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      Unusual development of the celiac trunk and its clinical significance Translated title: Desenvolvimento incomum do tronco celíaco e sua importância clínica

      case-report

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          Abstract

          We describe a case of unusual development of the celiac trunk observed in the cadaver of 1-year old male child. The celiac trunk branched into five vessels: the splenic, common hepatic and left gastric arteries, the left inferior diaphragmatic artery, and a short trunk that branched into the right inferior diaphragmatic artery and right accessory hepatic artery. Additionally, the manner of branching of the vessel was unusual: it was possible to distinguish two branching points that corresponded to its s-shaped trajectory. There were also other variations of vascular supply, such as the presence of a left accessory hepatic artery, an additional superior pancreatoduodenal artery, and others. It should be noted that multiple developmental variations can be common in clinical practice and clinicians should be aware of them during diagnostic and interventional procedures.

          Resumo

          Apresentamos um relato de caso de desenvolvimento incomum do tronco celíaco em um cadáver do sexo masculino de 1 ano de idade. O tronco celíaco ramificou-se para cinco vasos: as artérias esplênica, hepática comum e gástrica esquerda, a artéria diafragmática inferior esquerda e um tronco pequeno que se ramificou para a artéria diafragmática inferior direita e para a artéria hepática direita acessória. Além disso, a forma como o vaso se ramificou foi incomum: é possível distinguir dois pontos de ramificação que correspondem à trajetória em formato de S. Também houve outras variações do suprimento vascular, como a presença da artéria hepática esquerda acessória, da artéria pancreaticoduodenal superior acessória e outras. Cabe observar que a variação de desenvolvimento múltipla pode ser comum na prática clínica, e os médicos devem estar cientes dela durante os procedimentos de diagnóstico e intervenção.

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          Most cited references33

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          Surgical anatomy of the hepatic arteries in 1000 cases.

          Anatomic variations in the hepatic arteries were studied in donor livers that were used for orthotopic transplantation. Variations have occurred in 25% to 75% of cases. Donor livers represent an appropriate model for study because extrahepatic arterial anatomy must be defined precisely to ensure complete arterialization of the graft at time of transplantation. Records of 1000 patients who underwent liver harvesting for orthotopic transplantation between 1984 and 1993 were reviewed. Arterial patterns in order of frequency included the normal Type 1 anatomy (n = 757), with the common hepatic artery arising from the celiac axis to form the gastroduodenal and proper hepatic arteries and the proper hepatic dividing distally into right and left branches; Type 3 (n = 106), with a replaced or accessory right hepatic artery originating from the superior mesenteric artery; Type 2 (n = 97), with a replaced or accessory left hepatic artery arising from the left gastric artery; Type 4 (n = 23), with both right and left hepatic arteries arising from the superior mesenteric and left gastric arteries, respectively; Type 5 (n = 15), with the entire common hepatic artery arising as a branch of the superior mesenteric; and Type 6 (n = 2), with the common hepatic artery originating directly from the aorta. These data are useful for the planning and conduct of surgical and radiological procedures of the upper abdomen, including laparoscopic operations of the biliary tract.
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            Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA.

            To identify and evaluate the spectrum and prevalence of celiac axis (CA) and common hepatic artery (CHA) variations by using spiral computed tomography (CT) and digital subtraction angiography (DSA). Institutional review board approval was obtained, and the requirement for informed patient consent was waived. The findings in 5002 patients who underwent spiral CT and DSA were retrospectively evaluated. CHA was defined as an arterial trunk containing at least one segmental hepatic artery and the gastroduodenal artery. The pattern of the aortic origin of the branches of the CA and superior mesenteric arteries was analyzed. The CHA anatomy was then investigated. Of 15 possible types of CA variation, 13 types were identified. A normal CA was noted in 4457 (89.1%) of the 5002 patients. Twelve types of CA variation were identified in 482 (9.64%) patients. In the remaining 63 (1.26%) patients, the CA anatomy was classified as ambiguous because the CHA was absent owing to separate origins of the hepatic arteries and the gastroduodenal artery (n = 55) or because the origin of the CHA could not be determined owing to persistent anastomotic channels (n = 8). Seven CHAs originating from the normal CA had a retroportal (n = 6) or transpancreatic (n = 1) course. All eight CHAs originating from the left gastric artery passed the fissure of the ligamentum venosum. The 148 CHAs originating from the superior mesenteric artery showed diverse relationships with the pancreas--being supra-, trans-, or infrapancreatic--and the superior mesenteric-portal venous axis--being pre- or retroportal. The 20 CHAs originating from the aorta had a normal suprapancreatic preportal course. Known or newly found CA and CHA variations could be systematically described in detail. The authors propose a hypothetical anatomic model for summarizing the observed CHA variations. RSNA, 2010
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              Newer anatomy of the liver and its variant blood supply and collateral circulation.

              N Michels (1966)
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                Author and article information

                Journal
                J Vasc Bras
                J Vasc Bras
                jvb
                Jornal Vascular Brasileiro
                Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
                1677-5449
                1677-7301
                15 March 2021
                2021
                : 20
                : e20200032
                Affiliations
                [1 ] originalState University of Medicine and Pharmacy “Nicolae Testemitanu”, Laboratory of Allergology and Clinical Immunology, Chişinau, Republic of Moldova.
                [2 ] originalState University of Medicine and Pharmacy “Nicolae Testemitanu”, Department of Human Anatomy, Chişinau, Republic of Moldova.
                Author notes

                Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

                Correspondence Serghei Covantev State University of Medicine and Pharmacy “Nicolae Testemitanu”, Laboratory of Allergology and Clinical Immunology Stefan cel Mare si Sfant Boulevard 165, Bd. MD-2004 2005 - Chişinau, Republic of Moldova Tel.: +373 69019868 E-mail: kovantsev.s.d@ 123456gmail.com

                Author information SC - MD; BEc, Laboratory of Allergology and Clinical Immunology, State University of Medicine and Pharmacy “Nicolae Testemitanu”. NM - MD student, Department of Human Anatomy, State University of Medicine and Pharmacy “Nicolae Testemitanu”. ID - MD; Lecturer, Department of Human Anatomy, State University of Medicine and Pharmacy “Nicolae Testemitanu”. OB - MD; PhD; Associate Professor, Department of Human Anatomy, State University of Medicine and Pharmacy “Nicolae Testemitanu”.

                Author contributions Conception and design: SC, NM, ID, OB Analysis and interpretation: SC, NM, Data collection: SC, NM, ID Writing the article: SC, NM, ID, OB Critical revision of the article: SC, OB Final approval of the article: SC, NM, ID, OB Statistical analysis: N/A. Overall responsibility: SC, NM, ID, OB *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

                Author information
                http://orcid.org/0000-0001-7236-5699
                Article
                jvbRC20200032 00602
                10.1590/1677-5449.200032
                8147703
                dd21773b-9e7c-44e4-b920-74bc804a126d
                Copyright© 2021 The authors.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 May 2020
                : 17 August 2020
                Page count
                Figures: 5, Tables: 0, Equations: 0, References: 26
                Categories
                Case Report

                celiac trunk,accessory left hepatic artery,accessory right hepatic artery,additional superior pancreatoduodenal artery,tronco celíaco,artéria hepática esquerda acessória,artéria hepática direita acessória,artéria pancreaticoduodenal superior acessória

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