Evaluation of celiac artery and common hepatic artery variations by CT-angiography and new classification model

• Published in: Surgical and radiologic anatomy (English ed.) 2023-08, Vol.45 (8), p.1037-1047
• Main Authors: Türkyılmaz, Zeliha, Kula, Osman, Çelik, Ahmet Onur, Demirel, Tuğrul, Günay, Burak
• Format: Article
• Language: English
• Subjects: Adult; Anatomic Variations; Anatomy; Angiography; Aorta; Celiac Artery - anatomy & histology; Celiac Artery - diagnostic imaging; Classification; Computed tomography; Computed Tomography Angiography; Hepatic artery; Hepatic Artery - anatomy & histology; Hepatic Artery - diagnostic imaging; Humans; Imaging; Liver; Medical imaging; Medicine; Medicine & Public Health; Orthopedics; Radiology; Retrospective Studies; Splenic artery; Surgery; Variation
• ISSN: 1279-8517; 0930-1038; 1279-8517
• DOI: 10.1007/s00276-023-03180-1

Purpose Knowledge of anatomical variations is important in all interventional procedures. This study aims to evaluate the variations and prevalence of celiac trunk (CeT) and its branches. Methods The computerized tomography-angiography (CT-A) findings of 941 adult patients were evaluated retrospectively. Variations of the CeT and common hepatic artery (CHA) were evaluated according to the number of branches and their origin. Findings were compared with classical classification methods. A new classification model has been defined. Results Normal (complete) trifurcation was detected in 856 (90.9%) of them, where left gastric artery (LGA), splenic artery (SpA) and CHA branches were derived from the CeT. Among 856 complete trifurcation cases, 773 (90.3%) had non-classical trifurcation patterns. The rate of classic trifurcation was 8.8%, while non-classic trifurcation was 82.1% in all cases. In one case (0.1%), LGA and left hepatic artery together and right hepatic artery and SpA together appeared as a double bifurcation. Complete celiacomesenteric trunk was observed only in 4 (0.42%) cases. In seven cases (0.7%), LGA, SpA and CHA were coming out of abdominal aorta (AAo) independently. CHA normal anatomy (Michels Type I) was detected in 618 (65.5%) patients. We found that 49 (5.2%) of our cases were ambiguous according to the Michels Classification. We have described five different variations of hepatic arteries directly arising from the AAo. Conclusion Preoperative recognition of anatomical variations of CeT, superior mesenteric artery and CHA is of primary importance in both surgical and radiological procedures. With careful evaluation of CT-angiographies, it is possible to detect rare variations.