Accessory Left Gastric Artery: Angiographic Anatomy

PURPOSE: To evaluate the angiographic anatomy of the accessory left gastric artery (accLGA). MATERIALS AND METHODS: We evaluated the angiographic findings of the accLGA in 50 patients (Angiostar; Siemens, Erlangen, Germany). Performing celiac and selective angiography in 50 and 34 patients, respectively. By means of celiac angiography, 1) site of origin, 2) anatomical course, 3) diameter, 4) degree of tortuosity, and 5) distal tapering were evaluated, while selective angiography was used to determine 1) arterial branching, 2) area of blood supply, and 3) patterns of gastric wall stain. RESULTS: Celiac angiography showed that the accLGA arose from the left hepatic artery (LHA) in 45 cases(90%) and from the proper hepatic artery in five (10%). If the accLGA arose from the LHA, its origin entirely depended on the branching pattern of the latter. It always arose from the lateral branch of the LHA furthest to the left and uppermost, and proximal to its umbilical point. The most common anatomical course of the accLGA, seen in 27 cases (54%), was between the S2 and S3 segmental branch. The diameter and degree of tortuosity of the accLGA were similar to those of adjacent intrahepatic branches in 21 (42%) and 33 cases (66%), respectively. The degree of tapering was less than that of adjacent intrahepatic vessel in 28 (56%). Selective angiography demonstrated esophageal branching of the accLGA in 27 cases (79%), inferior phrenic arterial branching in three (9%), a mediastinal branch in one (3%), and hypervascularity of the lung in one (3%). In 15 cases (44%), bifurcation of the accLGA was recognized. The vascular territory of the accLGA was the gastric fundus together with the distal esophagus in 21 cases (62%), mainly the gastric fundus in six (18%), and mainly the distal esophagus in four (12%). The pattern of gastric mucosal stain was curvilinear wall in 31 cases (91%) and nodular in three (9%). CONCLUSION: A knowledge of the angiographic anatomy of the accLGA facilitates accurate recognition of this artery on routine celiac and hepatic arteriography, thus reducing gastric complications after transarterial management of hepatic tumors and improving the angiographic diagnosis and treatment of upper gastrointestinal bleeding.

Intralobar Pulmonary Sequestration, Supplied from Left Gastric Artery: A Case Report

Pulmonary sequestration is a relatively rare anomaly. Arterial supply is usually derived from the aorta or its major branches, or very rarely from the left gastric artery. We present a case of intralobar sequestration in which blood was supplied by the left gastric artery.

Normal Variation of Right Gastric Artery Origin on Abdominal Angiogram

PURPOSE: To evaluate the normal variations in the origin of the right gastric artery (RGA), as seen on abdominal angiogram. MATERIALS AND METHODS: Four hundred and twenty-six patients underwent celiac and superior mesenteric arteriogram, and in 154, the origin of the RGA was identified (M:F=116:38 ; mean age, 56 years ; range, 6-84 years). Digital subtraction angiography were performed in 101 patients, and conventional angiography in 53 ; we thus evaluated the origin of the RGA, normal variation of the hepatic artery, and the relationship between them. RESULTS: The origin of the RGA was the proper hepatic artery (PHA) in 43% of cases (n=67), the left hepaticartery (LHA) in 41% (n=63), the common hepatic artery (CHA) in 9% (n=14), the right hepatic artery (RHA) in 4% (n=6),and the gastroduodenal artery (GDA) in 3% (n=4). of these 154 patients, 126 (82%) showed a normal hepatic artery branching pattern, with both hepatic arteries arising from the PHA ; in 18 patients (12%), the RHA arose from the superior mesenteric artery (SMA), and in 6 patients (4%), the LHA arose from the left gastric artery (LGA). In 4 patients (3%), other branching patterns of the hepatic artery were noted. In 16 of 18 patients (89%) whose RHA arose from the SMA, the RGA originated in the LHA ; in the other two, the RGA arose from the GDA and CHA, respectively. CONCLUSION: In 43% of cases, the main site from which the RGA originated was the PHA, and in 41%, the LHA, as seen on abdominal angiogram. Where the RHA arose from the SMA, its most frequent site of origin, seen in 89% of cases, was the LHA. The exact recognition of the origin of the RGA, as seen on abdominal angiogram, could lead to a reduction of transarterial chemoembolization-related gastric complications.