Contrast Enhanced Computed Tomographic Evaluation of Coeliac, Hepatic and Superior Mesenteric Arterial Variants

Abstract Purpose: With the advent of new hepato-biliary interventions, preoperative assessment of coeliac, hepatic, and mesenteric arterial anatomy has now become a necessity for surgeons and interventional radiologists. The primary aim is to avoid or minimize the ischemic complications that could occur during surgeries such as liver transplants, abdominal interventions etc. This study was undertaken to evaluate the variants in coeliac, hepatic, and superior mesenteric arteries based on CECT abdomen. Methods: A prospective study was conducted over a period of 2 years (2020- 2021) on 388 patients who underwent CECT abdomen for evaluation of the above-mentioned variants.Results: 14 types of CM trunk and 11 types of hepatic artery variants were identified in this study. Anatomical variations in CM trunk and CHA were seen in 6.4 % and 7.7 % respectively. The average diameter of the coeliac artery was found to be 6.6 mm, common hepatic artery was 5.04 mm and superior mesenteric trunk was 6.6 mm. In cases with variant coeliac -SMA axis, the average diameter of the coeliac trunk was 5.7 mm while the average arterial diameter of the hepatic artery in CHA variants was 4.38 mm.The pathological variations found in the study were: MALS/ Dunbar syndrome, SMA compression syndrome, aortoarteritis and nutcracker syndrome.Significant correlation was noted between presence of CHA and coeliac -SMA axis variations i.e., the patients with CHA variation were 3.38 times more likely to have coeliac-mesenteric arterial variation.The diameters of common hepatic and coeliac artery was noted to be reduced in cases with anatomical variations (p < 0.05). CONCLUSION - There is an association of coeliac -mesenteric artery variations with common hepatic arterial variations. Another correlation was found between the arterial diameters in cases with variant anatomy versus normal cases in the study population. No significant association between pathological variants like median arcuate ligament syndrome, SMA compression syndrome etc. with normal hepatic /CM trunk variations.Attempt was also made to describe the newly found variations in these target vessels, not previously characterized in the standard classification system.