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 Table of Contents  
CASE REPORTS
Year : 2019  |  Volume : 6  |  Issue : 4  |  Page : 259-261

Bilateral variant origin of the inferior phrenic artery


Department of Anatomy, Christian Medical College and Hospital, Ludhiana, Punjab, India

Date of Submission22-Apr-2019
Date of Decision27-Aug-2019
Date of Acceptance01-Sep-2019
Date of Web Publication21-Nov-2019

Correspondence Address:
Angel
Department of Anatomy, Christian Medical College and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_46_19

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  Abstract 


The inferior phrenic arteries (IPA) arise from aorta, just above the level of celiac artery. Although descriptions of the right and left phrenic arteries are typically brief, the inferior phrenic arteries have received attention in recent years because of its involvement in treating unresectable hepatocellular carcinoma (HCC) by using transcatheter embolization. Since IPA contributes to the arterial supply of adrenal glands, they are important in angiographic examination of adrenal lesions. During routine dissection for MBBS students, bilateral variant origin of inferior phrenic arteries was observed. In this case, coeliac artery was tortuous and it measured 2 cm in length and 0.6 cm in diameter. The right IPA originated from the coeliac artery as a common trunk. This common trunk divided into two. One branch formed the right IPA and the other branch formed the superior suprarenal artery. On the left side, a common trunk originated from coeliac artery which divided into two branches. One branch joined the splenic artery and the other branch again formed a common trunk which further divided into two i.e superior suprarenal artery and left IPA. In patients with left suprarenal mass or oesophgo- gastric junction hemorrhage, certain interventional procedures such as selective IPA angiography is necessary. Due to variable anatomy of its origin, cannulation of IPA can be challenging. Therefore, the knowledge of this type of variations should be kept in mind by the surgeons and care should be taken to avoid unintentional sectioning of small caliber arteries.

Keywords: Cannulation of inferior phrenic artery, hepatocellular carcinoma, variant inferior phrenic artery


How to cite this article:
Angel, Jain A. Bilateral variant origin of the inferior phrenic artery. CHRISMED J Health Res 2019;6:259-61

How to cite this URL:
Angel, Jain A. Bilateral variant origin of the inferior phrenic artery. CHRISMED J Health Res [serial online] 2019 [cited 2019 Dec 14];6:259-61. Available from: http://www.cjhr.org/text.asp?2019/6/4/259/271332




  Introduction Top


The inferior phrenic arteries (IPAs) arise from the aorta, just above the level of the celiac artery. Occasionally, they may arise from a common aortic origin with the coeliac trunk, from the coeliac trunk itself, or from the renal artery. They supply the diaphragm.[1] Each artery ascends anterolaterally to the diaphragmatic crus, near the medial border of the suprarenal gland (SR). The left IPA (LIPA) passes posterior to the esophagus and then runs anteriorly on the left side of the diaphragmatic opening. The right IPA (RIPA) passes posterior to the inferior vena cava, and then along the right side of the diaphragmatic opening. Each IPA divides into medial and lateral branches near the posterior border of the central tendon.[2] The capsule of the liver and spleen may also receive arterial supply from the IPAs.[1] Although the descriptions of the right and left phrenic arteries are typically brief, the IPAs have received attention in recent years because of their involvement in treating unresectable hepatocellular carcinoma by using transcatheter embolization.[3] Furthermore, LIPA gives branches to the esophagus and stomach and can be a source of arterial bleeding at the esophagogastric junction.[4] As IPAs contribute to the arterial supply of adrenal glands, they are important in angiographic examination of adrenal lesions.[5]


  Case Report Top


During routine dissection for MBBS students, bilateral variant origin of inferior phrenic arteries was observed. In this case, coeliac artery (CA) was tortuous and it measured 2 cm in length and 0.6 cm in diameter. On the left side, a CT originated from CA which divided into two branches. One branch joined the splenic artery and the other branch again formed a CT which further divided into two i.e superior suprarenal artery and LIPA [Figure 1]. The RIPA originated from CA as a common trunk (CT). This CT divided into two branches. One branch formed the RIPA and the other branch formed the superior suprarenal artery [Figure 2]. The knowledge of aberrant origin of IPA is important for clinical, radiological and surgical diagnosis.
Figure 1: Variant origin of the LIPA. CA: Coeliac artery, CT: Common trunk, LIPA: Left inferior phrenic artery, Br 1: Branch 1 (to splenic artery), Br 2: Branch 2 (common trunk dividing into superior SR artery and LIPA. SR: Suprarenal gland, K: Kidney, SP: Spleen, D: Diaphragm

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Figure 2: Variant origin of the RIPA. CA: Coeliac artery, RIPA: Right inferior phrenic artery, SR: Suprarenal gland, K: Kidney, S: Stomach, D: Diaphragm

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  Discussion Top


The inferior phrenic artery supplies diaphragm, adrenal glands, esophagus, stomach, liver and inferior vena cava. The variations in the source of origin of inferior phrenic nerve has been reported in literature as shown in [Table 1].
Table 1: Variation in the origin of inferior phrenic artery

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The present case differed from other studies as it showed a rare variation on the left side. On the left side, a common trunk arose from coeliac artery which divided into two branches. One of these gave a branch to splenic artery and the other branch was a common trunk which further divided into a left IPA and left suprarenal artery.

The above mentioned variation could be explained by the embryological basis. The primitive aorta posses ventral, lateral and posterior segments. The ventral segments, which later becomes celiac axis, have longitudinal anastomosis between each other.

Regression of the ventral segment roots or non-regression and continuous growth of longitudinal anastomosis result in anatomical variation of celiac axis.[11],[12]

In patients with left suprarenal mass or oesophgo- gastric junction hemorrhage, certain interventional procedures such as selective IPA angiography is necessary. Due to variable anatomy of its origin, cannulation of IPA can be challenging.[10]

Therefore, the knowledge of this type of variations should be kept in mind by the surgeons and care should be taken to avoid unintentional sectioning of small caliber arteries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Standring S, Healy JC, Johnson D, Collins P, Borley NR, Crossman AR, et al., editors. Posterior abdominal wall and retroperitoneum. In: Gray's Anatomy. 40th ed. China: Churchill Livingstone; 2008. p. 1069-81.  Back to cited text no. 1
    
2.
Standring S, Anand N, Birch R, Collins P, Crossman AR, Gleeson M, et al., editors. Posterior abdominal wall and retroperitoneum. In: Gray's Anatomy. 41st ed. New York: Elsevier; 2016. p. 1083-97.  Back to cited text no. 2
    
3.
Loukas M, Hullett J, Wagner T. Clinical anatomy of the inferior phrenic artery. Clin Anat 2005;18:357-65.  Back to cited text no. 3
    
4.
Gürses İA, Gayretli Ö, Kale A, Öztürk A, Usta A, Şahinoǧlu K, et al. Inferior phrenic arteries and their branches, their anatomy and possible clinical importance: An experimental cadaver study. Balkan Med J 2015;32:189-95.  Back to cited text no. 4
    
5.
Kahn PC, Nickrosz LV. Selective angiography of the adrenal glands. Am J Roentgenol Radium Ther Nucl Med 1967;101:739-49.  Back to cited text no. 5
    
6.
Piao DX, Ohtsuka A, Murakami T. Typology of abdominal arteries, with special reference to inferior phrenic arteries and their esophageal branches. Acta Med Okayama 1998;52:189-96.  Back to cited text no. 6
    
7.
Saeed M, Murshid KR, Rufai AA, Elsayed SE, Sadiq MS. Coexistence of multiple anomalies in the celiac-mesenteric arterial system. Clin Anat 2003;16:30-6.  Back to cited text no. 7
    
8.
Pulakunta T, Potu BK, Gorantla VR, Rao MS, Madhyastha S, Vollala VR. The origin of inferior phrenic artery: A study in 32 South Indian cadavers with a review of literature. J Vasc Bras 2007;6:3.  Back to cited text no. 8
    
9.
Chakravarthi KK. Unilateral multiple variations of renal, phrenic, suprarenal, inferior mesenteric and gonadal arteries. J Nat Sci Biol Med 2014;5:173-5.  Back to cited text no. 9
    
10.
Kundu B, Ghosh I, Sarkar S Sengupta G. Anomalous origin of right inferior phrenic artery. Int J Anat Res 2014;2:394-6.  Back to cited text no. 10
    
11.
Song SY, Chung JW, Yin YH, Jae HJ, Kim HC, Jeon UB, et al. Celiac axis and common hepatic artery variations in 5002 patients: Systematic analysis with spiral CT and DSA. Radiology 2010;255:278-88.  Back to cited text no. 11
    
12.
Iezzi R, Cotroneo AR, Giancristofaro D, Santoro M, Storto ML. Multidetector-row CT angiographic imaging of the celiac trunk: Anatomy and normal variants. Surg Radiol Anat 2008;30:303-10.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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