Origin Of Inferior Phrenic Artery Research Articles

VARIATIONS IN THE ORIGIN OF INFERIOR PHRENIC ARTERIES AND THEIR RELATIONSHIP TO CELIAC AXIS VARIATIONS ON CT ANGIOGRAPHY.

Background: The inferior phrenic arteries are the rst branch of abdominal aorta. It is necessary to be familiar with the anatomy of the inferior phrenic arteries in surgical and traumatic vascular injuries, haemoptysis, especially due to pulmonary pathologies located in the lung base, and gastroesophageal haemorrhage from the gastroesophageal junction. It is the most common extra-hepatic supply of hepato-cellular carcinomas. TACE is the treatment of choice for unresectable and advanced hepatocellular carcinomas. Knowledge of the detailed arterial anatomy is required for successful embolization by TACE and to prevent complications. Data set Methods: consisted of 150 patients who underwent triple phase CT angiography in GI bleed protocol. The association of CA variation with common trunk, RIPA and LIPA, Chi-square test was used. RIPA most commonly originated from abdomina Results: l aorta in 88 (58.7%) patients followed by celiac artery 45 (30%). LIPA most commonly originated from abdominal aorta in 77 (51.3%) patients followed by celiac artery 69 (46%). There was no statistical signicance detected between the common truncus of IPA, RIPA & LIPA with celiac axis variations. The anatomy Conclusion: and variations in the origin of inferior phrenic arteries are clinically important and should be evaluated with CTA prior to the surgical or interventional management. In our study we did not nd any relationship between the origin of the common trunk of IPA, LIPA and RIPA with celiac axis variations. The variations in the origin of inferior phrenic arteries and celiac axis variations can be explained by their embryological development.

Unraveling Variations in Celiac Trunk and Hepatic Artery by CT Angiography to Aid in Surgeries of Upper Abdominal Region.

Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region.

A STUDY OF THE MORPHOLOGICAL FEATURES OF THE HUMAN THORACO-ABDOMINAL DIAPHRAGM IN FOETUSES

Background: An incidence of 1 in 4000 of diaphragmatic hernias certainly warrants a thorough study especially in the light of possible noninvasive diagnostic techniques and treatment in utero. Aim: Study of the diaphragm in various gestational stages. Objectives: In-depth study of the thraco-abdominal diaphragm in fetuses was done as there is a paucity of literature. Morphometry of various aspects like attachments, foramina, blood supply and nerve supply. The major openings of the diaphragm were observed and as many structures as discernable were elucidated. The findings are compared with those of adult cadavers. Methods: 50 Fetuses of both sexes were procured from ANITS and KGH, Visakhapatnam and 10 adult cadavers were acquired from the Department of Anatomy from NRIIMS, Visakhapatnam for the study. Results: Variation of origin of inferior phrenic arteries were found. The accessory phrenic nerve was found arising from the nerve to subclavius. The eventration of the left dome of the diaphragm and oesophageal hiatus hernia with atretic lung were observed. Conclusion: Such a comprehensive study is of immense value for the detection of relevant hernias of the diaphragm in early intrauterine life by the clinicians and for alleviation of such disorders by surgical measures.

Identification of Celiac Trunk Variations using Multi-Detector Computed Tomographic Angiography

Introduction: Variation in celiac trunk is common and has importance in preoperative planning to reduce the risk of accidental vascular injuries during surgical and radiological intervention. Our aim was to measure the prevalence of coeliac trunk types and describe its different variations using MDCT angiography among patients in Hospital Tengku Ampuan Afzan (HTAA), Kuantan. Materials and method: A retrospective cross sectional study was conducted. Computed Tomographic Angiography (CTA) images were retrieved from July till December 2017. Images were reconstructed in 3D Volume Rendering (VR) format using workstation and reviewed for the normal and anatomical variations of the celiac trunk. The variations were classified using Uflacker’s classification. The results were calculated using IBM SPSS statistic version 22. Results: A total of 140 cases were found, from which 23 were excluded. Mean age was 57.3 years and male/female percentage was 65.8/34.2. Anatomical variation of the CT was found in 54 (46.2%) cases. The most common variation was the origin of inferior phrenic artery (IPA) from the CT in 21 (17.9%) cases followed by celiac-colic trunk in 15 (12.8%) cases. However, 31 (26.5%) cases displayed variations not described in Uflacker’s classification. They include celiaco-phrenic trunk, coexistence of IPA with other Uflacker’s variations, Buhler arc, accessory hepatic artery from the CT and coexistence of celiac-colic trunk with gastro-splenic and hepato-splenic trunk in one case each. Conclusion: Accurate knowledge and identification of anatomical variations in CT is crucial before undergoing any surgical or invasive imaging procedure. This can help surgeons and interventional radiologists to prevent accidental vascular injuries and perform a safe procedure.

A Variation of the Inferior Phrenic Arteries: A Case Report

Introduction: Arterial anatomic variations and focusing on their path and relations are highly important for clinical, radiological, pathological and surgical diagnosis and treatment. Both inferior phrenic arteries usually originate from the abdominal aorta, just after passing through the aortic hiatus of the diaphragm. They rarely originate from the celiac trunk or from the renal arteries. They have an important role in the blood supply of the diaphragm. Each artery goes upward and laterally to the crus of the diaphragm, near the medial side of the suprarenal gland. Case Presentation: During the regular dissections in the dissecting room of the Anatomy Department (from 2008 - present) in 15 male cadavers with 55 years of age in average, variations in origin of the inferior phrenic arteries were observed in one cadaver. They originated from the celiac trunk. Conclusions: In the present study there was a variation in the origin of both inferior phrenic arteries. The most common source of origin was abdominal aorta in 14 cadavers, but in one cadaver it originated from the celiac trunk in both sides. This case report provides helpful information about inferior phrenic arteries (variations and relations) also their clinical importance as well. Accurate knowledge about normal and variant origins of inferior phrenic artery is essential in liver tumor treatment and for the radiologists and surgeons.

Bilateral variant origin of the inferior phrenic artery

The inferior phrenic arteries (IPA) arise from aorta, just above the level of celiac artery. Although descriptions of the right and left phrenic arteries are typically brief, the inferior phrenic arteries have received attention in recent years because of its involvement in treating unresectable hepatocellular carcinoma (HCC) by using transcatheter embolization. Since IPA contributes to the arterial supply of adrenal glands, they are important in angiographic examination of adrenal lesions. During routine dissection for MBBS students, bilateral variant origin of inferior phrenic arteries was observed. In this case, coeliac artery was tortuous and it measured 2 cm in length and 0.6 cm in diameter. The right IPA originated from the coeliac artery as a common trunk. This common trunk divided into two. One branch formed the right IPA and the other branch formed the superior suprarenal artery. On the left side, a common trunk originated from coeliac artery which divided into two branches. One branch joined the splenic artery and the other branch again formed a common trunk which further divided into two i.e superior suprarenal artery and left IPA. In patients with left suprarenal mass or oesophgo- gastric junction hemorrhage, certain interventional procedures such as selective IPA angiography is necessary. Due to variable anatomy of its origin, cannulation of IPA can be challenging. Therefore, the knowledge of this type of variations should be kept in mind by the surgeons and care should be taken to avoid unintentional sectioning of small caliber arteries.

Variant morphology and arterial supply of diaphragmatic crura with probe patent foramen ovale

Crura are the posterior pillars of the tendino-muscular partition between thoracic and abdominal cavity. This study highlights bilaterally an unfamiliar morphology of diaphragmatic crura with uncommon origin of inferior phrenic artery and accompanying atrial septal defect in a 63-years-old female cadaver with scoliosis. An attempt is made to portray the clinical implications of these variations. In addition authors have discussed the embryological and genetic basis of these variations. In the recent few decades, surgical correction of scoliosis involving intervention with the crura has gained pace. Knowledge about the normal as well as variant crural morphology is imperative for the surgeons to decide the correct approach during spinal corrective surgeries and for radiologist to prevent any diagnostic pitfall. Familiarity about the variant origin of inferior phrenic artery may prevent complications during treatment of pathological conditions related to inferior phrenic artery. Preoperative awareness about the coexisting atrial septal defect is vital for anesthesiologists promoting them to administer cardioprotective anesthetic drugs. To the best of our knowledge, description of such a combination of variations in anatomical literature is rare and scarcely reported. Awareness of these anatomical variations is relevant for operating surgeons, radiologists, anesthesiologists and anatomists.

Variations in the Origin of Inferior Phrenic Arteries and Their Relationship to Celiac Axis Variations on CT Angiography.

ObjectiveKnowing the origin of the inferior phrenic artery (IPA) is important prior to surgical interventions and interventional radiological procedures related to IPA. We aimed to identify variations in the origin of IPA and to investigate the relationship between the origin of IPA and celiac axis variations using computed tomography angiography (CTA).Materials and MethodsThe CTA images of 1000 patients (737 male and 263 female, the mean age 60, range 18–94 years) were reviewed in an analysis of IPA and celiac axis variations. The origin of IPA was divided into two groups, those originating as a common trunk and those originating independently without a truncus. The relationship between the origin of IPA and celiac axis variation was analyzed using Pearson's chi-square test.ResultsBoth IPAs originated from a common trunk in 295 (29.5%) patients. From which the majority of the common trunk originated from the aorta. Contrastingly, the inferior phrenic arteries originated from different origins in 705 (70.5%) patients. The majority of the right inferior phrenic artery (RIPA) and the left inferior phrenic artery (LIPA) originated independently from the celiac axis. Variation in the celiac axis were detected in 110 (11%) patients. The origin of IPA was found to be significantly different in the presence of celiac axis variation.ConclusionThe majority of IPA originated from the aorta in patients with a common IPA trunk, while the majority of RIPA and LIPA originating from the celiac axis in patients without a common IPA trunk. Thus, the origin of IPA may widely differ in the presence of celiac axis variation.

Variation in Site of Origin of Inferior Phrenic Arteries

Variation in Site of Origin of Inferior Phrenic Arteries

Bilateral variant origin of inferior phrenic artery

Bilateral variant origin of inferior phrenic artery

Variations in the source of origin of inferior phrenic artery: a cadaveric study

Introduction: The right and left inferior phrenic arteries perfuse the diaphragm. They may originate either from the aorta, celiac trunk, or from the renal artery. Most textbooks of human anatomy give little information regarding the functional anatomy of the inferior phrenic artery. In the past few years, however, more articles have been published regarding the arterial supply in cases of hepatocellular carcinoma. The inferior phrenic artery is seen as an important source of collateral arterial supply to hepatocellular carcinoma, the hepatic artery being the main source. Materials and methods: A cadaveric study was conducted in the Anatomy Department of Bangalore Medical College during the years 2009–2011. Manual dissection was done to identify the inferior phrenic arteries, and their origins were traced. Results: The inferior phrenic artery arose from the aorta in 53.125%, celiac trunk in 28.125%, renal artery in 15.625%, and the superior mesenteric artery in 3.125% of the 32 cadavers studied. The right inferior phrenic artery arose from aorta in 56.25%, celiac trunk in 18.75%, renal artery in 18.75%, and superior mesenteric artery in 6.25% cases. The left inferior phrenic artery arose from aorta in 50%, from celiac trunk in 37.5%, and the rest arose (12.5%) from the renal artery. Discussion: The results were compared with those of earlier studies so that such findings could be applied in the treatment of hepatocellular carcinoma. The significance of this information is due to the fact that an unresectable hepatocellular carcinoma can be treated by transcatheter embolization of the right inferior phrenic artery, in case it is involved.

Pentafurcation of the Celiac Trunk

“Variability is the law of life” Sir William Osler – Father of modern medicine. The aim is to illustrate the variation in the branching pattern of the celiac trunk. The study was conducted in the Department of Anatomy, Kamineni Institute of medical sciences Narketpally, Nalgonda Dt. Andhra Pradesh, India. A case of unusual origin of Inferior phrenic arteries from the celiac trunk in addition to its usual left gastric, splenic and common hepatic arteries were recorded. The pattern of the branching of the celiac trunk was observed to vary from classical trifurcation to an abnormal pentafurcation. This type of rare variation has significant importance in surgical and radiological procedures. Knowledge of variations of the celiac trunk is important as to do an appropriate vascular ligation and anastomosis.