肝动脉闭塞后侧支循环DSA表现

目的探讨肝动脉闭塞后侧支循环数字化减影血管造影(DSA)表现。方法收集肝动脉闭塞7例患者,其中男性6例,女性1例;年龄36～60岁,平均年龄49.6岁(标准差11.0岁)。肝动脉闭塞原因:肝动脉插管所致6例,外科手术1例。对患者均进行腹腔动脉和肠系膜上动脉造影以显示肝动脉侧支循环。结果肝总动脉近端完全闭塞7例,均可见侧支循环形成,肝脏侧支循环动脉起源于肠系膜上动脉6例,起源于胃左动脉1例。结论肝动脉闭塞后侧支循环形成并供应肝脏;DSA能清晰显示肝动脉闭塞后侧支循环并为介入治疗提供途径。     

腹腔动脉与肠系膜上动脉侧支增粗显影1例

患者女性，37岁，CT发现肝血管瘤行肝动脉灌注栓塞术，术中造影显示：肝左动脉起自肝总动脉，胃十二指肠动脉起自肝右动脉，肝右动脉通过胃十二指肠动脉之侧支支与肠系膜上动脉连接。肝总动脉略细，管壁光滑。吻合支较粗大，管壁光滑。腹腔动脉或肠系膜上动脉造影时对方动脉显影清晰。     

肝右动脉变异1例

<正>作者在局部解剖学标本制作过程中发现肝右动脉变异1例,变异类型较为少见,现报道如下。该标本为男性,从腹主动脉上发一短干,起始处外径17.54mm,向左前下方走行31.48mm后分为腹腔干和肠系膜上动脉(见图1)。在腹腔干和肠系膜上动脉分叉处的右侧壁,发出异常的肝右动脉,走在肝     

肝动脉分支分布变异1例

作者在解剖一老年男性尸体时，发现其肝动脉的分支分布变异，现报道如下：腹腔干发出3大分支，即脾动脉、肝总动脉和副左肝动脉。肝总动脉正常，距腹腔干1.85cm处发出肝固有动脉和胃右动脉，肝固有动脉又发出肝左、右地动脉。①副肝右动脉：起自胃右动脉，在距肝总动脉分支处0.24cm处发出，总长为4.6cm，跨过门静脉的前方，走行于胆总管的后方，随后分为两支进入肝右叶。     

肠系膜上动脉发出副肝右动脉及胆囊动脉1例

胆囊动脉的起源 ,分支变异较多 ,最常见的变异即胆囊动脉行经肝总管的前方。我们在解剖一具成年男尸时发现 :由肠系膜上动脉发出副肝右动脉及胆囊动脉。现报道如下 :在解剖腹腔血管时 ,见腹腔干、肝总动脉、胃十二指肠上动脉、肝固有动脉左、右支 ,但未见胆囊动脉。于右侧肝管与胆囊之间发现一支动脉 (副肝右动脉 )入肝右叶 ,向下追踪该动脉 ,发现其在胆总管后方行走 ,且发出三条分支 ,其中有二支进入胆囊 ,一支进入肝右叶。继续向下追踪 ,发现该动脉由肠系膜上动脉发出。该变异动脉起始部距肠系膜上动脉根部2 9ｃｍ ,位于胰后方。发出后向…     

肝总动脉及腹腔干共同缺如1例

在解剖1例成年女性整尸过程中,发现其肝总动脉及腹腔干共同缺如(图1),此变异罕见,为累积解剖资料及为临床提供参考,现报道如下:打开腹腔,见腹主动脉前壁于第1腰椎水平发出肠系膜上动脉,在其上方1.47cm处,腹主动脉前壁发出胃脾动脉干。该动脉干起始处外径4.20 mm,其主干向     

腹腔脏器动脉多发变异一例

在为一位40岁,女性肝癌病人行肝动脉造影时,遇腹腔脏器动脉多发变异一例,为积累资料和临床工作参考,现报道如下:本例行肝动脉造影时,术中未发现腹腔动脉,而改为腹主动脉造影,发现腹腔动脉缺如,肝总动脉与肠系膜上动脉共干起始腹主动脉;脾动脉和胃左动脉直接起自腹主动脉(见附图)。肝总动脉与肠系膜上动脉共干长约6cm,起始平面在第一腰椎体中部,然后分为肝总动     

肝固有动脉变异1例

肝固有动脉起点变异的情况临床较常见。多见肝固有动脉起自肠系膜上动脉或肝固有动脉与胃左动脉共干[1-3]。作者在尸体标本肝动脉应用解剖过程中,发现1例有2支不同起源的肝固有动脉,现报道如下,为临床应用提供参考。1材料与方法10%福尔马林固定成年男尸1例,年龄约70岁,常规方法解剖显露肝门区,发现该标本有左右2支肝固有动脉,仔细追踪动脉来源,观察记录其行程及毗邻关系,数码相机拍照,利用游标卡尺测量其外径和长度。2结果右侧肝固有动脉(图1 a):起自肠系膜上动脉,起始处管径a:右侧肝固有动脉起源;b:左侧肝固有动脉起源;1:腹主动脉;2:肠系膜…     

胆囊动脉起于副肝右动脉和胆囊肝管1例

肝动脉的起源、分支和肝外胆道变异较多。作者在解剖１具成年女性腹部标本时，发现胆囊动脉发自来源于肠系膜上动脉的副肝右动脉和存在胆囊肝管，这种变异较少见，现报道如下：肠系膜上动脉紧邻腹腔动脉下方起于腹主动脉前壁，在距该动脉起点２．０ｃｍ处发出１支副肝右动...     

肝动脉及胆囊动脉变异1例

肝动脉的变异比较多见 ,变异的肝动脉可发自胃左动脉等腹腔干的分支 ,也可发自肠系膜上动脉等腹腔干以外的动脉的分支 ,这种变异的肝动脉叫迷走肝动脉〔1〕。肝的某一部分无正常的肝左支或肝右支 ,而是由其它动脉的分支供血 ,这种肝动脉叫替代肝动脉。我们在解剖一具约 6 0岁男尸时发现一起自肠系膜上动脉的替代肝动脉 ,且胆囊动脉由此替代肝动脉发出 ;为积累资料及为临床应用提供参考 ,特报道如下。1　替代肝动脉、胆囊动脉、肝固有动脉的起始、走行和分布1.1　替代肝动脉及胆囊动脉的起始走行和分布肠系膜上动脉 (管径 1.19cm)在第一腰椎…     

Median arcuate ligament syndrome: Predictor of ischemic complications?

Median arcuate ligament syndrome (MALS) is a pathologic entity that can affect the celiac axis. Due to the extensive collateral network of mesenteric circulation, stenosis of one mesenteric artery does not lead to significant symptoms. The purpose of this study was to describe multidetector computed tomography (MDCT) angiography findings of celiac artery entrapment by the median arcuate ligament and determine those patients with high risks of ischemic complications. From January 2012 to March 2016, 103 patients with celiac artery (CA) compression by median arcuate ligament were detected. In 23 patients collateral circulation was developed. In order to investigate the problem, we managed to estimate the correlation between range of stenosis of CA and presence of collateral circulation between the celiac artery (CA) and superior mesenteric artery (SMA). A statistically significant correlation was found between range of CA stenosis and collateral circulation presence (Spearman's correlation coefficient 0.339, P < 0.0001). In conclusions, based on our observations, we hypothesize that ischemia as a result of mesenteric vessel narrowing by the median arcuate ligament may occur more often than indicated by clinical symptoms and described in literature. Clin. Anat. 29:1025–1030, 2016. © 2016 Wiley Periodicals, Inc.     

肝动脉解剖变异的DSA研究

目的:进一步探讨肝动脉解剖变异的种类及分型,结合文献提出肝动脉变异的新分型。方法:回顾分析1000例因肝脏疾病而行DSA检查患者肝动脉的起源、走行、分布情况,并分别统计其变异类型和发生率。结果:1000例肝动脉造影中,正常型占72.7%(727例)。肝动脉变异占27.3%(273例)。273例肝动脉变异中肝总动脉分叉变异占5.4%(54例);肝动脉起源变异占21.4%(214例);肝动脉分叉 起源变异占0.5%(5例)。结论:肝动脉解剖变异的种类具有多样性、复杂性。结合文献和本研究结果提出肝动脉解剖变异的新分型:正常型、肝总动脉分叉变异、肝动脉起源变异、肝总动脉分叉变异合并肝动脉起源变异、多种变异共存五大类,共50余种。     

Aortic origin of right hepatic artery and superior mesenteric origin of splenic artery two rare variations demonstrated angiographically

Abstract Anatomical variations of the celiac trunk and superior mesenteric artery are not infrequent. Knowledge of the existing aberrations is important in planning and conducting surgical or radiological procedures. A case of right hepatic artery arising independently from the aorta supplying an hepatocellular carcinoma was identified, through which transarterial chemoembolization was successfully performed. A second case is presented with a common splenomesenteric trunk branching into the splenic and superior mesenteric arteries. These two cases represent exceptional arterial variations in the upper abdomen.     

The topographic relationships of the unpaired visceral branches of the aorta

We examined the metric relationship among the origins of the unpaired visceral branches of the aorta, their relationship to the total descending aorta (TDA), and the relationship between the TDA and stature to see whether a graft for the TDA, e.g., from the left subclavian artery to the aortic bifurcation, which includes its visceral branches, could be pre-constructed. These proportions were compared between the genders and between adults and children to see whether any differences exist. Thirty-four adult aortae and eight juvenile aortae were examined. These segments—TDA, aortic bifurcation to celiac artery, aortic bifurcation to superior mesenteric artery, and aortic bifurcation to inferior mesenteric artery, were defined as the distances between the origins of the left subclavian, celiac, superior mesenteric, and inferior mesenteric arteries, respectively, to the aortic bifurcation. Stature was known only in 15 adult cadavers. The absolute lengths of the segments were correlated to each other and the ratios of these absolute lengths (proportional lengths) were calculated. The statistical significance was examined by Student's T-test and variability by the F test. The TDA correlated well with aortic bifurcation to celiac artery and aortic bifurcation to superior mesenteric artery, whereas a weaker correlation existed with aortic bifurcation to inferior mesenteric artery. The ratio aortic bifurcation to celiac artery and aortic bifurcation to superior mesenteric artery to TDA was less variable than the ratio aortic bifurcation to inferior mesenteric artery to TDA. The abdominal aorta measured approximately a one-third of TDA. No differences in correlation nor in ratio were found between genders and between adults and children. No correlation between stature and TDA was found. The two upper unpaired visceral branches originate from the aorta in a prefixed site, which correlates closely with the length of the descending aorta, whereas the lower one has a more variable point of origin. This is true for all ages and for both genders. Aortic length does not correlate with stature. It is not possible thus to predict the length of the descending aorta by stature. However, a model of the descending aorta can be constructed, but with less accuracy, for the inferior mesenteric artery. Clin. Anat. 11:304–309, 1998. © 1998 Wiley-Liss, Inc.     

Anatomic variation of the celiac trunk with special reference to hepatic artery patterns

Based on a large homogeneous sample from a Japanese population, anatomic variations in the celiac trunk (CT) and the hepatic artery were studied. Previously we analyzed the branching mode of the CT in 450 Japanese cadavers. In order to maximize the database on the CT and hepatic artery, we examined the anatomy of these arteries in 524 cadavers, a total of 974 cases. A total of 89.8% of cases showed the classical trifurcation of the CT. The typical normal pattern of the CT and the hepatic artery was confirmed in 66.6% and 72.4% of the cadavers, respectively. Variant left and right hepatic arteries were observed in 11.0% and 4.9%, respectively. A variant anatomy involving both the left and right hepatic arteries was found in 1.5%. A common hepatosplenic trunk and a gastrohepatic trunk were seen in 4.4% and 0.3%, respectively. A common hepatic artery (CHA) arising from the superior mesenteric artery (SMA) or directly from the aorta was present in 3.5% or 0.5%, respectively. A hepatosplenomesenteric trunk and a celiomesenteric trunk were encountered in 0.7%, respectively. This anatomical update of the CT and the hepatic artery can be useful for transplantation and general surgeons, as well as vascular radiologists in this area.     

A cadaveric study of the anatomical variation of the origins of the celiac trunk and the superior mesenteric artery

Gray's Anatomy states, “the celiac trunk is the first anterior branch of the abdominal aorta and arises just below the aortic hiatus. The superior mesenteric artery originates from the aorta c1.0 cm below the celiac trunk.” (Standring, 2008a, Gray's Anatomy. 40th Ed. London: Churchill Livingstone Elsevier, p. 1073–1074). During dissection classes with medical students we found this not to be the case. We have re‐evaluated the anatomy of the origins of the celiac trunk (CT) and superior mesenteric artery (SMA) and the relationship of the CT to the median arcuate ligament (MAL) in 99 cadavers. We have found the external distance between the CT and SMA to range from 0 to 20 mm (mean 3.4 mm, SD 5.17 mm), with the two in direct apposition in 57.6% (n = 99) of cases: a higher figure than previously documented. However, the internal distance between the CT and SMA ranged from 10 to 30 mm (mean 18.9 mm, SD 4.09 mm). There was no distance measurable between the MAL and the CT in 88 cadavers (92.6%, n = 95) and, of these, 32 (33.7%) showed evidence of compression or kinking of the CT. We suspect that the MAL is responsible for the approximation of the CT to the SMA in these cadavers, and that the high incidence of kinking of the CT (33.7% of cases) may have implications with regard to its role in MAL syndrome. Clin. Anat. 26:971–974, 2013. © 2013 Wiley Periodicals, Inc.     

Variations in the source of origin of inferior phrenic artery: a cadaveric study

Introduction: The right and left inferior phrenic arteries perfuse the diaphragm. They may originate either from the aorta, celiac trunk, or from the renal artery. Most textbooks of human anatomy give little information regarding the functional anatomy of the inferior phrenic artery. In the past few years, however, more articles have been published regarding the arterial supply in cases of hepatocellular carcinoma. The inferior phrenic artery is seen as an important source of collateral arterial supply to hepatocellular carcinoma, the hepatic artery being the main source. Materials and methods: A cadaveric study was conducted in the Anatomy Department of Bangalore Medical College during the years 2009–2011. Manual dissection was done to identify the inferior phrenic arteries, and their origins were traced. Results: The inferior phrenic artery arose from the aorta in 53.125%, celiac trunk in 28.125%, renal artery in 15.625%, and the superior mesenteric artery in 3.125% of the 32 cadavers studied. The right inferior phrenic artery arose from aorta in 56.25%, celiac trunk in 18.75%, renal artery in 18.75%, and superior mesenteric artery in 6.25% cases. The left inferior phrenic artery arose from aorta in 50%, from celiac trunk in 37.5%, and the rest arose (12.5%) from the renal artery. Discussion: The results were compared with those of earlier studies so that such findings could be applied in the treatment of hepatocellular carcinoma. The significance of this information is due to the fact that an unresectable hepatocellular carcinoma can be treated by transcatheter embolization of the right inferior phrenic artery, in case it is involved.     

A common hepatic artery passing in front of the portal vein

A variation in liver vascularization was discovered in a 50-year-old man. A single common hepatic artery was found to be responsible for vascularization of the entire liver. This artery was unusual in that it formed the first branch of the superior mesenteric artery, crossing the portal trunk shortly after its origin, and passed in front of the portal vein to reach the hilum of the liver, where it divided into a right and a left branch. This artery was a true common hepatic artery because a gastroduodenal artery emerged from it 2 cm after its origin. A common hepatic artery originating from the mesenteric artery and passing in front of the portal vein has never been described before. The patient had a second anatomical variation: the left gastric artery and the splenic artery arose directly from the aorta, without celiac trunk separation. This observation confirms the importance of carrying out a precise vascular assessment before all types of hepatic or pancreatic surgery, to identify possible variations in the number or trajectory of hepatic arteries.With the collaboration of the association Arold (Boulogne, France)     

The arterial blood supply of the pancreas: a review. V. The dorsal pancreatic artery. An anatomic review and a radiologic study

The present article is the fifth part of a comprehensive review on the arterial blood supply of the pancreas and deals with the dorsal pancreatic artery. The aim of this review is to summarise the anatomic studies, starting from Haller’s reports, and to supply, as far as possible with original material, angiographic evidence for the classic anatomic notions. For this purpose, the overall research was carried out by studying 1015 selective angiographies (celiac trunk and its branches, superior mesenteric artery) taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (Catholic University), and Perugia. Angiographically, the authors could demonstrate the dorsal pancreatic artery, present in most instances, as arising from the splenic artery, common hepatic artery, superior mesenteric artery or celiac trunk and accessory right hepatic artery as coming from the superior mesenteric artery. Variations in the course and length of the dorsal pancreatic artery were demonstrated as well as some collateral branches. The authors underline the discordant opinions still existing regarding the incidence of the different ways the dorsal pancreatic artery arises, and discuss its uncertain embryologic development and surgical relevance.