Unusual Anatomy of the Testicular Arteries: A Case Report and Review of the Clinical Implications.

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.

Persistence of Ventrolateral Splanchnic Longitudinal Channels

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.

Anatomical variant origin of suprarenal arteries from coeliac trunk development, and its clinical significance

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.

Embolization of the inferior phrenic artery as nonbronchial systemic artery for hemoptysis / 实用放射学杂志

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.

Lipiodol brain embolism through right inferior phrenic artery-pulmonary vein shunt after transcatheter arterial chemoembolization

Lipiodol brain embolism is a rare complication associated with transcatheter arterial cheomoembolization (TACE). The present case describes a patient with lipiodol brain embolism who presented with several symptoms, including drowsy mental state, right facial palsy, and weakness in the right upper and lower limbs. The patient's non-enhanced computed tomography scan and magnetic resonance imaging (MRI) findings revealed multifocal lipiodol deposition and an acute infarction of the brain. A retrospective review of the angiography findings revealed a right inferior phrenic artery-pulmonary vein shunt, which was not observed during the previous TACE. Three days after TACE, the patient's symptoms improved; however, the extent of the brain hyperintensity had widened further on the following MRI. The patient gradually recovered and was finally discharged.

Variations in the Origin of Inferior Phrenic Arteries and Their Relationship to Celiac Axis Variations on CT Angiography

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.

Normal and variant origin and branching pattern of inferior phrenic arteries and their clinical implications: a cadaveric study.

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.

The appliacation of retrospective ECG-gated 256 slices spiral CT technique in inferior phrenic artery angiography / 实用放射学杂志

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.

Inferior Phrenic Arterial Embolization for Massive Hemoptysis of Tuberculosis / 中国医学影像学杂志

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.

Anomalous Origin of Right Inferior Phrenic Artery.

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.

Clinical relevance of variations in the origin of inferior phrenic arteries.

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.

A Variant Origin of Common Hepatic, Right Inferior Phrenic Artery and Accessory Right Renal Artery

A case of variations in the ventral and lateral and dorsal branches of abdominal aorta were observed in a 50-year-old male cadaver during routine dissection for medical undergraduate students. The common hepatic artery was arising directly from abdominal aorta. Right inferior phrenic artery originated directly from the abdominal aorta along with upper right renal artery about 0.4cm below the origin of superior mesenteric artery. Triple renal arteries were seen on the right side, all arising from abdominal aorta whereas on the left side, a single renal artery was seen entering the kidney. The upper right renal artery was present behind the inferior vena cava whereas the middle and inferior right renal arteries were present in front of the inferior vena cava. On the right side, ureter was placed anterior to renal vessels. Knowledge of the above variations in the branches of abdominal aorta have clinical importance not only for surgeons but also for interventional radiologists.

Anatomic Assessment of Right Inferior Phrenic Artery with Multi-detector Row CT / 实用放射学杂志

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.

TACE in patients with hepatocelluar carcinoma feeded by left inferior phrenic artery / 中国介入影像与治疗学

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.

Multiple vascular anomalies in the abdomen: a gross anatomical study / Múltiples anomalías vasculares en el abdomen: un estudio anatómico macroscópico

Knowledge of the branching pattern of the abdominal aorta is clinically important for any abdominal surgeon operating on parts of the gut or neighboring structures like the suprarenals, spleen, pancreas, liver, kidneys and ureter. The presence of abnormal inferior phrenic artery associated with aberrant branch from the celiac trunk supplying the pancreas and duodenum is a rare anomaly. In the present case, we observed four branches of the celiac artery i.e. (a) left gastric artery (b) common hepatic artery (c) splenic artery and (d) an aberrant branch, which took a course inferiorly towards the pancreas. The aberrant artery supplied the body of the pancreas and gave a branch which supplied the horizontal part of the duodenum and then entered the transverse mesocolon to supply the hepatic flexure and some portions of the ascending and the transverse colon. The inferior phrenic artery was absent on the left side. Concomitant anomalies of such type are to be kept in mind by the surgeon, while operating cases of carcinoma head of pancreas and performing kidney transplantations.

El conocimiento del patrón de ramificación de la aorta abdominal es clínicamente importante para cualquier cirujano abdominal que opere en partes del intestino o estructuras vecinas, como glándulas suprarenales, bazo, páncreas, hígado, riñones y uréteres. La presencia anormal de la arteria frénica inferior asociada con una rama aberrante originada del tronco celiaco, supliendo el páncreas y duodeno, es una variación anatómica rara. En el presente caso, se observaron cuatro ramas de la arteria celiaca: (a) arteria gástrica izquierda (b) arteria hepática común (c) arteria esplénica y (d) una rama aberrante, que tuvo un curso inferior hacia el páncreas. La arteria aberrante suministraba irrigación al cuerpo del páncreas y daba una rama para la parte horizontal del duodeno para luego entrar en el mesocolon transverso para irrigar la flexura hepática y algunas partes del colon ascendente y transverso. La arteria frénica inferior estaba ausente en el lado izquierdo. Anomalías concomitantes de este tipo deben ser consideradas por el cirujano, en casos de operación de carcinoma de cabeza de páncreas y la realización de trasplante renal.

A Case of Swan-Ganz Catheter Malposition: A case report / 대한마취과학회지

A Swan-Ganz catheter is a useful monitoring device for measuring the pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac output, but its insertion brings about many complications, including dysrhythmias, pulmonary artery rupture, thrombosis and infection. We report here on a case of malposition of a Swan-Ganz catheter in a 49-year-old female patient who had undergone liver transplantation due to alcoholic liver cirrhosis.

Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Via the Inferior Phrenic Artery / 实用放射学杂志

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.

The value of blood supply by inferior phrenic artery to hepatic carcinoma in interventional embolization therapy / 中国微创外科杂志

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.

Image and interventional management of inferior phrenic artery supplying to hepatic tumors / 中国微创外科杂志

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.

Inferior phrenic arteries supply to the pulmonary hemorrhagic lesions:angiographic identification and interventional management / 中华放射学杂志

Objective To describe the manifestations of the inferior phrenic arteries(IPA)supply to the pulmonary hemorrhagic lesions and to evaluate the safety and efficacy of transcatheter arterial embolization(TAE)of the IPA.Methods The clinical data and imaging findings of eighteen patients with the additional blood supply to the pulmonary hemorrhagic lesions from the IPA were evaluated retrospectively.The causes of the bleeding were lung malignancies in 9,bronchiectasis in 7,and chronic inflammation in 2 patients.TAE supplementally was performed in patients with IPA supply to the pulmonary lesions,using polyvinyl alcohol particles,gelatin sponge particles,and microcoils.Results Selective arteriogram demonstrates an enlarged IPA,with numerous branches and hypervascularity in all 18 cases, with tumor staining in 9,the contrast material extravasation in 6,and non-specific staining in 2 cases.In addition,IPA-to-pulmonary shunting was found in 9 cases.All the lesions supplying by IPA were adjacent to the pleurae,including adjacent to the diaphragmatic pleura in 11,the mediastinal pleura in 5,and the lateral pleura of the lower lobe in 2 cases.Technical success of IPA embolization was achieved in the 18 cases.Embolization of other nonbronchial systemic arteries(the internal thoracic artery in 7 and intercostal artery in 3)was performed at the same session.All bleeding ceased immediately after supplemental IPA embolization.Follow-up time ranged from 8 months to 4 years.Mild recurrent hemoptysis occurred in 3 patients at 1,2,6 months respectively,after the embolization.These patients were responsive to conservative management.Recurrent bleeding did not occur in 15 patients during the follow-up. Conclusion The pulmonary hemorrhagic lesions,especially adjacent to the diaphragmatic and mediastinal pleurae,can be supplied by IPA,and may result in clinical failure following BAE.Supplemental TAE of IPA is a safe and effective adjunct to BAE in the management of bronchial bleeding supplied by IPA.