The Celiac Axis Revisited: Anatomic Variants, Pathologic Features, and Implications for Modern Endovascular Management

Abstract

The celiac axis (CA) and its branches are critically important arteries that supply blood to the vital solid and hollow abdominal viscera of the foregut. There are many potential anatomic configurations, with up to half the population having a variation from the classic pattern of the CA bifurcating into the hepatosplenic trunk and left gastric artery. These configurations result from permutations in the fusion of the paired dorsal aortas during the first trimester. Despite the short length of the CA, it is affected by a wide range of pathologic conditions, including mesenteric ischemia due to intrinsic occlusion (secondary to causes such as atherosclerosis or thromboembolic events) and extrinsic compression from masses or the median arcuate ligament. Symptoms of mesenteric ischemia are nonspecific and include postprandial abdominal pain and weight loss; thus, the underlying pathologic condition may be found only when being sought specifically. More unusual pathologic conditions include dissection, aneurysms, and vascular malformations. Awareness of the pathologic conditions that affect the CA is important for both diagnostic and interventional radiologists. Early recognition and treatment of CA disease may prevent catastrophic hemorrhage and bowel infarction. Both endovascular and surgical approaches to treatment are greatly enhanced by correct identification of arterial anatomic variants; catheter angiography, computed tomographic angiography, and magnetic resonance angiography can facilitate detection of these variants. Knowledge of the different anatomic permutations is essential to guide endovascular procedures, such as hemorrhage control, transarterial interventional oncologic therapy, and treatment of visceral artery aneurysms. Online supplemental material is available for this article.

Arterial anomalies of the celiac trunk and median arcuate ligament compression in dogs and cats assessed by computed tomography angiography

“…The increased interest in transcatheter therapies in veterinary medicine and the development of interventional radiology as a specialty has renewed interest in the anatomical variations of the major abdominal arteries in dogs and cats that are accessed during interventional catheterization . An understanding of such variation improves success during catheterization procedures and may decrease the risk of procedural morbidity, as reported in the human literature . Venous anomalies including portosystemic shunts are frequently reported in dogs (0.18%), with a higher prevalence of extra‐hepatic portosystemic shunt in specific small breeds of dog (3.2% in Havanese and 2.9% in Yorkshire Terrier), while intrahepatic portosystemic shunts are more commonly reported in large breeds of dog .…”

Symptomatic Celiomesenteric Trunk: Variable Presentations and Outcomes in 2 Patients

“…3 As seen in Patient 1, collateralization through the IMA can partially compensate for chronic stenosis or occlusion of a CMT. However, when the normally diminutive IMA is left as the sole conduit from the aorta, both it and the mesenteric arcade can undergo marked hypertrophy.…”

“…In these patients, successful diagnosis and management depends on astute interpretation of radiologic images (usually computed tomographic angiograms [CTAs]). 3,4 Misdiagnosis can lead to prolonged suffering or death.…”

Assessment of Congenital Vascular and Organ Anomalies in Subjects With Thalidomide Embryopathy Using Non-Contrast Magnetic Resonance Angiography

“…11 A common offspring of both the coeliac and superior mesenteric arteries was defined as a coeliac-mesenteric trunk. 12 Normal renal vascular anatomy was defined in the presence of 1 renal artery and 1 renal vein on each side arising from or draining into the abdominal aorta or the inferior vena cava (IVC), respectively. Kidneys were considered normal if they were paired and slightly obliquely positioned.…”