Accessory Left Gastric Artery Research Articles

Bariatric arterial embolization in patients with body mass index ranging from 25 to 40 kg/m2: A systematic review & meta-analysis.

The present review sought to evaluate by meta-analysis the efficacy of bariatric arterial embolization (BAE) in promoting weight loss in patients with body mass index (BMI) ranging from 25-40 kg/m2. This study was performed and reported according to Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. A systematic literature search of MEDLINE, Embase Google Scholar, and World Health Organization Library database was done for studies evaluating BAE for promoting weight loss in patients with BMI ranging from 25-40 kg/ m2 published up to March 10, 2021. Primary outcome measure included weight loss after the embolisation procedure. Three single-arm studies comprising of a total of 28 patients (BMI: 25- 40 kg/m2) were found eligible for meta-analysis. All patients underwent embolization with either Embosphere microspheres or PVA particles. The predominant artery embolised was left gastric artery (in all patients). Additional arteries embolised included gastroepiploic artery (8 patients), or accessory left gastric artery (1 patient), or short gastric artery (1 patient). Pooled absolute mean weight loss was 7.854 kg (95% CI: 6.103-9.605). No significant statistical heterogeneity was detected (I2=51.75%, P=0.126) among pooled studies. In conclusion, limited single-arm studies report BAE as an effective, and relatively safe procedure for promoting weight loss in patients with BMI ranging from 25-40 kg/m2, although the number of patients included is very small. Initial results of BAE in promoting weight loss are promising with no major/severe complications reported; however, long term follow-up is required to see the sustainability of the effects.

An Unusual Anatomical Variation of Accessory Left Gastric Artery Arising from Left Hepatic Artery

An Unusual Anatomical Variation of Accessory Left Gastric Artery Arising from Left Hepatic Artery

Branching Pattern Variations of the Celiac Trunk and Superior Mesenteric Arteries in a 94‐Year‐Old White Female Cadaver

Recognizing the presence of abdominal vascular anatomical variations in patients is imperative for surgeons who perform major abdominal surgeries, vascular interventionalists performing ablations or embolizations, and oncologists administering targeted chemotherapies. Neglecting to identify such variations can lead to significant patient morbidity and mortality. It is similarly important to anatomical instructors in the education of future medical providers. During cadaveric dissection of fifty-six cadavers, we observed several unique anatomical variations occurring within the major enteric vessels of the abdomen of a 94-year-old white female cadaver. These variations included a celiac trunk that gave rise to bilateral inferior phrenic arteries, the splenic artery, and a gastrohepatic artery that gave off the left gastric artery, an accessory left hepatic artery, and then continued as a common hepatic artery. Shortly from its origin, the common hepatic artery then trifurcated into a large gastroduodenal artery, the right hepatic artery, and the left hepatic artery. There was no definitive proper hepatic artery present. The accessory left hepatic artery gave off an accessory left gastric artery. The cystic artery derived directly from the superior mesenteric artery, and the middle colic artery arose from the gastroduodenal artery. The middle colic artery also had an accessory aberrant left colic artery branching from it. These anatomical variations described herein are of both clinical significance and academic consequence. While single anatomic variations are well described, the presence of multiple, complex variations in a single patient, such as those described here, is less common in the literature. To our knowledge, there are no other reports of this combination of variations in the literature to date. Operating surgeons and vascular interventionalists should be aware of these variants as they occur both individually and in combination while treating diverse patient populations. Accordingly, the developmental and clinical significance of these anomalous vessels is discussed here.

Transarterial embolisation for gastroduodenal bleeding following endoscopic resection.

Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed. Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1-30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures. This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.

Extrahepatic Arteries Originating from Hepatic Arteries: Analysis Using CT During Hepatic Arteriography and Visualization on Digital Subtraction Angiography.

To investigate the prevalence and site of origin of extrahepatic arteries originating from hepatic arteries on early phase CT during hepatic arteriography (CTHA) was accessed. Visualization of these elements on digital subtraction hepatic angiography (DSHA) was assessed using CTHA images as a gold standard. A total of 943 patients (mean age 66.9±10.3years; male/female, 619/324) underwent CTHA and DSHA. The prevalence and site of origin of extrahepatic arteries were accessed using CTHA and visualized using DSHA. In 924 (98.0%) patients, a total of 1555 extrahepatic branches, representing eight types, were found to originate from hepatic arteries on CTHA. CTHA indicated the following extrahepatic branch prevalence rates: right gastric artery, 890 (94.4%); falciform artery, 386 (40.9%); accessory left gastric artery, 161 (17.1%); left inferior phrenic artery (IPA), 43 (4.6%); posterior superior pancreaticoduodenal artery, 33 (3.5%); dorsal pancreatic artery, 26 (2.8%); duodenal artery, 12 (1.3%); and right IPA, 4 (0.4%). In addition, 383 patients (40.6%) had at least one undetectable branch on DSHA. The sensitivity, specificity, and accuracy of visualization on DSHA were as follows: RGA, 80.0, 86.8, and 80.4%; falciform artery, 53.9, 97.7, and 80.0%; accessory LGA, 64.6, 98.6, and 92.3%; left IPA, 76.7, 99.8, and 98.7%; PSPDA, 100, 99.7, and 99.9%; dorsal pancreatic artery, 57.7, 100, and 98.8%; duodenal artery, 8.3, 99.9, and 98.7%; and right IPA, 0, 100, and 99.6%, respectively. Extrahepatic arteries originating from hepatic arteries were frequently identified on CTHA images. These arteries were frequently overlooked on DSHA.

Assessment of 64-slice spiral computed tomography angiography with image fusion for perigastric arteries anatomy

To evaluate the efficacy and clinical significance of 64-multislice spiral computed tomography angiography(MSCTA) with image fusion for the anatomy of perigastric arteries. A total of 53 patients underwent abdominal 64-MSCTA, among whom 26 patients with gastric cancer underwent gastrectomy. Using volume rendering techniques, computed tomography angiography(CTA) of perigastric arteries and the stomach were reconstructed respectively, and then the images were fused together. The branching pattern of the celiac trunk and the origins and courses along the stomach of the 10 perigastric arteries were assessed. The accuracy, sensitivity, and specificity of 64-MSCTA were determined based on intraoperative findings. CTA clearly showed the celiac trunk. The most common branching pattern of the celiac trunk was Michels type I( in 46 patients(86.8%). The anatomy of perigastric arteries and stomach could be clearly demonstrated from any angle according to image fusion. The left gastric artery and the right gastroepiploic artery were shown in 100%, the left gastroepiploic artery 94.3%(50/53), the right gastric artery 83.0%(44/53), short gastric artery 58.5%(31/53), posterior gastric artery 49.1%(26/53), the replaced left hepatic artery 15.1%(8/53). The accessory left hepatic artery, accessory left gastric artery and replaced right hepatic artery were all identified in 7.5%(4/53) patients. The accuracy of preoperative CTA in term of correctly identifying perigastric arteries ranged from 84.6% to 100%, the sensitivity 82.6% to 100%, and the specificity was 100% for all the perigastric arteries. 64-MSCTA can clearly reveal individual perigastric arteries. The anatomy of the stomach and perigastric arteries can be shown in vivo by fused image, and can provide guidance for gastrectomy.

Three liver grafts from a deceased whole liver

Although the lateral segment (LS) from the split-liver of a deceased donor or a live donor can increase the organ pool of pediatric patients awaiting liver transplantation, the shortage of organ donation in Asia countries is still serious and results in high death rates of pediatric patients. The medial segment (MS) of the liver is sacrificed during the standard technique of splitting a whole liver into an LS and an extended right liver because the cutting sites of portal vein, hepatic artery and bile duct are all in the bifurcation of the liver hilum to have adequate length of vascular and biliary pedicles for easier grafting. However, the surgical techniques of vascular and biliary reconstructions for liver transplantation, particularly from the experiences of living donor liver transplantation, have been much improved in the last decade. Therefore it may be possible for an additional MS of the liver to be an isolated graft for a small recipient on the premise that grafts of right lobe (RL) and LS are minimally injured.In light of detailed reviews of anatomies of hepatic arteries, hepatic veins, portal veins and bile ducts, the dissection and reconstruction of vessels and bile ducts for the MS can possibly be performed if the extra-hepatic length of the artery to the MS is long enough. As the artery for the MS, middle hepatic artery (MHA), usually derives from a branch of the left hepatic artery and often in the liver parenchyma, the length is usually too short to be reconstructed. If the MHA for the MS is isolated and its extra-hepatic length is more than 1cm, triple liver grafts from a deceased whole liver, consisting of the RL, MS and LS may be possible.The anatomies of the hepatic artery in abdominal computed tomography (CT) or magnetic resonance imaging (MRI) for live liver donors in our institution were retrospectively analyzed. The results showed that three types of hepatic arterial anatomies could be considered for possible recovery of triple segments: type I is an accessory left gastric artery to feed the lateral segment; type II is an isolated MHA; type III is an early bifurcation of the left hepatic artery and MHA.

Angiographic branching patterns of the splenic artery

Most previous studies of the splenic artery were cadaver dissections, andin vivo anatomical studies have been reported only rarely. Selective arteriography could be used as anin vivo study of the branching patterns of the splenic artery. Forty-three splenic arteriograms and seven celiac arteriograms were included in this study. There were 36 males and 14 females, aged 23–67 years (mean 48 years). The branching patterns of the splenic artery show 80% dorsal pancreatic, 98% pancreatic magna, 84% caudal pancreatic, 76% superior polar, 24% inferior polar, 46% left gastroepiploic, 28% accessory left gastric, 100% terminal superior and inferior, and 28% terminal media arteries. The branching patterns of the splenic artery were similar to the many reports of cadaver dissection in the Korean literature and there was a more frequent incidence of splenic arterial branches than in the reports from the study of Caucasians except for the accessory left gastric artery.

The left inferior phrenic artery arising from left hepatic artery or left gastric artery: radiological and anatomical correlation in clinical cases and cadaver dissection

The purpose of this study is to assess angiographic and CT appearance of left inferior phrenic artery (LIPA) arising from left hepatic or left gastric artery and to recognize its specific anatomical location with the help of cadaver dissection. We retrospectively reviewed 761 abdominal angiographies and found 13 patients (1.7%) with LIPA arising from left hepatic or left gastric artery. We classified those origins and assessed radiological features. We also presented a cadaver dissection to identify anatomical location of LIPA arising from left hepatic artery. The origin of the LIPA was classified as follows: (a) left hepatic artery: four, (b) accessory left gastric artery: one, (c) accessory left hepatic artery: three, and (d) left gastric artery: five patients. The proximal portion was located in gastrohepatic ligament and its distal portion was located in front of esophageal hiatus. In a cadaver dissection, the proximal portion ascends along ligamentum venosum and distal portion courses along superior aspect of left hemi diaphragm in front of esophagus. The LIPA rarely arises from left hepatic or left gastric artery. The proximal portion was located in gastrohepatic ligament and the distal portion runs in front of the esophageal hiatus.

Embolization of accessory left gastric artery to prevent acute gastric mucosal lesions in patients undergoing repeated hepatic arterial infusion chemotherapy

To retrospectively evaluate results of selective embolization of the accessory left gastric artery prior to repeated hepatic arterial infusion chemotherapy using a port-catheter system. Of 22 patients with unresectable advanced liver cancer who underwent percutaneous implantation of a port-catheter system, an accessory left gastric artery was revealed by arteriography in 16 patients before and in six patients after port-catheter implantation. The right gastric artery was embolized to prevent gastric mucosal lesions in all 22 patients. In addition, the accessory left gastric artery was selectively embolized for the same purpose using from one to six microcoils, which were from 3 to 5 mm in diameter. Within 10 days after implantation, arteriography was performed while contrast material was infused via the port. Selective embolization of the accessory left gastric artery was successful in all 22 patients. No complication related to embolization of this artery occurred in any patient. A gastrointestinal mucosal lesion developed in only one case during hepatic arterial infusion chemotherapy, but was unrelated to the accessory left gastric artery. Prophylactic embolization of the accessory left gastric artery is useful to avoid development of a gastrointestinal mucosal lesion resulting from hepatic arterial infusion chemotherapy.

Accessory Epiploic Artery Originating from the VIII Segment Branch of the Right Hepatic Artery Discovered During Hepatic Chemoembolization

Knowledge of the standard anatomy and anomalies of the hepatic vessels is mandatory to obviate complications secondary to hepatic surgery, especially in liver transplantation, as well as in many radiological procedures such as transarterial chemoembolization for hepatic tumors. An international classification of the main variations in the vascular anatomy of the liver was proposed by Michels [1] in 1966 and modified by Hiatt et al. [2] in 1994. A standard finding, in 52–79% of cases, is the common hepatic artery arising from the celiac trunk, becoming the proper hepatic artery, and thus giving off the left and right hepatic arteries. Many other articles, in particular those concerned with living related liver transplant donor candidates, have tried to describe any unreported variations in direct relation to the potential surgical risk [3, 4]. Another large series was recently published by Song and colleagues [5], who did an angiographic analysis of nonhepatic arteries originating from the hepatic arteries in 250 patients. They found the right gastric artery to be the most common of these nonhepatic arteries, followed by the hepatic falciform artery, accessory left gastric artery, posterior superior pancreaticoduodenal artery, and left inferior phrenic artery; furthermore the left hepatic artery was the most frequent origin of nonhepatic arteries. We present a case of an accessory epiploic artery originating from a segmental branch of the right hepatic artery, also supplying a hepatocellular carcinoma located at the hepatic dome. The anomaly was discovered on the MDCT scan (Fig. 1) in association with a Michels type V variation (accessory right hepatic artery arising from the superior mesenteric artery) [1] (Fig. 2). The MDCT finding was subsequently confirmed at selective segmental arteriography of the VIII segment (Fig. 3) done before chemoembolization. The treatment was subsequently safely performed by positioning a microcatheter distal to the origin of this accessory epiploic artery. To our knowledge this anatomic variation of the hepatic vasculature has not been described previously.

Preoperative Evaluation of Perigastric Vascular Anatomy by 3-Dimensional Computed Tomographic Angiography Using 16-Channel Multidetector-Row Computed Tomography for Laparoscopic Gastrectomy in Patients With Early Gastric Cancer

The purpose of this study was to evaluate the efficacy of 3-dimensional computed tomographic angiography (3D CTA) using 16-channel multidetector-row helical computed tomography (MDCT) in the preoperative visualization of laparoscopic gastrectomy for early gastric cancer. Twenty consecutive patients with early gastric cancer who underwent computed tomographic (CT) examination using 16-channel MDCT (0.625 mm x 16) before surgery were included in this study. At a rate of 4 mL/s, 2 mL/kg of 300 mg I/mL contrast material was intravenously injected. Timing for arterial phase scanning was determined by using a test bolus injection. Portal phase imaging was performed 70 seconds after the start of bolus injection. By using volume rendering and maximum intensity projection techniques, 3D CT angiograms of perigastric vessels were reconstructed from CT images of 0.625-mm thickness on computer workstations. In all cases, the left gastric artery (LGA) and the right gastric artery were correctly identified on 3D CTA, and the left gastric vein was also depicted on 3D CTA in all cases. In 2 cases, the aberrant left hepatic artery from LGA was correctly identified on 3D CTA. In 1 case, the accessory LGA from the left hepatic artery was correctly identified on 3D CTA. The variations of the veins included the left gastric vein flowing into the portal vein in 10 cases: the splenic vein in 9 and the junction of the portal and splenic veins in 1. A 3D CTA reconstructed from 16-channel MDCT images clearly revealed perigastric vascular anatomy in all cases, which is important for laparoscopic gastrectomy. Three-dimensional CTA is useful for the preoperative visualization of laparoscopic gastrectomy.

Perigastric vascular abnormalities and the impact on esophagogastrectomy

The surgeon's ability to recognize abnormal vascular anatomy has greater importance than ever in modern esophagogastric surgical procedures. Some aberrations of vascular vessels around the stomach found during extensive surgery due to primary cancer of the stomach, cardia and lower esophagus are presented in this paper. The purpose of the prospective study is to evaluate and classify these variations with respect to their impact in visceral surgery. A total of 426 patients who underwent total or extensive gastrectomy and esophagectomy combined with lymphadenectomy, have been analyzed prospectively. For the period of 10 years some vascular aberrations have been found in 54/426 (12.67%) of the patients in the operative field during lymphadenectomy as single or combined anomalies. An arterial perigastric anatomy considered normal in textbooks was found in 372 (87.32%) cases. An accessory left hepatic artery arising from the left gastric artery was found in 19/54 (35.18%), and replaced type in 7/54 (12.96%). The replaced right hepatic artery branching from the superior mesenteric artery was found in 5/54 (7.40%) cases. Replaced and accessory left gastric artery branching from the aorta was found in 8/54 (14.8%); accessory posterior gastric artery was found in 25/54 (44.4%), and abnormalities of the splenic, and subphrenic arteries were found in 6/54 (11.11%). Combined anomalies of both left and right hepatic arteries and variations of the celiac trunk were found in 2/54 (3.70%) cases. Forty-nine cases were classified according to established Michels' typology system. Six cases presented with extremely rare variations and remain unclassified. Possible intraoperative problems concerning postoperative complications are also emphasized.

Accessory Left Gastric Artery from Left Hepatic Artery Shown on MDCT and Conventional Angiography: Correlation with CT Hepatic Arteriography

The objective of our study was to evaluate the diagnostic accuracy of MDCT and conventional angiography in the detection of an accessory left gastric artery using CT hepatic arteriography as the standard of reference. The study group consisted of 118 patients who underwent MDCT with a triple-phase liver protocol with a slice thickness of 5 mm, conventional angiography, and CT hepatic arteriography. The early-phase images of MDCT and conventional angiography were retrospectively reviewed. The presence or absence of an accessory left gastric artery was evaluated using CT hepatic arteriography as the standard of reference. The sensitivity, specificity, and accuracy of MDCT and conventional angiography were calculated. CT hepatic arteriography revealed an accessory left gastric artery in 25 (21.2%) of 118 cases, including 15 proximal- and 10 distal-type accessory left gastric arteries. On MDCT, there were seven false-negative cases and one false-positive case. Six of the seven false-negative cases were a proximal-type accessory left gastric artery, and nine of 10 distal-type accessory left gastric arteries were correctly diagnosed using MDCT. The sensitivity, specificity, and accuracy of MDCT were 72.0%, 98.9%, and 93.2%, respectively. On conventional angiography, there were three false-negative and two false-positive cases, none of whom underwent selective left hepatic arteriography. Two of the three false-negative cases were the distal-type accessory left gastric artery, but eight of the 10 distal-type accessory left gastric arteries were correctly diagnosed. The sensitivity, specificity, and accuracy of conventional angiography were 88.0%, 97.8%, and 95.8%, respectively. Approximately 70% of accessory left gastric arteries can be diagnosed at the early phase of MDCT even with a slice thickness of 5 mm.

Nonhepatic Arteries Originating from the Hepatic Arteries: Angiographic Analysis in 250 Patients

To investigate the prevalence and patterns of origin of nonhepatic arteries originating from the proper hepatic artery (PHA) or its distal branches and to assess their relation to anatomic variations. Digital subtraction celiac arteriography and selective left hepatic arteriography was performed in 250 patients with hepatocellular carcinoma. Three interventional radiologists interpreted the angiograms on the monitor by consensus. If necessary, further superselective arteriography was performed. The prevalence of nonhepatic arteries, their sites of origin, and the influence of underlying anatomic variants were analyzed. Nonhepatic arteries were found in 205 patients. The most common nonhepatic artery was the right gastric artery (RGA; n = 196), followed by the hepatic falciform artery (HFA; n = 129), accessory left gastric artery (LGA; n = 43), posterior superior pancreaticoduodenal artery (PSPDA; n = 18), and left inferior phrenic artery (LIPA; n = 5). The left hepatic artery (LHA) was the most frequent origin of nonhepatic arteries (170 of 250). Regardless of anatomic variation, the most common origins of the RGA and HFA were the PHA and the segment IV hepatic artery, respectively. In patients with an aberrant LHA from the LGA, no accessory LGAs or LIPAs were found. PSPDAs preferentially arose from variant hepatic arteries arising from the gastroduodenal artery. Nonhepatic arteries commonly arise from the hepatic arteries, especially the LHA and PHA. Moreover, variants of the celiac and hepatic arteries influence the prevalence and sites of origin of nonhepatic arteries.

Accessory Left Gastric Artery: Angiographic Anatomy

Purpose: To evaluate the angiographic anatomy of the accessory left gastric artery (accLGA). Materials and Methods: We evaluated the angiographic findings of the accLGA in 50 patients (Angiostar; Siemens, Erlangen, Germany). Performing celiac and selective angiography in 50 and 34 patients, respectively. By means of celiac angiography, 1) site of origin, 2) anatomical course, 3) diameter, 4) degree of tortuosity, and 5) distal tapering were evaluated, while selective angiography was used to determine 1) arterial branching, 2) area of blood supply, and 3) patterns of gastric wall stain. Results: Celiac angiography showed that the accLGA arose from the left hepatic artery (LHA) in 45 cases(90%) and from the proper hepatic artery in five (10%). If the accLGA arose from the LHA, its origin entirely depended on the branching pattern of the latter. It always arose from the lateral branch of the LHA furthest to the left and uppermost, and proximal to its umbilical point. The most common anatomical course of the accLGA, seen in 27 cases (54%), was between the S2 and S3 segmental branch. The diameter and degree of tor-tuosity of the accLGA were similar to those of adjacent intrahepatic branches in 21 (42%) and 33 cases (66%), respectively. The degree of tapering was less than that of adjacent intrahepatic vessel in 28 (56%). Selective angiography demonstrated esophageal branching of the accLGA in 27 cases (79%), inferior phrenic arterial branching in three (9%), a mediastinal branch in one (3%), and hypervascularity of the lung in one (3%). In 15 cases (44%), bifurcation of the accLGA was recognized. The vascular territory of the accLGA was the gastric fundus together with the distal esophagus in 21 cases (62%), mainly the gastric fundus in six (18%), and mainly the distal esophagus in four (12%). The pattern of gastric mucosal stain was curvilinear wall in 31 cases (91%) and nodular in three (9%). Conclusion: A knowledge of the angiographic anatomy of the accLGA facilitates accurate recognition of this artery on routine celiac and hepatic arteriography, thus reducing gastric complications after transarterial management of hepatic tumors and improving the angiographic diagnosis and treatment of upper gastrointestinal bleeding.

Angiographic Branching Patterns of the Splenic Artery

Most previous studies of the splenic artery were cadaver dissections, and in vivo anatomical studies have been reported only rarely. Selective arteriography could be used as an in vivo study of the branching patterns of the splenic artery. Forty-three splenic arteriograms and seven celiac arteriograms were included in this study. There were 36 males and 14 females, aged 23–67 years (mean 48 years). The branching patterns of the splenic artery show 80% dorsal pancreatic, 98% pancreatic magna, 84% caudal pancreatic, 76% superior polar, 24% inferior polar, 46% left gastroepiploic, 28% accessory left gastric, 100% terminal superior and inferior, and 28% terminal media arteries. The branching patterns of the splenic artery were similar to the many reports of cadaver dissection in the Korean literature and there was a more frequent incidence of splenic arterial branches than in the reports from the study of Caucasians except for the accessory left gastric artery.

Variations and topography of the arteries in the lesser omentum in humans.

Modern surgical techniques depend in part on knowledge of both the "normal" and the anomalous arterial blood supply. For instance, in liver transplantation, during surgery of the gallbladder, gastrectomy, and gastric lymphadenectomy, or when selective arterial chemotherapy is used for treatment of liver cancer, aberrant hepatic arteries can be a significant problem. A series of 138 cadavers with arterial latex injection were dissected and 10 corrosion casts were made to obtain an exact knowledge of the topography of the normal and anomalous arteries of the lesser omentum in humans. The so-called normal anatomy was found in only 9% (15 of 148 individuals), the remaining five-sixths presenting some variations from this, many of direct surgical importance. In these cases one or two aberrant hepatic arteries (37%), an artery in the free border of the hepatoduodenal ligament (19%), a right hepatic artery crossing the portal vein posteriorly (4%), the right hepatic artery entering the triangle of Calot anteriorly (29%) or not (7%), or an accessory left gastric artery branching off the left hepatic artery (2%) were found.

Prevention of Gastric Complications in Hepatic Arterial Chemoembolization

Gastric complications may be a problem in transcatheter arterial chemoembolization, if the right gastric artery branches distally from the proper hepatic artery or its branch, or the accessory left gastric artery arises from the left hepatic artery. We occluded the proper hepatic artery with a balloon catheter to redirect blood flow in these gastric branches toward the liver. This procedure prevented chemoembolic agents from flowing into the gastric branches, and accordingly protected against gastric complications even when chemoembolization was performed by injecting the agents proximally to the gastric branches.

The Blood Supply of the Stomach

156 abdominal preparations were explored by arteriography, corrosion and dissection. The stomach is vascularized by four well-anastomosed main arteries: the arteria gastrica dextra and sinistra and the arteria gastroepiploica dextra and sinistra. Other important vessels include: the arteria gastroduodenalis, the arteriae gastricae breves for the upper half of the greater curvature, a posterior gastric artery (36%), an accessory left gastric artery (12%) and an arteria supraduodenalis. The main vessels give rise to some very specific collaterals, e.g. the omental arteries that may form an omental arcade (44%), supra- and infra-pyloric branches, retroduodenal branches, rami cardiaci, esophagei and tuberales and an accessory left hepatic artery. The gastroduodenal artery always arises at a fixed point.