Peculiarities of Extra-Organic Variant Anatomy of the Celiac Trunk and Hepatic Artery in Patients with Liver Cancer

Abstract

Introduction. Knowledge of the different variants of the structure of the celiac trunk and the hepatic artery is of great importance in the planning, treatment and choice of approaches for transcatheter vascular interventions.Objective: to study features of variant hematopoietic anatomy from direct and multispiral computed tomography angiography (MSCTA) data in order to determine its significance in routine clinical practice.Materials and methods. We analysed the most common variants of branching of the celiac trunk and anatomy of the hepatic artery according to direct angiography and MSCTA data in 112 patients with primary liver cancer. The sample comprised 71 men (63.3 %) and 41 women (36.7 %).Results and discussion. It was found that the most frequent aberration was the passage of the replacement right hepatic artery from the superior mesenteric artery — type 3 according to N. Michels. The second aberration in terms of frequency was Michels type 2. We describe two unusual celiac trunk and hepatic anatomy variants: the first of these comprising a celiac trunk 22 cm long extending from the superior mesenteric artery; the second consisting in a complete absence of the celiac trunk, with all its elements (left gastric artery, common hepatic artery and splenic artery) departing independently from the abdominal aorta.Conclusions. A typical anatomy of the celiac trunk and hepatic artery was found in 60 % of cases, the most frequent aberration being the Michels type 3, noted in 14.2 % of patients, and type 2 noted in 9.8 % of patients. Knowledge of individual blood supply features largely determines the procedure for conducting operations, permitting purposeful intraoperative revision and the selection of the optimal vascular reconstruction variant, and avoiding damage to aberrant arteries.