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.

Intra-arterial Port Implantation for Intra-arterial Chemotherapy: Comparison between PIPS(Pe rcutaneouslyImplantable Port System) and Port System

PURPOSE: To compare the techniques and complications of intra-arterial port implantation for intra-arterialchemotherapy between PIPS and the port system. MATERIALS AND METHODS: For intra-arterial port implantation, 27cases in 27 patients were retrospectively evalu-ated using PIPS(PIPS-200, William Cook Europe, Denmark) while for21 cases in 19 patients a pediatric ve-nous port system(Port-A-Cath, 5.8F, SIMS Deltec, U.S.A.) was used. Allintra-arterial port implantation was performed percuteneously in an angiographic ward. Hepatocellular carcinomawas diagnosed in 18 patients and hepatic metastasis in 16. Peripheral cholangiocarcinoma, and pancreatic gastric,ovarian, renal cell and colon carcinoma were included. We compared the techniques and complications between PIPSand the port system. The follow up period ranged from 23 to 494(mean, 163) days in PIPS and from 12 to 431(mean,150) days in the port system. RESULTS: In all cases, intra-arterial port implantations were technicallysuccessful. Port catheter tips were locat-ed in the common hepatic artery(n=8), proper hepatic artery(n=7), righthepatic artery(n=5), gastroduodenal artery(n=2), left hepatic artery(n=1), pancreaticoduodenal artery(n=1),inferior mesenteric artery(n=1), lum-bar artery(n=1), and renal artery(n=1) in PIPS, and in the proper hepaticartery(n=6), gastroduodenal artery(n=6), common hepatic artery(n=3), right hepatic artery(n=4), inferiormesenteric artery(n=1), and in-ternal iliac artery(n=1) in the port system. Port chambers were buried ininfrainguinal subcutaneous tissue. Using PIPS, complications developed in seven cases(25.9%) and of these, four(57.1%) were catheter or cham-ber related. In the port system, catheter or chamber related complications developedin four cases(19.0%). CONCLUSION: Because PIPS and the port system have relative merits and demetrits, successfulintra-arterial port implantation is possible if equipment is properly selected.

Diagnosis of Normal Variation of Hepatic Artery on Axial Image of Spiral CT: Importance of a vascular structure in a portocaval space and fissure of ligamentum venosum

PURPOSE: To determine the predictability of an aberrant hepatic artery by detection of a vessel in the portocaval space or fissure for the ligamentum venosum, as seen on arterial-phase spiral CT images. MATERIALS AND METHODS: Axial spiral CT scans (10mm section thickness, 10mm table feed) were obtained in 100 patients with hepatic mass and were examined by two radiologists. In each case, each determined whether a vessel was located in the portocaval space or fissure for the ligamentum venosum, and the type of aberrant artery. All patients underwent conventional angiography and the results were interpreted by another radiologist and compared with the results as shown on CT. RESULTS: Twelve-one cases with a vessel within the portocaval space and 14 with a vessel within the fissure for the ligamentum venosum showed variation of the hepatic artery. When a vessel was located transversely in the portocaval space, sensitivity, specificity, and positive and negative predictive value of an aberrant hepatic artery were 94%, 100%, 100%, and 99%, respectively; when a vessel was located in the fissure for the ligamentum venosum, the corresponding rates were 88%, 100%, 100%, and 98%. CONCLUSION: The detection on arterial-phase spiral CT images of a vessel in the portocaval space or fissure for the ligamentum venosum can reliably predict the existence of an aberrant hepatic artery.