Inferior Suprarenal Artery Research Articles

THU619 Atypical Clinical Presentation Of Adrenal Hemorrhage

Abstract Disclosure: T.L. Madsen-Barbosa: None. F.H. Antoni: None. A. Ghazi: None. Introduction: Adrenal hemorrhage (AH) is an uncommon condition that is challenging to diagnose due to its nonspecific findings. We illustrate a case of AH that presented with acute clinical deterioration and had catecholamine overproduction. Case: A 58-year-old woman with a history of migraine headaches and prediabetes presented to the emergency department for “the worst headache of her life” and palpitations of 4 hours duration. On admission, her blood pressure was 224/139 mmHg and heart rate was 102 bpm. Her physical examination was significant for diaphoresis and active vomiting. Initial laboratory tests showed hyperglycemia and leukocytosis. Her ECG, non-contrast CT scan of the head and CT angiography of the head and neck were unremarkable. Her hospital course was complicated by recurrent hypertensive episodes, arrhythmias including Torsades de pointes, and left flank pain. A CT chest, abdomen, and pelvis revealed a large left retroperitoneal hemorrhagic collection which seemed to arise from the inferior aspect of the left adrenal gland. She subsequently underwent successful IR embolization of the left inferior suprarenal artery. Further workup showed elevated urinary fractionated metanephrine and normetanephrine levels, as well as elevated levels of plasma free metanephrine and normetanephrine. Given concern for pheochromocytoma, phenoxybenzamine was started. A repeat CT abdomen after six days demonstrated shrinkage in hematoma and a 7 mm hypoattenuating nodule arising from the medial limb of the left adrenal gland. Outpatient follow-up CT abdomen showed left adrenal thickening with a 2.3 cm nodular area with 78.9 Hounsfield units and absolute washout of 60.9% suggestive of adenoma. After one month, repeat catecholamine levels normalized. Discussion: The clinical manifestation of AH varies widely. Acute adrenal insufficiency is seen if bilateral glands and 90% of the cortices are compromised. However, unilateral AH is most often asymptomatic - found incidentally on imaging. Having elevated catecholamines is described in 30% of patients in one case series. Differentiating spontaneous AH from hemorrhagic adrenal tumors is also a dilemma. Among the hemorrhagic adrenal masses, pheochromocytoma is the most common. Conclusion: This case highlights that clinicians should be aware of clinical manifestations of catecholamine excess when evaluating patients with AH. A catecholamine producing adrenal mass (pheochromocytoma) should also be ruled out in these situations. Reference:1- Elhassan YS, Ronchi C, Wijewickrama P, Balvedeweg SE. Approach to the patient with adrenal hemorrhage. J Clin Endocrinol Metab. 2023, 108 (4):995-1006.2- Karwacka IM, Obolonczyk L, Sworczak K. Adrenal hemorrhage: a single center experience and literature review. Adv Clin Exp Med. 2018; 27 (5): 681-687. Presentation: Thursday, June 15, 2023

Anomalous origin of the left suprarenal, inferior phrenic arteries and left ovarian artery in a human cadaver.

This report addresses three variants identified within a female cadaver. Specifically, these were an anomalous origin of the right suprarenal artery, an abnormal bilateral ovarian vein branch, and a arterial tortuosity of the left ovarian artery. Indeed, the cadaver evinced abnormal origins in the case of the middle suprarenal artery (MSA), right inferior phrenic artery (IPA), and the renal capsule artery (emanating from the right renal artery). The MSA and IPA shared a common trunk with the inferior suprarenal artery. It was additionally observed that the right ovarian vein anastomoses the branches from the right kidney posterior inferior along with those to the renal fat capsule. Abnormal origin was evident in the case of the left ovarian artery, and arterial tortuosity was apparent in the lower region of the vessels. This report addresses both the clinical import of these variations and their likely causes. In the subdiaphragmatic region, surgical success and prognosis may be impacted by such anomalies; accordingly surgeons must be aware of anatomical variants of the ovarian and suprarenal arteries.

Prevalence and clinical relevance of the anatomical variations of suprarenal arteries: a review.

The suprarenal arteries are arising from three sources: superior suprarenal artery, middle suprarenal artery, and inferior suprarenal artery. Variations in the arterial supply of the suprarenal glands in respect to origin and number are quite common and very frequently reported. The most common variation noted is in the inferior suprarenal artery followed by the middle suprarenal artery and the least common variations were observed in the superior suprarenal artery. Arteriogram of the inferior suprarenal artery is crucial in suprarenal tumour diagnosis but variation in the branching pattern and multiplicity of these arteries can cause hindrance in arteriography. The absence of middle suprarenal artery was seen to be associated with increased number of the inferior suprarenal artery. Variation in the multiplicity of arteries was observed more frequently in the inferior suprarenal artery and middle suprarenal artery which was more on the right side in most of the studies. Also, the variation in suprarenal arteries was often correlated to variations in inferior phrenic and gonadal arteries. The variations were observed to be more common on the left side therefore right adrenalectomy should be preferred over the left one. The loop formed by the inferior suprarenal artery around the right renal vein can cause venous obstruction. These variations of suprarenal vasculature are explained on the developmental basis, and prior knowledge of such variants is crucial for nephrologists to ensure minimum blood loss while performing laparoscopic adrenalectomy especially for large adrenal tumours and pheochromocytoma where the duration of surgery exceeds the usual.

An accessory aberrant testicular artery branching from the inferior suprarenal artery: embryologic and genetic consideration

During routine educational dissection of a cadaver (61-year-old, male, white descent), multiple aberrant right testicular artery and veins were discovered. Detailed analysis of the abdominal vascular pattern showed that the accessory aberrant testicular artery branched off the right inferior suprarenal artery. It crossed the anterior pararenal space, gave several branches to the soft tissues of the posterior pararenal space, and descended towards the deep inguinal ring. The accessory aberrant testicular vein accompanied the aberrant artery and was drained by the right inferior suprarenal vein into the renal one. Two other testicular veins followed a typical course and opened into the inferior vena cava. The anatomical variability reported in this paper requires attention of the related specialists, as it may significantly complicate surgical and minimally invasive procedures on the organs of the retroperitoneal space and inguinal region. Thorough preoperative investigation regarding the variability of the vascular pattern should be conducted in patients considered for intervention on the adrenal gland, kidney, or testis.

Aberrant inferior suprarenal vessels crossing posterior pararenal space: a case report

During routine educational dissection of a cadaver (63-year-old, male, USA), an atypical course of the left inferior suprarenal vessels via the posterior pararenal space was discovered. Detailed analysis of the abdominal vascular pattern showed that the atypical inferior suprarenal artery represented a terminal branch of the left inferior phrenic artery. The last one branched off from the very beginning of the left renal artery, ascended between the fibers of the left crus of the diaphragm, then ran laterally giving off muscular branches and, finally, descended along the costal part of the diaphragm to the left posterior pararenal space. The terminal branch of the inferior phrenic artery pierced the retrorenal fascia and entered the perirenal space as an atypical left inferior suprarenal artery. It ran upward and medially crossing the anterior surface of the kidney to reach and supply the lower pole of the left suprarenal gland. The left inferior phrenic vein accompanied the artery taking a similar course. It received numerous tributaries passing via the posterior pararenal space, drained the inferior suprarenal vein, and opened into the left renal vein. Such anomalous pararenal vascular pattern is a challenge for surgeons performing open procedures on retroperitoneal organs, not to mention specialists employing minimally invasive laparoscopic techniques. The anatomical variation reported in this paper requires urgent attention of the related specialists.

Rare combined variations of renal, suprarenal, phrenic and accessory hepatic arteries

Knowledge of the morphological variations within the abdominal cavity is significant for all medical practitioners planning surgery. This report presents the rare origin of a common trunk for the right inferior phrenic artery, and superior and inferior suprarenal artery from the right renal artery. An accessory hepatic artery was found, which served as a branch of the right inferior phrenic artery. The diameter of the common trunk was 3.95 mm, and the diameters of the inferior and superior suprarenal arteries were 1.84 and 1.36 mm, respectively. The diameter of the right inferior phrenic artery was 2.55 mm. Both the embryological background and the potential clinical significance of this morphological variation are discussed. Knowledge of this common trunk and the occurrence of the accessory right hepatic artery may be of significance in diagnostic and surgical procedures.

A study on the variations of arterial supply to adrenal gland

Introduction: Adrenal glands are richly vascular and get their arterial supply by means of three arteries namely superior, middle, inferior suprarenal arteries. The inferior phrenic artery gives off the superior branch, while middle branch arises directly from the abdominal aorta, and the inferior suprarenal branch is given off by the renal artery. Materials and methods: The study was conducted in 15 formalin fixed cadavers obtained from the department of Anatomy and are carefully dissected to observe the arterial supply of both right and left adrenal glands. Observations: It has been noted that variations were observed in four cases out of 30 adrenal glands, two cases showed variations on right side and in two cases variation is seen on left side. First case on the right side, both MSA and ISA are given off by ARA. In the second case on right side IPA is given off by RA and from the junction of these two arteries MSA was given .In third case on left side MSA is given by the coeliac trunk and ISA is from ARA, in fourth case on left side ISA is originated from ARA. Conclusion: A good understanding in the variation of adrenal gland vasculature is obligatory for a surgeon while performing adrenalectomy, kidney transplantations etc. and also for radiological arbitrations.

Rare combined variation of left suprarenal vessels associated with retroaortic left renal vein

Suprarenal vascular variations should be known to surgeons performing laparoscopic adrenalectomy, partial nephrectomy, living donor nephrectomy and renal transplantation. A rare case of vascular variation of the left suprarenal gland was observed, in which the left suprarenal vein was draining into the inferior vena cava after crossing the abdominal aorta anteriorly, just below the origin of the superior mesenteric artery. The left inferior suprarenal artery was originating from the left gonadal artery, which originated from the abdominal aorta in front of the left renal artery. Besides this, the left renal vein passed obliquely downwards behind the abdominal aorta and drained into the inferior vena cava. The retroaortic left renal vein may lead to unilateral hematuria, left varicocele and could be a cause of infertility in men.

Anaesthetic management of a case of adrenal and extra-adrenal phaeochromocytoma for preoperative embolisation.

Sir, A 40-year-old asymptomatic patient was found to have a blood pressure (BP) of 170/110 mmHg during routine medical examination. His systemic examination was essentially normal and routine investigations did not reveal any abnormality. However, his 24 h urine normetanephrine levels were elevated to 1977.37 μg/g of creatinine (normal: 46-256 μg/g). Magnetic resonance imaging of the abdomen showed right adrenal, superior mesenteric and left paraaortic phaeochromocytoma. Biochemical screening for multiple endocrine neoplastia was negative. Antihypertensive drugs were used to manage hypertension and to prepare the patient for surgery; the patient was started on oral amlodipine 5 mg once daily, prazosin 5 mg once daily and carvedilol 25 mg twice daily and continued for 4 months while embolisation of tumour was planned to reduce vascularity before surgery. The technique of anaesthesia decided upon was sedation with monitored anaesthesia care. On the day of the procedure, patient was shifted to interventional radiology centre. A valid informed consent was obtained. All emergency equipments and drugs, including those required for general anaesthesia were checked and kept ready. Standard monitoring including pulse oximetry (SpO2), electrocardiogram (ECG) and non-invasive BP were applied. Baseline BP recorded was 120/80 mmHg with heart rate (HR) 64/min and ECG monitor showed normal sinus rhythm. Vasoactive drugs like sodium nitroprusside (SNP), nitroglycerin (NTG), noradrenaline and dopamine were kept ready and loaded in syringes in infusion pumps. A large bore 16 gauge intravenous (IV) cannula was inserted in left upper limb under local anaesthesia. Premedication consisted of ondansetron 4 mg, midazolam 2 mg and fentanyl 100 μg, all IV. Oxygen was started at 5 L/min through a facemask. The right radial artery was cannulated using a 20 gauge arterial catheter, and right subclavian vein was cannulated with a 7.5 French triple-lumen central venous catheter under strict asepsis under local anaesthesia. A baseline infusion of SNP was started at 0.3 μg/kg/min. Right femoral artery was canulated by the radiologist under local anaesthesia using 5 F femoral sheath. Flush aortogram was done and selective catheterisation and polyvinyl alcohol embolisation done in the right middle and inferior suprarenal and bilateral lumbar arteries at L1 level. Coils were placed in branches of left lumbar and paravertebral branch of middle suprarenal artery. After embolisation of main feeding vessel of tumour, BP rose to 172/110 mmHg with a drop in HR to 44/min. SNP infusion was increased stepwise till 1.2 μg/kg/min and NTG was started at 1.5 μg/kg/min. Both infusions were carefully titrated to maintain BP of 140/90 mmHg. Blood sugar levels were checked and were found to be 46 mg/dl and 50 ml of 50% dextrose was administered. The blood sugar value was checked 1/2 hourly thereafter during the procedure, which were normal. Arterial blood gas analyses obtained during the procedure were normal. Intraoperative central venous pressure (CVP) was maintained at 10 cm of water. Ringer's lactate, 2.5 L was infused during the procedure. Total duration of procedure was 3 h. Once procedure was over, patient was shifted to the Intensive Care Unit (ICU) under close monitoring where SNP and NTG were tapered down slowly. Patient was then closely monitored for hypotension and hypoglycaemia. Throughout ICU stay BP remained 130/90 mmHg with a HR of 80–90/min. He was taken up for laparotomic excision of the tumour next day. Previous reports have described the use of transcatheter arterial embolisation (TAE) in patients with phaeochromocytoma. Pre-operative embolisation in both adrenal and extra-adrenal location[1] has been shown to reduce the risk of catecholamines release during manipulation of the tumour at the time of surgery. Treatment of malignant phaeochromocytoma[2] or its metastatic lesions,[3] particularly liver metastasis has been performed too with TAE. Marked decrease in circulating levels of catecholamines following TAE may be associated with lower risks of haemodynamic fluctuations during surgical manipulation of the tumour and in the post-operative period. Hence, TAE may have an important role in the pre-operative management of large adrenal and extra-adrenal pheochromocytomas.[4,5] There are many anaesthetic choices available for this procedure. It can be performed under sedation with monitored anaesthesia care as in our case.[6] It can also be performed using supraglottic airway devices with general anaesthesia with spontaneous ventilation. Epidural anaesthesia can alleviate ischaemic pain after TAE of tumour, after ensuring stringent haemodynamic monitoring. Irrespective of the type of technique, it is useful to have invasive monitoring, including intra-aortic balloon pump and CVP so as to have constant haemodynamic monitoring, which is of prime importance in such a case.

Bilateral asymmetrical multiple renal arteries associated with the left testicular artery.

We found 3 right and 2 left renal arteries with asymmetrical origins in a 61-year-old Korean male cadaver, whose cause of death was 'laryngeal carcinoma'. According to a previous classification, the first and second right renal arteries correspond to the early division and other renal arteries - to the extra renal arteries, except the first left renal artery as a typical renal artery. The third right renal artery ran anterior to the inferior vena cava to the inferior pole of the kidney. The first and second left renal arteries were associated with the inferior suprarenal artery and the testicular artery, respectively. The bilateral asymmetry in the number of renal arteries can be explained by the embryological development, degeneration and persistence of the renal artery in the process of ascending of kidneys.

Anatomical Study of Variations in the Blood Supply of Kidneys

Each kidney is supplied by a single renal artery and a single renal vein, which accounts for about 20% of the cardiac output. However, variations in the form of level of origin and arrangement of renal arteries are so frequent. The present study aimed to note the vascular anatomy of kidneys with respect to the variations in their origin, course and any aberrant vessels which were present. The study material comprised of 15 formalin fixed human cadavers. During routine abdominal dissection for undergraduate students, the kidneys were exposed and the blood supply, along with its variations, were noted. The following anatomical findings are observed in this study: (i) Accessory renal arteries (ii) Presegmental arteries (iii) Upper polar arteries (iv) Lower polar arteries (v) Inferior suprarenal artery from accessory renal artery and (vi) Accessory renal vein. Awareness of the normal as well variational anatomy is mandatory for the surgeons, radiologists and urologists, for doing any uroradiological procedures or angiographic studies. Hence, this study will serve a useful guideline for the above mentioned procedures.

Multiple vascular anomalies involving testicular, suprarenal arteries and lumbar veins

Testicular arteries arise from the abdominal aorta and the inferior suprarenal artery from the renal artery. There are reports about variant origin and course of these arteries. Accessory testicular artery is also a common finding but its providing origin to inferior suprarenal artery is an important observation. During a routine dissection of abdomen of approximately 55-year-old male cadaver, unique vascular abnormality was observed. On the left side, a common arterial trunk originating from abdominal aorta immediately branched to give rise to superior testicular and inferior suprarenal arteries, the former after a short course hooked by the left suprarenal vein. In addition, the left suprarenal vein, second left lumbar vein, and left testicular vein joined to form a common trunk which drained into the left renal vein. A sound knowledge of vascular variations in relation to the kidney and suprarenal gland is important to surgeons dissecting the abdominal cavity.

Morphological assessments on the arteries of the superior renal segment

The study was performed on 461 renal arteries in order to assess some morphological aspects regarding the arteries that supply the superior renal segment using as study methods: dissection, injection of contrast medium, injection of plastic followed by corrosion together with the examination of MRI and renal angiographies (simple and angio CT). The posterior arteries of the superior renal segment originate mostly from the posterior terminal branch of the renal artery as 1-3 arterial branches. In only 42 cases, we found posterior branches that do not participate in the supply of the superior renal pole. In 190 cases, the anterior arteries of the superior segment originated from the anterior division of the renal artery and in 73 cases directly from the trunk of the renal artery. 34 cases were assessed as a terminal division of the renal artery, while the origin from the posterior division of the renal artery was encountered in 18 cases. In 138 cases, the artery of the superior segment originated from a supplementary renal artery, double (118 cases) or triple (20 cases); in this situation, from the polar artery started the inferior suprarenal artery, except five cases where it originated from the aorta. Of the total of 461 samples, in 244 cases the renal approach was performed above the renal hilum, as proper superior polar arteries and in 217 cases the artery entered through the upper part of the hilum as an apical artery. The morphology of the arteries of the superior renal segment shows a significant degree of variability mostly in what concerns the anterior ones. Frequently we encountered a clear delimitation of the superior renal segment (in 61% of the cases), a situation that allows a relatively facile nephrectomy.

The middle suprarenal artery arising from the superior mesenteric artery

We observed a rare case of the middle suprarenal artery branching out from the superior mesenteric artery in a 78-year-old male. This atypical artery enters the right suprarenal gland that was also supplied by the superior and the inferior suprarenal arteries as usual. In embryonic stages, vasculature of the vitelline system and the gonadal system is differentially organized. The superior mesenteric artery has been generally thought to be pure vitelline, since there has been no evidence that the superior mesenteric artery supplies other organs than digestive. We then speculate that the present middle suprarenal artery is a remnant of the embryonic gonadal artery from the superior mesenteric artery, whereas a stem artery to the testis disappeared. Surgeons should take notice of the middle suprarenal artery when operations are conducted around the superior mesenteric artery.

High origin of a testicular artery: a case report and review of the literature

IntroductionAlthough variations in the origin of the testicular artery are not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. We discuss the case of a high origin of the testicular artery, its embryology, classification systems, and its clinical significance.Case presentationWe report a very rare case of high origin of the left testicular artery in a 68-year-old Caucasian male cadaver. The artery originated from the anterolateral aspect of the abdominal aorta, 2 cm cranially to the ipsilateral renal artery. Approximately 1 cm after its origin, it branched off into the inferior suprarenal artery. During its course, the artery crossed anterior to the left renal artery.ConclusionsA knowledge of the variant origin of the testicular artery is important during renal and testicular surgery. The origin and course must be carefully identified in order to preserve normal blood circulation and prevent testicular atrophy. A reduction in gonadal blood flow may lead to varicocele under circumstances. A knowledge of this variant anatomy may be of interest to radiologists and helpful in avoiding diagnostic errors.

Value of multislice spiral CT simulation model of hepatic carcinoma in interventional therapy

Objective To explore the value of multislice spiral CT (MSCT) simulation model of hepatic carcinoma in interventional therapy.Methods Enhanced MSCT was performed in 42 cases of primary hepatic carcinoma before interventional procedure.The simulation model was established with postprocessing software to demonstrate the supply blood arteries of tumor, hepatic arteriovenous shunt, tumor thrombosis of portal vein.The schemes of interventional therapy were worked out ac-cording to the findings of MSCT simulation model of hepatic carcinoma and the time of transcatheter procedure recorded.Results With respect to display quality in the supply arteries of tumors and its trend of 42 patients, there was good or fair correlation between MSCT simulation model of hepatic car-cinoma and DSA.MSCT simulation model of hepatic carcinoma could clearly demonstrate the suppl-ying blood vessels of tumors including hepatic arterial anomalies(5 cases), diphragmic arteries (3 ca-ses), left gastric arteries (2 cases), intercostal arteries (2 cases) and inferior suprarenal arteries (2 cases).There was no significance in demonstrating hepatic arteioportal shunt and tumor thrombosis of portal vein between MSCT simulation model of hepatic carcinoma and DSA (P>0.05).The duration of transeatheter procedure was lower than that of the routine procedure.Conclusion MSCT simula-tion model of hepatic carcinoma has high clinical value and it can clearly display the supplying arteries of tumors and its trend, markedly reduce the duraiton of transcatherter and operative procedure and obtain complete embolization. Key words: Carcinoma, hepatoeellular; Spiral CT; Simulation model; Interventional therapy

Morphological aspects of the inferior suprarenal artery.

The study was performed on 120 cases, and evaluated the origin, caliber at the origin, course, place of termination and distribution of the inferior suprarenal arteries, together with their point of entry into the glandular parenchyma. Most often, the inferior suprarenal artery originated from the trunk of the renal artery, prior to its terminal division. Other possible origins were: as a terminal branch of the renal artery, from one of the terminal branches of the renal artery (most often from the anterior division and rarely from the posterior one), as a common trunk with the superior polar renal artery, from a supplementary renal artery (more often from the superior and rarely from the inferior one), directly from the aorta, either as an individual branch, as a common trunk with the superior polar renal artery or as a common trunk with the middle suprarenal artery. Rarely the inferior suprarenal artery may originate from the genital artery or, also very rarely, from the celiac trunk, either individually or as a common trunk with the middle suprarenal artery. Usually, the inferior suprarenal arteries originating from the aorta or the renal artery have a larger caliber than those from other arterial sources. Most often, we found two or three arterial branches as inferior suprarenal arteries, so we may speak of inferior suprarenal arteries or an inferior suprarenal arterial pedicle.

Studies on the vasa vasorum of the human renal artery

The transplantation of a donor kidney is currently the treatment of choice for terminal renal insufficiency. However, major postoperative problems may be caused by vascular complications. It was therefore decided to look for possible correlations between these vascular problems and the arterial wall supply. The following methods were used to elucidate the origin and distribution of nutrient vessels: 1. Injection of the abdominal aorta with resin in three fresh cadavers. 2. The precise microscopic location of the branches originating from the renal arteries in eighteen autopsy subjects. 3. Abdominal angiography and selective angiography of the first left lumbar artery and left renal artery in one patient. It was found that the renal artery receives its blood supply from both internal and external nutrient vessels. The external vascular supply of the renal arterial wall originates from the aorta itself, from the inferior suprarenal artery (which sometimes has connections with the first and/or second lumbar artery) or from the diffuse vascular system of the retroperitoneal space. Because of the variety in number, course and origin of these nutritional vessels, an ideal point for the anastomosis of the renal artery cannot be indicated.

Angioarchitecture of the coeliac sympathetic ganglion complex in the common tree shrew (Tupaia glis).

The angioarchitecture of the coeliac sympathetic ganglion complex (CGC) of the common tree shrew (Tupaia glis) was studied by the vascular corrosion cast technique in conjunction with scanning electron microscopy. The CGC of the tree shrew was found to be a highly vascularised organ. It normally received arterial blood supply from branches of the inferior phrenic, superior suprarenal and inferior suprarenal arteries and of the abdominal aorta. In some animals, its blood supply was also derived from branches of the middle suprarenal arteries, coeliac artery, superior mesenteric artery and lumbar arteries. These arteries penetrated the ganglion at variable points and in slightly different patterns. They gave off peripheral branches to form a subcapsular capillary plexus while their main trunks traversed deeply into the inner part before branching into the densely packed intraganglionic capillary networks. The capillaries merged to form venules before draining into collecting veins at the peripheral region of the ganglion complex. Finally, the veins coursed to the dorsal aspect of the ganglion to drain into the renal and inferior phrenic veins and the inferior vena cava. The capillaries on the coeliac ganglion complex do not possess fenestrations.

Angioarchitecture of the coeliac sympathetic ganglion complex in the common tree shrew (Tupaia glis)

The angioarchitecture of the coeliac sympathetic ganglion complex (CGC) of the common tree shrew (Tupaia glis) was studied by the vascular corrosion cast technique in conjunction with scanning electron microscopy. The CGC of the tree shrew was found to be a highly vascularised organ. It normally received arterial blood supply from branches of the inferior phrenic, superior suprarenal and inferior suprarenal arteries and of the abdominal aorta. In some animals, its blood supply was also derived from branches of the middle suprarenal arteries, coeliac artery, superior mesenteric artery and lumbar arteries. These arteries penetrated the ganglion at variable points and in slightly different patterns. They gave off peripheral branches to form a subcapsular capillary plexus while their main trunks traversed deeply into the inner part before branching into the densely packed intraganglionic capillary networks. The capillaries merged to form venules before draining into collecting veins at the peripheral region of the ganglion complex. Finally, the veins coursed to the dorsal aspect of the ganglion to drain into the renal and inferior phrenic veins and the inferior vena cava. The capillaries on the coeliac ganglion complex do not possess fenestrations.