Phrenic Artery Research Articles

Liver Transplantation for Polycystic Disease: Experience and Results of a Single-Center Series.

Polycystic liver disease (PLD) is a hereditary condition, and its symptoms are due to the growth of cysts. Liver transplantation (LT) is the only curative treatment. A retrospective single-center analysis was conducted on the 10 LTs performed for PLD between 2004 and 2023. Eighty percent of the patients were women, and 70% had polycystic hepatorenal involvement. Forty percent required a kidney transplant prior to LT, and in 30%, simultaneous hepatorenal transplantation was performed due to end-stage chronic kidney failure. In 70% of cases, hepatectomy was performed with vena cava preservation (the piggy-back technique). The median operative time was 235 minutes (range 190-398), and the mean weight of the explanted liver was 5050g (range 1840-9450). Two patients had major complications classified as ≥IIIa on the Clavien-Dindo scale: a hemorrhage from the phrenic artery and a hepatic artery anastomotic stenosis, both resolved through interventional radiology. The rate of surgical reoperation and postoperative mortality was zero. The median stay in the Intensive Care Unit was 4 days (range 3-7), and the median hospital stay was 17 days (range 10-25). No patient required re-transplantation. After a median follow-up of 43.5 months (range 8-284), both patient and graft survival were 100%. Overall, and based on our experience, LT provides excellent outcomes and it is the treatment of choice for PLD in patients with end-stage liver failure or clinically limiting symptoms.

Overview of Anatomical Variations in the Vasculature of Suprarenal Gland and Its Applied Surgical Importance

Background: The suprarenal gland (SrG) presents a substantial circulatory supply compared to its size. The superior, middle, and inferior suprarenal arteries (SrA) have one or more duplicate major branches, which supply each gland. this study aimed to observe the variable arteries and veins of the SrG. As the vessels of SrG are forming extensive network, they may get damaged during different surgical procedures like adrenalectomy, renal transplant surgeries Methods: Present study conducted with Twenty five cadavers embalmed in 10% formalin. The inclusion criteria for study were intact blood vessels along with SrGs and the exclusion criteria included the damaged blood vessels and SrGs. Dissection was carried out as per standard dissection protocol. Results: Origin of right superior suprarenal artery from inferior phrenic artery and superior mesenteric artery, Origin of right superior suprarenal artery from aorta and some other findings were noted. Conclusions: This study highlights the critical importance of understanding the anatomical variations in the vasculature of the SrG, particularly in the context of surgical interventions such as adrenalectomy and renal transplantation. The intricate and variable nature of the blood supply to the SrG, including the SrA, as well as their venous drainage, presents significant challenges during surgery. KEY WORDS: Suprarenal Gland, Suprarenal Artery, Suprarenal Vein, Phrenic Vessels.

ABDOMINAL SPLANCHNIC ARTERIAL MAPPING OF Cerdocyon thous: HELPING IN SURGICAL PLANNING

Inconceivable that in the 21st century, veterinary extrapolate knowledge of domestic animal anatomy to wild animals, neglecting the patient, especially in the face of the increasing number of professionals claiming to be wild animal specialists. Thus, we mapped the abdominal splanchnic arterial vasculature of Cerdocyon thous, with the aim of contributing to professionals who work directly with wild animal surgery. In specimens whose arterial system was evidenced by stained latex, we identified anatomical variations when compared to other species. The jejunal arteries issued nine branches, and the caudal abdominal phrenic and cranial arteries arose from the common trunk of the abdominal aorta. The cranial abdominal artery was bifurcated and inserted into the cranial pole of the left kidney, while the left renal artery was bifurcated in one specimen; in another specimen, the left renal artery was double and penetrated the renal pelvis. One specimen had the right kidney more caudally in relation to the left kidney, similar to the corresponding renal artery. The left renal artery originated from the left adrenal artery, and the right internal iliac artery was bifurcated. Given these findings, such knowledge is crucial in the clinical and surgical care of this species, as it will allow for the greatest success of the professionals involved.

Effectiveness of Steerable Microcatheters During Transarterial Chemoembolization for Hepatocellular Carcinoma.

Although transarterial chemo-embolization (TACE) is a key treatment for hepatocellular carcinoma (HCC), its effectiveness depends on the cannulation of the microcatheter tip into the feeding artery. Steerable microcatheters allow remote operation of the tip, enabling its insertion into feeding arteries otherwise difficult to reach. This study investigated the indications and effectiveness of steerable microcatheters in TACE for HCC. We retrospectively examined 22 patients with HCC who underwent TACE using steerable microcatheters at our Department between December 2014 and July 2024. Previous TACE administration, number of TACE sessions, and feeding artery disruption affecting TACE were examined. Among the first TACE cases requiring steerable catheters, three demonstrated steep bifurcation of the celiac artery or superior mesenteric artery from the parent artery, two had sharp bends in the posterior segment, and four had the left hepatic artery bifurcating from the left gastric artery. All three procedures performed in the inferior phrenic artery required second TACE sessions. Steerable microcatheters were used in two patients during their eighth TACE session; both procedures involved selective cannulation of neovessels feeding from a new anastomotic branch to segment 4, following damage to the main feeding artery from repeated treatments. Steerable microcatheters were effective in reaching steep or strongly bending branches of the parent or feeding artery in the first TACE cases or neovessels and anastomotic branches in previous TACE cases. Studies with larger sample sizes are warranted to validate the use of steerable microcatheters for effective TACE.

Endovascular embolization of a congenital inferior phrenic artery-to-pulmonary arteriovenous malformation: a rare case report

BackgroundPulmonary arteriovenous malformation (PAVM) is abnormal arteriovenous shunts between pulmonary artery (PA) and pulmonary vein, and rarely has congenital direct communications with systemic arteries.Case PresentationA 33-year-old male presented to our hospital with intermittent bloody sputum with no evidence of pulmonary infection, trauma or surgery. Chest computed tomography angiography (CTA) indicated the congenital inferior phrenic artery (IPA)-to-PAVM surrounded by diffuse alveolar hemorrhage located in the lower lobe of right lung. Both the afferent PA and IPA were successfully embolized with coils. Recurrent hemoptysis did not occur during one-year follow up.ConclusionsThe congenital communication between IPA and PAVM is rare, and the abnormal direct shunt would induce hemodynamically unstable condition within PAVM. Endovascular embolization of the afferent PA and IPA is a safe and effective method for this abnormal congenital shunt in lung.

Physician-modified funnel-shaped covered stent for selective false lumen exclusion in chronic type B aortic dissection.

To describe the technique of off-centering a balloon-expandable covered stent for selective occlusion of a distal entry tear (ET) in a patient, conservatively treated for chronic type B aortic dissection (cTBAD), presenting FL expansion. A 63-year-old male, with conservatively managed cTBAD, presented at follow-up with FL partial thrombosis and expansion (thoracic aorta FL from 21mm to 27mm and abdominal aorta FL from 11mm to 15mm in 6 months). No proximal ET was identifiable. Distal FL perfusion was caused by an ET in the abdominal aorta feeding a 2mm accessory renal artery (ARA). As the aortic diameter was below the threshold for endovascular repair, a selective occlusion of the distal ET and ARA was planned. A balloon-expandable covered stent was modified by off-centering the covered stent proximally and resulting in a funnel-shape occluder after deployment across the ET into the ARA. To prevent type Ic endoleak due to possible FL expansion caused by an intra-operatively detected phrenic artery (PA), coils were deployed into the lumen of the modified stent and the ARA. The pre-discharge computed tomography angiography showed exclusion of both the ARA and ET and a type 2 endoleak from the PA. A balloon-expandable covered stent can be modified by off-centering the covered stent resulting in a funnel shape to adapt to different diameter requirements.

An Atypical Case of Intracardiac Myxoma Fed by Extracardiac Arteries

Myxoma is the most common type of primary benign heart tumor and is usually easily identified by echocardiography. Tumor vascularity is a rare finding in atrial myxomas and reported cases of the right atrial myxomas most frequently involve feeding vessels from the right coronary artery or, less frequently, from both coronary arteries. In this case report, an echocardiographic examination of a 74-year-old male, who was admitted to hospital with chest pain revealed an echogenic solid mass in the right atrium. A coronary angiography showed an arteriocavity fistula connecting the feeding artery to the cardiac chamber. In the computed tomography angiography examination performed, a mass was observed with intense vascularity, containing feeding vessels from the left circumflex artery, the right inferior phrenic artery, and the left hepatic artery; calcifications in the right atrium were also present. The mass was completely and successfully resected. Pathology results of the mass were compatible with cardiac myxoma. This was an atypical case of a right atrial myxoma due to the presence of intense vascularization and the feed from the cardiac and extracardiac arteries.

Laparoscopic median arcuate ligament release using an anterior approach for median arcuate ligament syndrome.

Median arcuate ligament syndrome (MALS) is a rare condition characterized by nonspecific symptoms, such as abdominal pain, nausea, and vomiting. Furthermore, the development and rupture of pancreaticoduodenal artery aneurysms pose a potentially fatal risk. Median arcuate ligament release (MALR) is useful in the treatment of MALS, with most procedures performed laparoscopically. However, detailed descriptions of laparoscopic MALR (lap-MALR) procedures are rare. In this study, we performed lap-MALR via an anterior approach with dissection of the right lateral wall of the celiac artery (CA). For optimal visualization of the right side of the CA, the right branch of the inferior phrenic artery was divided. We believe that this procedure allows the MAL to be released within a sufficient surgical field and without excess or deficiency. Here, we present the details of six patients who underwent lap-MALR for varying indications; three for pancreaticoduodenal artery aneurysms due to CA obstruction (unruptured, n = 1; ruptured, n = 2), two cases prior to hepato-biliary-pancreatic surgery, and one symptomatic case. In all cases, lap-MALR was performed as described above, and the CA stenosis was successfully released. Our case series demonstrates the safety and reliability of our lap-MALR procedure in the treatment of MALS-related disorders, including pancreaticoduodenal artery aneurysms associated with CA compression.

New Classification of Inferior Phrenic Artery Variations Correlated with Computed Tomography Angiography: Clinical Significance

Background and Aim: A comprehensive understanding of the variations in the inferior phrenic artery (IPA) origin is essential for various interventional and surgical procedures utilized in treating conditions such as hepatocellular carcinoma, hemoptysis, trauma, iatrogenic injuries, and organ transplantations. In this study, we analyzed 1008 computed tomography angiography (CTA) cases and correlated the findings with the newly proposed classification of IPA variations of our study. Materials and Methods: Retrospectively evaluating IPA variations in 1040 cases, excluding 32 subjects, this study collected patient data from the hospital’s picture archiving and communication system. The analysis focused on IPA origins, including connections to the celiac artery, left gastric artery, and renal arteries. The inclusion criteria comprised routine CTA of the upper abdomen, with exclusion criteria excluding major vascular pathologies, upper abdominal surgeries, and motion artifacts. Results: An evaluation of 1008 CTA studies revealed the prevalence of IPA variations, leading to a new classification system grounded in embryology. IPA was categorized into four main types and respective subtypes: Type I (41.8%), Type II (41.4%), Type III (3.3%), and Type IV (7.2%), with detailed breakdowns of subtypes within each category. Conclusion: While recognizing the significant clinical importance of IPA variations, this study addresses the scarcity of comprehensive research on the topic. By presenting a various IPA variations, this research aims to simplify the identification and reporting of these variations for improved clinical practice.

Assessment of arterial supply to the stomach after bariatric surgery using multidetector CT arteriography.

To describe residual arterial supply to the stomach after bariatric surgery via a systematic arterial-phase CT assessment approach that can aid in diagnosis and treatment of postoperative complications and facilitate planning for future procedures. Arterial-phase CT of 46 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at 3 academic institutions were retrospectively reviewed to assess patency of left gastric artery (LGA), right gastric artery (RGA), gastroepiploic artery (GEA), and left inferior phrenic artery (LIPA) and presence of gastric perforators. In 25 RYGB and 21 SG patients, mean diameters were LGA 2.2 ± 0.4mm, RGA 1.6 ± 0.5mm, and GEA 1.7 ± 0.4mm. On RYGB scans, all LGAs, RGAs, and 24/25 (96%) of GEAs were identified. Excellent to good patency was seen in 20/25 (80%) LGAs, 21/25 (84%) RGAs, and 23/24 (96%) GEAs. On SG scans, all LGAs, 18/21 (86%) of RGAs, and 20/21 (95%) GEAs were identified. Excellent to good patency was seen in 17/21 (81%) LGAs, 15/18 (83%) RGAs, and 20/20 (100%) GEAs. In terms of gastric perforators, LGA supply was seen on 23/25 (92%) of RYGB and 17/17 (100%) of SG scans. RGA supply was seen on 13/21 (62%) RYGB and 9/18 (50%) SG scans. GEA supply was seen on 19/23 (83%) RYGB scans. No gastric supply via GEA was seen on SG scans. In this study, arterial supply to the stomach through the LGA was consistently identified in all RYGB and SG cases, indicating an uncomplicated surgical approach with regard to preserving the LGA. Dedicated CT angiography protocol or catheter-directed angiography is recommended for accurate and comprehensive assessment of the gastric blood supply, particularly before surgical re-intervention.

Hemothorax caused by injury of musculophrenic artery after ultrasound-guided percutaneous liver biopsy: a case report

BackgroundHemorrhage is the most common major complication after liver biopsy. Hemothorax is one type of bleeding and is very rare and dangerous. Several cases of hemothorax subsequent to liver biopsy have been documented, primarily attributed to injury of the intercostal artery or inferior phrenic artery and a few resulting from lung tissue damage; however, no previous case report of hemothorax caused by injury of musculophrenic artery after liver biopsy has been reported.Case presentationA 45-year-old native Chinese woman diagnosed with primary biliary cirrhosis due to long-term redness in urination and abnormal blood test indicators was admitted to our hospital for an ultrasound-guided liver biopsy to clarify pathological characteristics and disease staging. A total of 2 hours after surgery, the patient complained of discomfort in the right chest and abdomen. Ultrasound revealed an effusion in the right thorax and hemothorax was strongly suspected. The patient was immediately referred to the interventional department for digital subtraction angiography. Super-selective angiography of the right internal thoracic artery was performed which revealed significant contrast medium extravasation from the right musculophrenic artery, the terminal branch of the internal thoracic artery. Embolization was performed successfully. The vital signs of the patient were stabilized after the transarterial embolization and supportive treatment.ConclusionThis case draws attention to the musculophrenic artery as a potential source of hemorrhage after percutaneous liver biopsy.

Prevalence of anatomical variants in the branches of celiac and superior mesenteric arteries among Egyptians.

Celiac trunk and superior mesenteric artery (SMA) are the main blood supply to the liver and pancreas. The data of anatomical variations in these arteries or their branches are very important clinically and surgically. The aim of this study was to describe the different variants in these arteries through the examination of the angiographs of a large series of Egyptian individuals. This research involved 389 selective angiographies to celiac artery, its branches, and the SMA. Anatomy of the target arteries of people who experienced visceral angiograph was reviewed and the data were recorded. From the total available angiograms in this work, 286 patients (73.52%) had the standard anatomy of celiac trunk and superior mesenteric arteries, and 103 patients (26.47%) had a single or multiple vessel variation. The inferior phrenic artery originates from celiac trunk in 2.05% of patients, while quadrifurcation of the celiac trunk was noticed in only 0.51% of patients. Absence of celiac trunk is also found in 0.51% of patients. Left gastric artery showed an abnormal origin from the splenic artery in 0.51% of patients. Quadrifurcation of common hepatic artery was also noticed. Variant anatomy of the left hepatic artery (LHA) was seen in 9.51% of patients, while variations of the right hepatic artery (RHA) were 14.13%. With the different origin of hepatic arteries, the gastroduodenal artery arose either from the LHA (2.82%), RHA (2.31%) or even from the celiac trunk (1.79%).

Incidental finding of an arteriovenous malformation originating from the diaphragm: Case report and literature review

Arteriovenous malformations (AVMs) are defined as aberrant linkages between arteries and veins in the absence of a capillary network. This case report will discuss the incidental finding of an AVM likely originating from the diaphragm. A 65-year-old female presents for an umbilical hernia repair. Her past medical history is significant for HTN, type 2 diabetes mellitus, gastroesophageal reflux disease, and class 1 obesity. She has a past surgical history of hysteroscopy in 2020 and laparoscopy in 1996. She has no history of tobacco use, alcohol use, or recreational drug use. She is allergic to contrast. A computed tomography (CT) scan was ordered and incidentally showed a soft tissue mass in the left upper quadrant adjacent to the stomach and diaphragm, possibly a gastrointestinal stromal tumor (GIST) or splenule, in addition to diastasis of the abdominal wall. Biopsies of the esophagus, stomach, and duodenum from the esophagogastroduodenoscopy (EGD) were all benign. A nuclear medicine scan of the liver and spleen found an estimated 2.3 cm soft tissue nodule located between the fundus of the stomach and the left hemidiaphragm that does not demonstrate sulfa colloid uptake and is therefore not consistent with a splenule. This is the only incidence cited of an AVM originating from the diaphragm. We suspect that the origin of this AVM is the inferior phrenic artery. The decision for management for this case was to get a CT scan of the abdomen and chest to trace the path of the AVM and manage with surveillance.

Successful management of splenic artery dissection after sigmoid colon perforation in vascular Ehlers–Danlos syndrome

BackgroundEhlers–Danlos syndrome (EDS) is a genetic disorder that causes fragility of the systemic connective tissues. Of the 13 subtypes, vascular EDS (vEDS) is associated with abnormalities in collagen production, resulting in arterial rupture and intestinal perforation. Herein, we report the case of a man with confirmed vEDS who survived a ruptured dissected splenic artery aneurysm triggered by perforation of the sigmoid colon.Case presentationA 48-year-old man presented to our hospital with sudden severe lower abdominal pain. The patient was genetically diagnosed with vEDS at the age of 43 years. Abdominal computed tomography (CT) showed fluid and free air surrounding the sigmoid colon. These findings suggested sigmoid colon perforation, and emergency surgery was needed. Hartmann’s procedure was performed. The resected specimen showed a 2-cm-sized depression around the perforation. Histopathological findings showed an abscess and exudate in the serosa of the perforation and thinning of the intrinsic muscular layer in the depressed area. The patient was doing well postoperatively; however, on the ninth postoperative day, sudden upper abdominal pain developed. CT revealed an intra-abdominal hemorrhage due to rupture of a dissecting splenic artery aneurysm. The aneurysm was not observed on preoperative CT and was distant from the surgical site. Urgent transcatheter arterial embolization was performed. Although embolization of the splenic artery was attempted during the procedure, the arterial dissection spread to the common hepatic artery. Moreover, the proper hepatic and gastroduodenal arteries were poorly visualized, probably due to vasospasm. Although complications associated with extensive embolization were a concern, embolization of the splenic and common hepatic arteries was necessary to save the patient’s life. After embolization, angiography showed that the left hepatic blood flow was maintained from the inferior phrenic artery, and the right hepatic inflow was maintained from the superior mesenteric artery via the peribiliary vascular plexus in the hilar area. The patient recovered well and was discharged on the 19th postoperative day.ConclusionsvEDS can cause arterial rupture after intestinal surgery. Therefore, careful post-operative management is necessary. Moreover, cooperation with interventional radiologists is important for prompt treatment of vascular complications.

A morphological study of the inferior phrenic arteries on multidetector computed tomography and angiography

The inferior phrenic artery is a paired artery with a variable origin and course, primarily supplying the diaphragm, but also the suprarenal glands, inferior vena cava, stomach, and oesophagus. The aim of this study is to investigate the origin and course of the inferior phrenic arteries on multidetector computed tomography and angiography. The anatomy of the inferior phrenic artery was analysed on 2449 multidetector computed tomography scans. Three-dimensional reconstructions were made of the main variations. Additionally, the course and branching pattern of the inferior phrenic artery were descriptively analysed in a cohort of 28 angiograms. In 565 (23.1%) cases the inferior phrenic arteries arose as a common trunk and in 1884 (76.9%) cases as individual vessels. The most common origins of a common trunk were the coeliac trunk (n=303; 53.6%) and abdominal aorta (n=255; 45.1%). The most common origins of the right inferior phrenic artery were the coeliac trunk (n=965; 51.2%), abdominal aorta (n=562; 29.8%) and renal arteries (n=214; 11.4%). The most common origins of the left inferior phrenic artery were the coeliac trunk (n=1293; 68.6%) and abdominal aorta (n=403; 21.4%). The inferior phrenic artery has a very variable anatomy. The most common origins of the inferior phrenic artery are the coeliac trunk and its branches, the abdominal aorta, and the renal arteries.

Variant Anatomy and Morphometric Characteristics of the Celiac Trunk and its Branches According to Multislice Computed Tomography

Two classifications are currently most commonly used to classify branching variations of the celiac trunk (CT): N. Michels (1955) and R. Uflacker (1997). Many researchers note the imperfection of classifications and make additions to each of them. The aim is to determine the anatomical variants of the branching of the CT, and to perform a morphometry of it’s main branches. Material and methods. A sample of 700 MSCT angiograms of the abdominal aorta was analyzed. The study examined angiograms of 602 men and 98 women. Visualization of the vessels of the CT and measurement of the diameter of the arteries was carried out using digital computer programs of the personal station of the radiologist «Syngo.via». Results. The most common type of CT (77,9% observations), according to the classification of N. Michels, was type I, when the common hepatic artery (CHA) originated from the CT. The frequency of other variants was 22,1%. According to R. Uflacker, the most common variant (90,3% cases) was type I, corresponding to the typical anatomy of the CT, with the origin of the splenic, common hepatic and left gastric arteries. In addition to the main variants of the arterial basin of the liver and types of branching of the CT, we noted additional arteries that were not included in both classifications. In 48 cases, such vessels as the left inferior phrenic artery (44 observations / 91,7%), two inferior phrenic arteries (2IPA) (3 observations / 6,3%), and the right hepatic artery (RHA) (1 observation / 2,1%) were identified as originated from the CT. Conclusion. In the course of our study, we detected variants of CT that were not included in any of the most commonly used classifications: the RHA and 2IPA which ramified from CT. Three morphometric parameters of the CT: its length, diameter, and diameter of common hepatic artery had a significant correlation with gender. We consider that the data obtained on the variant anatomy of the CT will make additions to the current classifications in order to detail and objectify variations of the celiac-mesenteric basin arteries.

Arterial supply to the adrenal gland in the common marmoset (Callithrix jacchus).

The common marmoset (Callithrix jacchus) has attracted much attention as a nonhuman primate animal model for stress-related experiments. The adrenal gland plays a key role in stress responses and has abundant vasculature, through which the hypothalamic-pituitary axis hormonally controls its activity. Understanding the arterial supply pattern to the gland is fundamental to understanding its function and performing experiments. We therefore traced the arteries supplying the adrenal gland in six male and nine female common marmosets using the latex injection method. The adrenal artery originates from one to four parent arteries, including the caudal phrenic, celiac, left gastric, gonadal, and renal arteries and the abdominal aorta. The branching pattern of the adrenal arteries was divided into Types 1 to 4, having 1-4 parent arteries, respectively. Type 2 was most frequent on the right side (seven of 15 halves, 46%), whereas Type 3 was most frequent on the left (eight of 15 halves, 53%). The number of cranial, middle, and caudal adrenal arteries ranged from one to four in the cranial, one to five in the middle, and one to six in the caudal adrenal arteries. The total number of adrenal arteries varied from three to 13, predominantly as five on one side. The present study revealed frequent individual variations in the origin and number of adrenal arteries in the common marmoset, which may be informative for further research involving the adrenal glands in this species.

Hepatocellular carcinoma vascularization: CT angiography variations identifying arteries feeding the tumour

BackgroundHepatic arterial anatomy is important in performing many surgical and endovascular procedures. Familiarity with variations in the hepatic arterial anatomy is essential to achieving adequate embolization. In some patients, in addition to anatomic variations of the hepatic arteries, different extrahepatic collateral arteries may provide partial or total vascular supply to hepatocellular carcinoma (HCC), which makes transcatheter arterial chemoembolization (TACE) technically challenging. We aim to evaluate the different feeding vessels of HCC using multi-detector computed tomography angiography (MDCTA) as a pre-procedural step before planning suitable management.ResultsOne hundred patients with 150 focal HCC lesions were involved in our study. The anatomy of the blood supply and the morphological characteristics of HCC, including the size, location, and history of previous hepatitis, were quantitatively assessed and statistically analysed. The number of patients who had classic hepatic arterial supply for the HCC lesions in our study was 54 (54%). The number of patients with additional extrahepatic supply is 26, while the number of patients with anatomical vascular variants is 20. Among these 26 patients with extrahepatic (parasitic) blood supply, six patients were supplied by the right inferior phrenic artery, four patients were supplied by the right internal mammary artery, and two patients were supplied by each other type of extrahepatic feeder, which are the left inferior phrenic artery, left internal mammary artery, left gastric artery, cystic artery, right lumbar artery, direct branch from the aorta, omental arteries, right renal artery, and LHA from the LGA. Twelve of the 20 patients with anatomical vascular variants had replaced RHA from the SMA; four patients had replaced LHA from the LGA; two patients had replaced RHA from the GDA; and two patients had replaced CHA from the SMA. Only 50 cases of CT findings were correlated with the data from the interventional procedures of these patients.ConclusionsBecause of the differences in HCC blood supply between typical, parasitic, and anatomical vascular variants, MDCTA has significant clinical significance prior to TACE and any interventional procedure.

Radiological Vascular Anatomy of the Caudate Lobe of the Liver Required for Transarterial Chemoembolization of Hepatocellular Carcinoma

The caudate lobe is located between the bilateral hepatic lobes and is divided into three subsegments: the Spiegel lobe, paracaval portion, and caudate process. The caudate artery arises from various sites of the bilateral hepatic arteries as an independent branch, common trunk, or arcade. Extrahepatic arteries can enter the caudate lobe mainly by the right inferior phrenic artery. The caudate artery also supplies the main bile duct and posterior aspect of segment IV. Although catheterization into the caudate artery is occasionally difficult because of its small size and sharp angulation, selective embolization of a tumor feeder is a significant prognostic factor in patients with hepatocellular carcinoma originating there. Therefore, we should recognize the peculiarity of its vascular anatomy and should be familiar with catheterization and embolization techniques.

Clinical significance of morphological variations of the inferior phrenic arteries.

The rapid development of sciences such as genetics and molecular biology offers hope that better therapeutic methods can be developed and diagnosis and treatment made more effective. However, we must not forget that the basis for understanding the complex mechanisms of diseases and associated symptoms is knowledge of the relevant location and correlation among organs. In the present study, we focus on the clinical significance of the inferior phrenic artery. The diaphragm is a muscular structure that separates the abdominal and chest cavities. Thanks to this position, the inferior phrenic artery is much more significant than formerly assumed. A rich network of collaterals makes this vessel important in the development of neoplasms and metastases. Knowledge of anatomical variants of the inferior phrenic artery is also crucial for radiological procedures such as embolisation. The main aim of this study is to review the involvement of the inferior phrenic artery in physiological and pathophysiological processes. This work has value for all practicing doctors, especially radiologists and surgeons.