Aim: To determine the comprehensive spectrum of celiac axis including SMA, IMA, hepatic and renal artery variations with the use of multi-detector computed tomography (MDCT).

Material and Methods: This retrospective and prospective study was conducted in the Department of Radio diagnosis, Dr. S.N. Medical College and Associated Group of Hospitals, Jodhpur in 500 patients subjected to MDCT abdomen for various indications. Patients with a history of prior major upper abdominal surgery and patients with occlusion of celiac, hepatic, SMA and renal arteries were excluded.

Results: Seven types of celiac axis anatomic variations were identified in our study (including SMA). Anatomic variations in celiac axis were seen in 9% of patients with ambiguous celiac axis anatomy in 2% of the patients. IMA origin was normal in all patients. CHA originated from celiac axis in 95.20% of the patients. Variations in anatomic origin of CHA were seen in 2.8% patients. Normal origin of RHA from HAP and CHA was seen in 77.75% patients. LHA originated from HAP and CHA in 77.75% patients. MHA originated from RHA in 48% patients, LHA in 12% and from CHA in 12% cases. Origin of MHA could not be defined in 28% of patients. GDA originated from CHA in 95% of patients. Single renal artery was seen in 53% patients.  49% patient have variation in the form of early branching and additional renal arteries.

Conclusion: Variations in the celiac trunk, SMA, hepatic artery and renal artery are common, and their detection is important prior to any interventions or abdominal surgeries.   

Keywords: SMA/IMA-superior/inferior mesenteric artery; CHA- common hepatic artery; HAP-hepatic artery proper; RHA/LHA/MHA- right/left/middle hepatic artery; GDA-gastro duodenal artery.

1. Olga Kornafel, Bogusława Baran, Izabela Pawlikowska, Piotr Laszczyński et al. Analysis of anatomical variations of the main arteries branching from the abdominal aorta, with 64-detector computed tomography. © Pol J Radiol, 2010; 75(2): 38-45.
2. Michel NA. Observatons on the blood supply of the liver and gallbladder (200 dissections). Blood supply and anatomy of the upper abdominal organs, with a descriptive atlas. Philadelphia, Pa: Lippincott ;1955. p. 64-9.
3. Jonathan R. Hiatt, Joubin Gabbay, and Ronald W. Busuttil et al. Surgical Anatomy of the Hepatic Arteries in 1000 Cases. ANNALS OF SURGERY Vol. 220, No. 1, 50-52 C 1994 J. B. Lippincott Company.
4. Vandamme JP, Bonte J, Van der Scheueren G. A reevaluation of hepatic and cystic arteries: The importance of aberrant hepatic branches. ActaAnat 1969;73:192-209.
5. Suzuki T, Nakayasu A, Kawabe K, Takeda H, Honjo I.Surgical signifi cance of anatomic variations of the hepatic artery. Am J Surg 1971;122:505-12.
6. Song SY, Chung JW, Yin YH, Jae HJ, Kim HC, Jeon UB, et al. Celiac axis and common hepatic artery variations in 5002 patients: Systematic analysis with spiral CT and DSA.Radiology 2010;255:278-88.
7. Uflacker R. Atlas of vascular anatomy: an angiographic approach. Baltimore: Williams & Wilkins, 1997.
8. Catalano OA, Singh AH, Uppot RN, Hahn PF, Ferrone CR, Sahani DV. Vascular and biliary variants in the liver: Implications for liver surgery Radio Graphics 2008;28:359-78.
9. Fox M, Yalin R. Renal transplantation with multiple arteries. Br J Urol 1979;51:333–6.
10. Sampaio FJB, Passos MARF. Renal arteries: anatomic study for surgical and radiological practice. Surg Radiol Anat 1992;14:113–17
11. Susan standring. Gray’s Anatomy. Churchill Livingstone. 2008;40:1183.
12. Shakeri AB, Tubbs RS, Shoja MM, Pezeshk P, Farahani RM, Khaki AA, et al. Bipolar supernumerary renal artery. Surg Radiol Anat. 2007;29(1):89–92.
13. Rao M, Bhat SM, Venkataramana V, Deepthinath R, Bolla SR. Bilateral prehilar multiple branching of renal arteries: a case report and literature review. Kathmandu University Medical Journal (KUMJ). 2006;4(3):345–48.
14. Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries incidence and morphometry. Surg Radiol Anat. 2001;23(1):33–38.
15. Kadir S. Kidneys. In: Kadir S, ed. Atlas ofnormal and variant angiographic anatomy.Philadelphia: W.B. Saunders Company, 1991; 387-429.
16. Boijsen E. Renal angiography: Techniques and hazards; anatomic and physiologic considerations. In: Baum S, ed. Abrams’ angiography. 4th ed. Philadelphia: Little, Brown and Company, 1997; 1101-1131.
17. Sureka, et al.: Variations of celiac axis, and its branches in 600 patients- Indian Journal of Radiology and Imaging / August 2013 / Vol 23 / Issue 3.
18. Ahmed M. Osman et al.- Celiac trunk and hepatic artery variants: A retrospective preliminary MSCT report among Egyptian patients. The Egyptian Journal of Radiology and Nuclear Medicine 47 (2016) 1451–1458.
19. M S Ugurel et al (2010)- Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. The British Journal of Radiology, 83 (2010), 661–667.
20. De Cecco CN, Ferrari R, Rengo M, Paolantonio P, Vecchietti F, Laghi A. Anatomic variations of the hepatic arteries in 250 patients studied with 64-row CT angiography. EurRadiol. 2009;19(11):2765–2770. doi: 10.1007/s00330-009-1458-7. [PubMed] [Cross Ref].
21. Kiat Arjhansiri, Patcharee Charoenrat, Weeranuch Kitsukjit: Anatomic variations of the hepatic arteries in 200 patients done by angiography. publication/ 6122365_2006.
22. Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G. Anatomic variations of the hepatic arteries in 604 selective coeliac and superior mesenteric angiographies. Surg Radiol Anat2004;26:239–44 [PubMed].
23. Richard D. White et al- The Celiac Axis Revisited: Anatomic Variants, Pathologic Features, and Implications for Modern Endovascular Management. Radio Graphics 2015; 35:879–898.
24. Gumus H, Brdal Ozdemir E, Cetincakmak ML, Tekbas G, Ekici, Onder H, et al. Variations of renal artery in 820 patients using 64-detector CT-Angiography. Renal Faliure. 2012;34:286-90.
25. Rubin GD, Alfrey EJ, Dake MD, et al. Assessment of living renal donors with spiral CT. Radiology 1995; 195:457–462.
26. Saldarriaga B, Pérez AF, Ballesteros LE: A direct anatomical study of additional renal arteries in a Colombian mestizo population. Folia Morphol, 2008; 67(2): 129–34.
27. Kurcz J, Nienartowicz E, Słonina J et al: The usefulness of CT-angiography in detecting anatomical variants of arteries arising from the abdominal aorta and aortic arch. Adv Clin Exp Med, 2007: 16(6): 751–60.
28. Sampaio FJB, Passos MA: Renal arteries: anatomic study for surgical and radiological practice. Surg Radiol Anat, 1992; 14: 113–17
29. Tarzamni MK, Nezami N, Rashid RJ et al: Anatomical differences in the right and left renal arterial patterns. Folia Morphol, 2008; 67(2): 104–10.
30. Spring DB, Salvatierra O Jr, Palubinskas AJ, et al. Results and significance of angiography in potential kidney donors. Radiology 1979; 133:45–47.
31. Basti Ram S et al. - Spectrum of coeliac trunk, hepatic artery and renal artery variations- analysis by multidetector computed tomography. International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 12, Issue 1, 2014 pp 168-172.
32. Ozkan U, Oguzkurt L, Tercan T et al : Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol, 2006; 12: 183–86.
33. Kumaresan Munnusamy et al (2016). Variations in Branching Pattern of Renal Artery in Kidney Donors Using CT Angiography. J Clin Diagn Res. 2016 Mar; 10(3): AC01–AC03. Published online 2016 Mar 1. doi:  10.7860/JCDR/2016/ 16690.7342.

Chouhan Ajay Singh

Resident, Dr. S. N. Medical College and Attached Group of Hospitals, Jodhpur, India