Collateral Pathways in Patients with Celiac Axis Stenosis: Angiographic–Spiral CT Correlation

Abstract

Although celiac axis stenosis is a frequently encountered occlusive vascular disease, clinically significant ischemic bowel disease caused by celiac axis stenosis is rarely reported due to rich collateral circulation from the superior mesenteric artery (SMA). The most important and frequently encountered collateral vessels from the SMA in patients with celiac axis stenosis are the pancreaticoduodenal arcades and the dorsal pancreatic artery. Subtypes of collateral pathways via the dorsal pancreatic artery include a longitudinal pathway between the celiac branches and the SMA or its branches and a transverse pathway to either the splenic or gastroduodenal artery. A communicating channel between the right hepatic artery and the SMA can be a route for collateral circulation. Hepatic artery variants cause the development of unique collateral pathways that have different characteristics depending on the type of variant. These collateral pathways include intrahepatic interlobar collateral vessels, right gastric to left gastric arterial anastomoses, left hepatic to left gastric arterial anastomoses, and peribiliary arterial plexuses. Major collateral pathways in patients with celiac axis stenosis can be identified with spiral CT, and knowledge concerning this collateral circulation may be important for certain medical procedures such as interventional procedures for the management of hepatic tumors, pancreaticobiliary surgery, and liver transplantation.

Phase-contrast MRI evaluation of haemodynamic changes induces by a coeliac axis stenosis in the gastroduodenal artery

“…Flow in the GDA can thus be a direct marker of the real haemodynamic impact of CA stenosis on the hepatic vascularization and could participate in the pre-surgical workup of duodenopancreatectomy (in which a ligation of the GDA is often mandatory) or liver transplantation [7][8][9] in order to avoid unnecessary revascularization of a non-haemodynamically significant CA stenosis. Currently, this pre-operative assessment is mainly based on morphological assessment of the degree of CA stenosis and diameter of the GDA, preferentially performed by CT. 11,[23][24][25][26] This led Sugae et al, 10 based on a retrospective study comparing the pre-operative morphological grading of CA stenosis with required revascularization procedures during pancreatic surgery, to recommend: ,50% stenosis, no additional procedure; between 50% and 80%, release of the MAL if present; and .80% stenosis, reconstruction of the coeliac arterial axis. This recommendation could be modified according to our results.…”

“…Currently, this is performed mainly by anatomical measurement (X-ray angiography, CT or MRI 10 ) of the degree of CA stenosis and the diameter of the GDA, the main collateral pathway that can compensate for the decrease of flow due to the CA with retrograde flow from the superior mesenteric artery. 11 Nevertheless, these measurements only indirectly reflect the complex haemodynamics in the coeliac area: Doppler hepatic artery flow monitoring 12,13 or clamping trial of the GDA [14][15][16] are often necessary during the surgical procedure. 17 Thus, a simple and robust non-invasive tool would be of great interest to directly assess the effect of CA stenosis on the haemodynamics before surgery.…”

CT angiography of the celiac trunk: anatomy, variants and pathologic findings

“…9) (14, 15). Pancreatitis and pancreatic tumors have also been reported as etiologic factors of celiac trunk stenosis or occlusion (9,14). Furthermore, ethnicity plays a role in the incidence of these different etiologies; for example, in Western populations, arteriosclerosis is reportedly the most common cause of celiac stenosis (9).…”

Origin of the Celiac and Superior Mesenteric Arteries in a Common Trunk - Description of a Rare Vessel Variation of the Celiacomesenteric Trunk with a Literature Review

“…However, variations in the blood supply of the supramesocolonic organs have been frequently reported [6][7][8][9][10][11][12][13][14][15] . With the development of imaging technology, such as computed tomography (CT), magnetic resonance imaging (MRI), and angiography methods, information regarding vessel variation has become very important.…”