Rare variation: the absence of both the celiac trunk artery and the common hepatic artery

The celiac trunk trifurcating into three main branches (LGA, SA, and CHA) is the most classic and common. It was described by Haller and called tripus Halleri in 1756 [1, 2]. In Adam Whitley’s study, the prevalence of complete CA was 89.15%, the prevalence of variant CA anatomy was 10.85%. The pooled prevalence of the incomplete CA, absence, and other types was 8.71%, 0.28%, and 1.86% respectively. In the absence of CA, LGA, CHA, and SA were all derived from the AA respectively. Or one of the three vessels originated from SMA and the other two vessels originated from AA [3]. In the Soon-Young Song study, 96.30% of the cases had normal CHA anatomy, and 3.71% had a variation in the origin and/or anatomical process of the CHA. Among the cases with CHA variants, the absence of CHA account for 1.10%, GDA originated alone without hepatic artery component in the absence of CHA cases, and the most common origin of GDA was SMA [4]. We first reported the case with the absence of both CA and CHA. And LGA originated directly from the AA. SA and GDA originated from AA and joined together. LHA originated from LGA, and RHA originated from SMA. To our knowledge, no such variation has been described in the worldwide literature.

The limitation of this paper is that the abdominal angiography could not be performed before surgical operation, but this vascular anatomy was reconstructed by the computer 3D reconstruction technology. Since the operation was a laparoscopic radical gastrectomy, the surgical field of view also have a few limitations. It is a pity that the images of the mutant blood vessels and their adjacent blood vessels could not be fully exposed.

Accurately understanding the vascular anatomy of the CA is essential for surgery on the stomach, pancreas, spleen, liver and biliary tree. Identifying vascular variation prevents intraoperative confounding and complications [5]. Before any major surgery on the upper gastrointestinal organs, preoperative Multi Detector CT angiography and 3D reconstruction should be performed to identify all vascular variants for optimal preoperative planning. Celiac trunk anatomy is pivotal in the surgical field. And it is equally important for some interventional radiology procedures, such as endovascular treatment of aneurysms, angioplasty and stent placement of mesenteric ischemia, arterial embolization for bleeding control, and chemoembolization for liver tumors [6].

In conclusion, our case demonstrated a novel, undescribed, and unclassified vascular anatomy. We hope provide new tips for the field of surgery and interventional radiology.

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