-old male cadaver within anatomical dissection was assessed. We observed that the left inferior phrenic artery originated from the celiac trunk and gives off middle and superior suprarenal arteries, while the left gastric artery arose from the abdominal aorta independently. The identification of anatomic vascular abnormalities of the abdominal aorta and its branches is clinically important in surgical and invasive arterial procedures and preoperative knowledge of vascular anomalies should prevent iatrogenic vascular trauma and complications during surgery (Fig. 3, Ref. 14).

Lung metastases have been very common in advanced cancer, which were observed in 30%-40% of cancer cases. Transarterial chemoembolization (TACE) is one of the choice for treating lung cancer. In our center, 119 cases of lung metastases were treated with TACE, and we found that inferior phrenic artery (IPA) played an important role in this procedure. From June 2011 to June 2015, 119 cases with malignant lung metastases received TACE procedure in our center. The TACE procedure was performed through bronchial artery (BA) and collateral arteries. In these 11 cases, we found that part of metastatic lesions was supplied by the IPA. Angiography and embolization technique, successful rate, safety and clinical adverse events, and survival were retrospectively studies. The lung metastases were mainly supplied by BA, thoracic artery, and intercostal artery. In 11 cases, the IPA was involved in the blood supply of lung metastases (9.2%). Right IPA (RIPA), left IPA (LIPA), and both LIPA and RIPA were involved in blood supply of 6, 3, and 2 cases of lung metastases, respectively, especially for the lesions located in the lower lobe of the lung. All lesions of the 11 cases were successfully embolized; no diaphragmatic dysfunction and spinal cord injury or other serious complications were observed. The average survival time was 14.7 months since the diagnosis of lung metastases. The IPA was an important feeding artery for lung metastases, especially for lesions in the lower lung lobe. It should be searched as much as possible for achieving complete embolization of metastases.

The purpose of this work was to demonstrate the appearance of the right inferior phrenic artery (RIPA) on CT in patients with hepatocellular carcinoma (HCC). We assessed the biphasic helical CT scans using 10 mm collimation in 16 patients with arteriographically proven HCCs supplied by the RIPAs. Size of the right and left inferior phrenic arteries and origin of the RIPA were evaluated and correlated with arteriographic images. Helical CT showed dilated RIPAs on the right diaphragmatic crus as foci of high attenuation on arterial-phase images in all patients. Diameter of the RIPA (average 3.3 mm) was larger than that of the left inferior phrenic artery (average 1.5 mm). The origin of the RIPAs was correctly predicted in 13 of 16 (celiac artery 6, abdominal aorta 5, right renal artery 2) patients. Asymmetric dilatation of the RIPA as an indicator of extrahepatic collateral of HCC can be demonstrated on the right diaphragmatic crus with arteriographic images of biphasic helical CT.

The purpose of this study was to retrospectively analyze the frequency and anatomical pattern of the anterior branch of the left inferior phrenic artery (LIPA) arising from the right inferior phrenic artery (RIPA). Angiography of the RIPA for patients (n = 140) with hepatic malignancy was retrospectively reviewed. The frequency at which the anterior branch of the LIPA arose from the RIPA was 14.3% (20 of 140 patients [pts]). Among the three branches that may arise from the RIPA in these cases (the anterior branch of the LIPA and the anterior and posterior branches of the RIPA), the anterior branch of the LIPA was the first branch of the RIPA in 9 of 20 pts (45%), and the posterior branch of the RIPA in 11 of 20 pts (55%). The anterior branch of the LIPA ran along the ventral side of the esophagus or stomach and supplied the esophagogastric region and dome of the left diaphragm in all cases. In conclusion, the anterior branch of the LIPA arises from the RIPA at a comparatively high frequency. In embolization of the RIPA, to effectively treat and avoid possible complications, interventionalists should be aware of this potential variant anatomy.

Objective To observe the origin of right inferior phrenic artery (RIPA) by 64-slice spiral CT angiography.Methods The imaging data of 105 patients underwent abdominal enhanced CT scan from July 2010 to October 2010 were retrospectively analyzed,and the origin,site and opening direction of RIPA were observed and recorded.Results Among the 105 cases,the origins of 97 cases of RIPA were clear,the visualization rate was 92.4％,35 cases originated in celiac artery,34 cases originated in abdominal aorta,24 cases originated in right renal artery,2 cases originated in left gastric artery and LIPA,2 cases originated in LIPA.Conclusions 64-slice spiral CT angiography can aquire original information of RIPA,and provide reference for intervention performers. Key words: Spiral computed tomography; Angiography; Right inferior phrenic artery