(1) Background. The vertebral level of origin (VLO) of the celiac trunk (CT) and superior mesenteric artery (SMA) has been scarcely investigated. (2) Method. This study used 107 computed tomography angiograms and an eleven type grading system to classify the VLO of the CT and SMA. Each of the T12–L2 vertebra were divided in three horizontal levels. The intervertebral discs were considered distinct levels. (3) Results. The VLO of the CT ranged from the upper third of the T12 vertebra to the lower third of the L1 vertebra. The VLO of the SMA ranged from the lower third of the T12 vertebra to the upper third of the L2 vertebra. There was a highly significant association between the VLO of the CT and SMA (Chi2 = 201, p < 0.001), usually respecting a “plus two” rule. The mean CT–SMA distance was 1.82 +/− 0.66 cm in males and 1.55 +/− 0.411 cm in females, the difference being statistically significant. The mean CT–SMA distance tended to decrease with increasing CT–SMA types, the differences being statistically significant. (4) Conclusions. These characteristics of CT and SMA origins and their relations should be known by surgeons, as they could impact operative management and should be evaluated on a case-by-case basis.

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We report here anatomic variants which were found during a retrospective study of a male patient, 54 years old, evaluated in computed tomography: heptafurcation of the celiac trunk (CT) and bilateral double renal arteries. The seven branches of the heptafurcated CT were the (1) left and (2) right inferior phrenic arteries, the (3) splenic and (4) left gastric artery, the (5) common hepatic artery, further sending off the (a) proper, continued as left, hepatic artery and (b) the gastroduodenal artery, (6) a replaced right hepatic artery and (7) the dorsal pancreatic artery. To our knowledge, heptafurcation of the CT was not reported previously. The arterial variants have great importance during various surgical and interventional procedures and should be documented prior to respective procedures.

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The rare anatomic variants of the celiac trunk and superior mesenteric artery include the hepatosplenic, hepatosplenomesenteric (HSMT), celiacomesenteric, hepatomesenteric and gastrosplenic trunks. We report a 72-year-old female patient whose computed tomography angiograms indicated a rare anatomic feature whereby the right inferior phrenic artery was inserted in the origin of an HSMT, thus modifying it into a hepatosplenomesentericophrenic trunk (HSMPT). Above the HSMPT, the insertion of the left inferior phrenic artery in the origin of the left gastric artery determined a left gastrophrenic trunk (GPT). Proper identification of this type of rare anatomic variant is of utmost importance prior to different surgical procedures. For example, an HSMT origin of the right inferior phrenic artery is surgically relevant if this artery is an extrinsic pedicle of a hepatocellular carcinoma and is used for embolization of the tumor.