Anatomical variations of celiac trunk and hepatic arterial system using multi detector computed tomographic angiography

Abstract

Variation in celiac trunk (CT) and hepatic arterial system (HAS) is common and has relevance in preoperative planning to reduce the risk of accidental vascular injuries during surgical and radiological intervention. The objectives of the study were to measure the prevalence of CT and HAS variations and describe different types of variations using multi-detector computed tomographic angiography (MDCTA) in a study population in Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, Malaysia. A cross sectional study was conducted. Computed tomographic angiography (CTA) images were retrieved from July till December 2017. Images were reconstructed in three dimensional (3D) format using workstation and reviewed for the normal and anatomical variations of both the CT and HAS. Variations of the CT were classified according to Uflacker’s classification and of the HAS were classified according to Michel’s and Hiatt’s classification. A total of 100 patients were selected, from which 15 were excluded. The results were calculated using IBM SPSS statistic version 22. Mean age was 58 years and male/female percentage was 66/34. Anatomical variation of the CT was found in 38 cases (44.7%). The most common variation was the celiac-phrenic trunk in 14 cases (16.5%) followed by celiac-colic trunk in 10 cases (11.8%). However, 22 cases (25.8%) displayed variations that were not described in Uflacker’s classification. These variations include celiac-phrenic trunk, coexistence of inferior phrenic artery (IPA) with other Uflacker’s variations, Buhler arc, and accessory hepatic artery from celiac trunk and coexistence of celiac-colic trunk with gastro-splenic trunk or hepato-splenic trunk in one case each. In addition, anatomical variation in the HAS was found in 25 cases (29.4%). The most common variation in HAS was 8 cases (9.4%) depicted (Michel’s type ?). Accurate knowledge and identification of anatomical variations in CT and HAS which can be found in one third of the patients, 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.