CELIAC ARTERY VARIATIONS ON CT ANGIOGRAPHY: VALIDATION OF THE ETHIRAJ EMBRYOLOGY-BASED CLASSIFICATION WITH EXPANSION OF TYPE II & IV SUBCATEGORIES

Abstract

Background: The primordial ventral splanchnic arteries' embryological remodelling causes the coeliac trunk (CT) to exhibit significant morphological diversity. For transplantation, hepatopancreatobiliary surgery, and interventional radiology, accurate identification of these differences is critical.

Material and Method: The CT angiography of 1008 patients was examined in this retrospective single-centre investigation using 3D volume-rendered imaging, maximum intensity projection, and multiplanar reformations. The Ethiraj approach was used to evaluate and categorise the origin and branching pattern of the inferior phrenic artery (IPA), superior mesenteric artery (SMA), and CT. Variants that were recently discovered were classified using embryological interpretation.

Result: Classical Type 1 trifurcation occurred in 46.4% of cases. The most common atypical pattern was Type VI celiophrenic variations (37.9%), of which Type VI(c) (CT +left IPA) was the most common (17.5%). Type IV variations were present in 11.3% of the samples, the most common of which was Type IV(c) right hepatomesenteric trunk (9.0%). The type II variations were detected in 3.76% and mostly in the hepatosplenic trunk. There were two other rare types: hepatosplenic trunk (Type II (d), 0.4%) and splenomesenteric trunk (Type IV (h), 0.3%).

Conclusion: Coeliac trunk anatomy is extremely varied. The classification by Ethiraj is simple, comprehensive, and useful, and the inclusion of Type II(d) and IV(h) improves the accuracy of classification, which aids in performing accurate preoperative vascular mapping and surgical planning.