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Testicular artery (previously known as internal spermatic artery or also known as gonadal artery) is an artery that branches from the anterolateral part of abdominal aorta at the level of the second lumbar vertebra and supplies the blood to the testes. Anatomical variations of the testicular vessels are not frequently reported in the literature. The available data demonstrates that there is an overall decrease in the number of cadaver studies published in the literature. The current case demonstrates a unique variation where the right testicular artery began as a common trunk with superior polar, inferior phrenic, capsular arteries and then had an unusual course covering the surface of the kidney. The left testicular artery, had a high origin from the aorta and also descended in an oblique course, covering the kidney. The current case is important because of its implications in renal transplantation, renal and adrenal surgery, vascular surgery, oncological surgery and other disciplines.
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The coeliac trunk is the branch of the abdominal aorta at the level of the twelfth thoracic vertebra. Its branches namely left gastric, common hepatic and splenic arteries supply the primary organs of the supracolic abdominal compartment namely the stomach, pancreas, spleen and liver. In this article, we report case series of three cases in male cadavers aged 65yrs, 60yrs and 70yrs respectively in the Department of Anatomy, Pondicherry Institute of Medical Sciences and MVJ Medical College and Research Institute wherein we discovered that the branching pattern of the coeliac trunk varied from the usual pattern, thus the specimens were photographed to understand further. The observation of first case, common trunk from abdominal aorta showed common hepatic and superior mesenteric artery and left gastric and splenic artery aroused as another common trunk from abdominal aorta. The second case showed the superior mesenteric artery arising from coeliac trunk and the third case was observed the inferior phrenic arteries were arising from coeliac trunk. Knowledge of this variable anatomy may be useful in planning and executing surgical or radiological interventions.
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Background: One of the most vascular organ in the body Adrenal gland being highly variant in vasculature and tough to approach, its knowledge needs to be updated regularly. Anatomists, Surgeons and Radiologists will be benefitted with this study and improves the quality of care provided to patients by reducing morbidity and mortality.Methods: This study was done on 48 formalin fixed cadavers (33 males, 15 females) in the department of anatomy, between 2014-2019. Coeliac trunk was skeletonized, and branches traced looking for suprarenal arterial branches.Results: Superior Suprarenal Artery originated from Inferior phrenic artery in 13(27%) cases, and these Inferior phrenic arteries were arising from the Coeliac trunk, and in one (2.03%) case Superior suprarenal artery was arising directly from Coeliac trunk and which had even replaced the Middle Suprarenal Artery. None of the Middle and Inferior Suprarenal Artery came from coeliac trunk.Conclusions: Knowledge of Superior Suprarenal Arterial variations while doing surgeries, and during radiological interventions in and around the lesser sac, and involving the Coeliac trunk helps the clinicians in reducing the morbidity and mortality.
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Objective To investigate the safety and efficacy of embolization of inferior phrenic artery as nonbronchial systemic artery(NBSA) for hemoptysis.Methods Imaging and clinical data of 1 1 patients with inferior phrenic artery as NBSA were analyzed retrospectively, and complications and hemoptysis recurrence rate were recorded.Results Seven patients underwent enhanced CT examination and 4 patients underwent plain CT examination before embolization.Six of those patients who underwent enhanced CT examination were found abnormal arteries,and were confirmed as NBSA by angiography.The other 5 patients were found unmatch of lesion distribution and bronchial arteries during procedure,and inferior phrenic artery as NBSA were found by expanding angiography.All procedure were successfully performed,3 cases occurred hiccup and need not treatment.No serious complications occurred,such as incontinence and paraplegia.During (1 8.7 ± 1 3.8)months follow-up,only 1 patient recurrence of hemoptysis,and successful after conservative treatment,and the other 10 patients had no recurrence of hemoptysis.Conclusion The inferior phrenic artery as NBSA can induce hemoptysis.It is safe to embolization of the inferior phrenic artery,which can reduce the recurrent rate of hemoptysis.
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OBJECTIVE: Knowing the origin of the inferior phrenic artery (IPA) is important prior to surgical interventions and interventional radiological procedures related to IPA. We aimed to identify variations in the origin of IPA and to investigate the relationship between the origin of IPA and celiac axis variations using computed tomography angiography (CTA). MATERIALS AND METHODS: The CTA images of 1000 patients (737 male and 263 female, the mean age 60, range 18–94 years) were reviewed in an analysis of IPA and celiac axis variations. The origin of IPA was divided into two groups, those originating as a common trunk and those originating independently without a truncus. The relationship between the origin of IPA and celiac axis variation was analyzed using Pearson's chi-square test. RESULTS: Both IPAs originated from a common trunk in 295 (29.5%) patients. From which the majority of the common trunk originated from the aorta. Contrastingly, the inferior phrenic arteries originated from different origins in 705 (70.5%) patients. The majority of the right inferior phrenic artery (RIPA) and the left inferior phrenic artery (LIPA) originated independently from the celiac axis. Variation in the celiac axis were detected in 110 (11%) patients. The origin of IPA was found to be significantly different in the presence of celiac axis variation. CONCLUSION: The majority of IPA originated from the aorta in patients with a common IPA trunk, while the majority of RIPA and LIPA originating from the celiac axis in patients without a common IPA trunk. Thus, the origin of IPA may widely differ in the presence of celiac axis variation.
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Female , Humans , Male , Abdomen , Angiography , Aorta , ArteriesABSTRACT
Background: Inferior phrenic arteries, which constitute the chief arterial supply to the diaphragm, are generally the branches of abdominal aorta, however, variations in their mode of origin is not uncommon. Very less information is available regarding the functional anatomy of the inferior phrenic artery in anatomy textbooks. Methods: The present study was conducted utilizing 36 formaline-fixed cadavers between 22 years to 80 years over a period of 5 years. The frequency and anatomical pattern of the origin of the right and left inferior phrenic arteries were studied. Results: On the right side, the inferior phrenic artery arose independently from abdominal aorta in 94.4% cases and on the left side in 97.2% cases.Other sources of origin were seen in 5.55% cases. Left hepatic artery was seen as the source of origin for right inferior phrenic artery in one case while in second case left gastric artery was the source for both the right and left inferior phrenic artery. The right inferior phrenic artery is the most common source of collateral arterial supply to hepatocellular carcinoma, next to the hepatic artery. Conclusion: Knowledge of variations of inferior phrenic artery origin could be valuable during treatment of hepatic neoplasm, liver transplants, biliary tract surgery and during tanscatheter oily chemoembolisation technique.
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Purpose Bronchial arterial embolization is the preferred hemostasis method for hemoptysis when medical treatment is invalid. This paper aims to discuss the safety and efficacy of inferior phrenic artery (IPA) embolization in the treatment of hemoptysis of tuberculosis when IPA is involved. Materials and Methods Twenty-eight patients who were confirmed that IPA got involved in the hemoptysis due to pulmonary tuberculosis by IPA angiography underwent embolization. CT scan was performed before the procedure and IPAs arteriography were performed during the interventional procedure. Once the blood supply was identified, catheterization and embolization was carried out with gelatin sponge particle, sodium polymannuronate microsphere or microcoil according to the patients' conditions. After the procedure, the IPA angiographic manifestations, clinical efficacy and complications were evaluated. Results Thirty-three IPAs were identified as getting involved in the blood supply in the 28 patients. Among those patients, 12 had left IPA involved, 11 had right IPA involved and the rest 5 had IPAs involved in both sides. The selective IPA angiography showed IPAs had enlargement, with numberous and disordered branches and hypervascularity. IPA-pulmonary artery shunt was found in 22 cases. None of the cases was found extravasation of contrast medium. The hemoptysis reoccurred in 4 patients on the second day, sixth day and 6 months after the first embolization, thus the procedures were performed three times in 1 patient and twice in the other 3 patients. Nine patients had fever as complication, 19 patients had chest pain and 5 suffered from mild dyspnea. These complications usually disappeared in 3-7 days after symptomatic treatment. Conclusion IPA embolization is technically feasible and safe, whose complications are likely to be few and self-restrictive.
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Objective To evaluate the value of retrospective ECG-gated 256 slices spiral CT technique in the scanning of inferior phrenic artery (IPA).Methods 80 patients with underdone abdominal CTA were divided randomly into two groups (40 patients each)as regular abdominal CTA scanning group and retrospective ECG-gated technique group.And further analysis was done to evaluate the display of IPA branches and the image quality.Results 80 patients were all scanned successfully.40 cases LIPA and 40 cases RIPA were showed in the regular group.80 cases showed 1st level branches of IPA,73 cases with 2nd level,59 cases with 3rd and 43 ca-ses showing 4th level.40 cases LIPA and 40 cases RIPA were showed in ECG-gated group.And the numbers of IPA branches levels were 80,79,71,65,respectively.There is no significant difference in the ability of showing the1st level IPA or their image quality between those two groups (P >0.05);and there is a statistical significance in the ability of showing other levels of IPA and their im-age quality.Conclusion It is feasible that we use retrospective ECG-gated 256 slices spiral CT scanning technique to show the IPA. And it could improve the ability of showing the IPA branches as well as the image quality.
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Background: To show the anomalous origin of right inferior phrenic artery from right renal artery and to discuss the embryological basis and surgical significance of such variation. Method: This was found during routine dissection of abdomen in a 61 year old adult male cadaver in the department of anatomy, R.G.Kar Medical College. Results: It was seen that right inferior phrenic artery(RIPA) took its origin from right renal artery. Further distribution of RIPA was normal. Left inferior phrenic artery (LIPA) arose normally from abdominal aorta. Conclusion: Accurate knowledge regarding this is important for carrying out vascular and reconstructive surgery and for evaluation of angiographic images . The RIPA is a major source of collateral arterial supply to hepatocellular carcinoma, second only to the hepatic artery. So a surgically inoperable HCC can be treated by transcatheter embolization of not only the right or left hepatic arteries, but also by embolization of a RIPA, if involved.
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Introduction: The inferior phrenic arteries are major source of collateral arterial supply to hepatocellular carcinoma second only to the hepatic artery. The right inferior phrenic artery is one of the chief postoperative bleeding sources in liver transplant recipients. The aim of the present study was to identify the variations in origin of inferior phrenic arteries. Methods: We dissected inferior phrenic arteries in 100 human adult cadavers (75 males and 25 females) for the origin of both inferior phrenic arteries. Results: We found variant origin of left inferior phrenic artery in 22 male cadavers and in 7 female cadavers. The variant origin of right inferior phrenic artery was found in 27 male cadavers and in 8 female cadavers. Conclusion: The higher incidences of variant origin of inferior phrenic arteries have major clinical implications in the transcatheter arterial chemoembolization in hepatocellular carcinoma patients.
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Objective To estimate the anatomic variation of the right inferior phrenic artery(RIPA)with multi-detector tomography(MDCT)scans.Methods 45 patients with hepatocellular carcinoma(HCC)and 46 healthy subjects were examined by contrast-enhanced CT scan(CTA)at 16-section CT scanner.Then the images were reconstructed with MPR,VR and MIP.Results RIPA were detected by CTA in all cases(sensitivity was 100%).The origin of RIPAs directly from the aorta in 42%,celiac trunk in 37%,right renal artery in 15%,left gastric artery in 3% and proper hepatic artery in 2%.For the reconstructive images quality,MPR and MIP were better than VR,but in showing the origin of RIPAs,MPR and VR were better than MIP.In compared with normal group,the diameters of RIPAs in tumor group were larger.Conclusion MDCT estimates well for the anatomy of RIPAs,which is significant for planning and embolization of extrahepatic RIPA supply in HCC.
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Objective To evaluate the efficacy of transcatheter arterial chemoembolization through left inferior phrenic artery (LIPA) in hepatocellular carcinoma (HCC) feeded by LIPA. Methods Angiographic data of 187 HCC patients were retrospectively analyzed. Five patients with LIPA feeding HCC were diagnosed and successfully treated with TACE through LIPA. Results All 5 patients underwent CT and angiography after 3 months, 3 of them achieved complete remission. LIPA recanalized in the other 2 patients, then these 2 patients underwent TACE through LIPA again. Conclusion LIPA could formed lateral branch to feed HCC. TACE through LIPA is safe and effective.
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Objective To study blood supply by inferior phrenic artery to hepatic carcinoma and the value of interventional embolization of the artery. Methods 35 cases of primary hepatic carcinomas,with one severe biliary tract hemorrhage,underwent both hepatic and phrenic artery angiography,and chemoembolizational therapy through the hepatic arteries and the phrenic arteries that had blood suply.And those with the biliary tract hemorrhage were managed by means of gelfoam and coil embolization. Results It was found that 21 of the 35 cases had blood supply by inferior phrenic artery to hepatic carcinomas and they were mainly in mass pattern and diffuse infiltration pattern with invasion of hepatic membrane.The regions of blood supply varied from 20%to 70%.The tumors shrank 40%～50% in 14 cases,10%～30% in 18 cases,with no change in 3cases.Biliary tract hemorrhage ceased. Conclusions Among the collateral arteries that supply blood to hepatic carcinoma,inferior phrenic artery peays a main part.It seems that both the hepatic and phrenic artery should be embolized in interventional therapy to hepatic carcinoma in order to get a better therapeutic result.
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20?g/L)prior to IPA embolization, and returned to normal after embolization. Conclusion Tumors located posteriorly and superticially in the liver may recruit blood supply though IPA collaterals. Phrenospasm should be cautious during IPA embolization.
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Objective To investigate the factors and rate of the forming of the collateral feeding arteries from inferior phrenic artery(IPA) in hepatocellular carinoma(HCC).Methods IPA was demonstrated on angiographs in 137 patients with HCC during transcatheter arterial chemoembolization(TACE),TACE was performed through diaphragmatic inferior artery(DIA) super setectively.Results Of 137 cases,21 cases underwent TACE through DIA(15.3%),of them 2 cases were recurrent after surgical operation(9.5%),3 cases had the tumor receive blood supply from IPA at first TACE(14.3%) and 16 cases were occured after TACE tow and more times(76.2%).Conclusion Collateral branches originated from IPA are important feeding arteries in HCC,TACE of IPA can be performed with a high success rate without major complications.
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Objective To evaluate the efficacy of transcatheter lipiodol chemoembolization therapy (TOCE) for HCC via inferior phrenic artery (IPA) and to analyse the location of the tumor feeding inferior phrenic artey. Methods Twenty five cases of HCC underwent the procedure of TOCE via the IPA, as well as the hepatic artery using Seldinger's method. The patterns of tumor growth included huge type in 12 cases, solitary nodular type in 8 cases and multiple nodular type in 5 cases. Hepatic artery and inferior phrenic artery chemoembolizations were performed in all cases. Results Inferior phrenic artery originated from celiac trunk in 16 cases (64%); abdomen aorta around celiac trunck in 8(32%). The sitesot tumors supplied by IPA in right lobe (Ⅶ,Ⅷ segment) were 23 cases and left lobe (Ⅳ segment) 2 cases. The cumulative survival rates of IPA chemoembolization for hepatocellular carcinoma were 84%(1 year) and 68%(2 years). No severe complications occurred. Conclusions TOCE of the IPA is a safe and effective method in the management of HCC supplied by IPA. When the tumor site is adjacent to diaphragm, hepatic ligaments or bare area, may arouse the blood supply by IPA, especially in no tumor staining or staining defect in hepatic artery angiography but tumor enhancement on CT, and increase of the level of serum ? fetoprotein.