Eleni Panagouli

A morphometric study of the celiac trunk and review of the literature.

The anatomy of the celiac trunk and its branches was examined in 77 adult human cadavers of Caucasian (Hellenic) origin. The celiac trunk followed the normal pattern, namely trifurcation to the common hepatic, splenic, and left gastric arteries, in 90.9% of the dissections (70/77). Two different types of trifurcation were observed: (a) a true tripod when the celiac trunk ended in a complete trifurcation (74.0%, 57/77) and (b) a false tripod when the three arteries did not have a common origin (16.9%, 13/77). Such a clear predominance of the true tripod is not reported elsewhere. Anatomic variations were found in 9.1% (7/77). Bifurcation of the celiac trunk into splenic and left gastric artery (splenogastric trunk) was observed in one specimen (1.3%), whereas the common hepatic artery emerged directly from the aorta. Absence of the celiac trunk was also found in two individuals (2.6%). The celiac trunk presented additional branches (lumbar and inferior phrenic arteries) in 5.2% (4/77). The median level of origin of the celiac trunk was at the upper third of L1 (22.7% to 17/75). The total length of the celiac trunk ranged from 1.1 to 5.0 cm, whereas the mean length was 2.8 cm (standard deviation = 0.80 cm, standard error of mean = 0.09 cm) irrespective of the existence of variations. The mean length of the celiac arteries which formed a false tripod was found to be larger than those of the arteries which formed a true tripod but only a weak statistically significant difference was established (P = 0.073). Clin. Anat. 26:741–750, 2013.

Variations in the anatomy of the celiac trunk: A systematic review and clinical implications.

The normal pattern of the celiac trunk (CT) implies its bifurcation to three branches, the common hepatic, the splenic and the left gastric artery. According to the available literature the CT presents several anatomical variations. The purpose of our study is to investigate the different types of these variations, the corresponding incidences and the probable influence of genetic factors, as they are presented in the existing literature. Four databases were searched for eligible articles for the period up to January 2013 and a total of 36 studies were collected. The CT was trifurcated into the three basic branches in the 89.42% (10,906/12,196) of the cases. Bifurcation of the CT occurred in the 7.40% of the pooled samples (903/12,196). Absence of the CT was the rarest variation with a percentage of 0.38% (46/12,196), hepatosplenomesenteric trunk was found in 49 out of the 12,196 cases (0.40%) and the celiacomesenteric trunk presented an incidence of 0.76% (93/12,196). Other variations of the CT were detected in the 1.64% of the pooled cases (199/12,196). The 14.9% of the cases in the cadaveric series (489/3278 specimens), the 10.5% in the imaging series (675/6501 specimens) and the 4.6% (104/2261) in the liver transplantation series presented variations. These differences are statistically significant (p<0.001). The Japanese and Korean populations presented more variations in the CT than Caucasians (p<0.05 and p<0.001). Negro, colored and black populations presented more variations of the CT than Indian ones (p>0.05). Using those data, a novel classification of CT variations is proposed.

Study of the ascending lumbar and iliolumbar veins: surgical anatomy, clinical implications and review of the literature.

The surgical anatomy (geometrical features, metric relations, and drainage pattern) of the ascending lumbar vein (ALV) and iliolumbar vein (ILV) is clinically important. Notwithstanding, the available literature comprises but a small number of studies and a limited number of specimens involved. The present study constitutes a detailed description and classification of the drainage pattern of both these veins. The detailed anatomy of ALV and ILV was examined in both sides in 59 embalmed adult human cadavers of Caucasian origin. Cases with anatomical variations (9 cadavers) of the inferior vena cava (IVC), common iliac vein (CIV), external iliac vein (EIV) and internal iliac vein (IIV) were excluded from subsequent study and analysis. In the remaining 50 cadavers (100 sides) two main drainage types of the lower end of ALV were found. In Type I (54%, 54/100) the ALV presented the same pattern in both sides. In Type II, the ALV differed in pattern from one side to the other (46%, 46/100). Four subtypes were recorded for each Type. An ALV-ILV common trunk occurred in 15% (15/100). The percentage of variations of ALV was 34% and ILV 91%. The number of variations of the two veins differed significantly (p<0.001). No statistically significant difference was found relating to side or gender. Thorough knowledge of the surgical anatomy of ALV and ILV prevents injury, bleeding and further complication of many operations in the retroperitoneal space and pelvis. Awareness of the geometrical features of ALV and ILV helps avoiding or aids early recognition of a misplacement of a vascular catheter into the ALV during femoral vein catheterizations.

A morphometric study concerning the branching points of the main arteries in humans: Relationships and correlations

An adequate quantity of data on the branching points and important arterial segments of the main arteries in humans is missing. Moreover, a suitable data collection and thereby observed correlations might provide some important clues relating to angiogenesis issues. Thus, we chose to examine in sixty-two embalmed human cadavers of Hellenic origin: The level and angles of the branching points did not differ substantially from similar data, mentioned in the literature. Our results revealed that symmetry exists between the limbs and the aortic length and the branching positions of the abdominal aorta. The aortic length is negatively related to the length of both common iliac arteries. The lengths of the celiac and the brachiocephalic artery (correlated weakly with one another) presented fewer correlations, while the segment between the inferior mesenteric and the celiac artery was correlated with other segments from different locations mainly on the right side. This last distance, the aortic length, the distance between the celiac and inferior mesenteric arteries, the length of both common femoral arteries differed significantly according to gender, independently of body length and height. Our data support the view that the final position and length of the arteries might be due to the location of the corresponding viscera during angiogenesis, to the body length and height and to some (hypothetical) elongation angiogenetic factors.

Anomalous Origin and Course of the Suprascapular Artery Combined with Absence of the Suprascapular Vein: Case Study and Clinical Implications

Background: Variations concerning the origin and course of the suprascapular artery are numerous and present important clinical implications. Aim: In the present study the origin and course of the suprascapular artery are investigated in a sample of Greek (Caucasian) origin. Materials and Methods: The anatomy and course of the suprascapular artery were carefully examined in 31 adult human cadavers (16 male and 15 female). Results: Anomalous origin of the suprascapular artery from the third segment of the subclavian artery was observed in the right side of only one female Caucasian specimen (1/62 = 1.6%). The suprascapular artery and the suprascapular nerve passed together under the superior transverse scapular ligament through the suprascapular notch, whereas the suprascapular vein was absent. Conclusion: According to the available literature, this type of variation in the origin of the suprascapular artery is considered rare. This variation is clinically important, since it is related to the creation mechanism of suprascapular neuropathy and has also obvious surgical implications. The variation is embryologically enlightened and has an interesting ontogenic aspect.

Variations of the iliac and pelvic venous systems with special attention to the drainage patterns of the ascending lumbar and iliolumbar veins.

The anatomy of the inferior vena cava (IVC) and common, external and internal iliac veins (CIV, EIV, IIV respectively) was examined in 59 embalmed adult human cadavers of Caucasian origin. In the present study, we focus our attention on the drainage patterns of the ascending lumbar and iliolumbar veins (ALV, ILV) when there are variations in the major pelvic veins by highlighting and describing the variations themselves. The above patterns, when no variations exist, have already been reported. Among the 59 cadavers, nine (9/59, 15.3%) presented anomalies of the major pelvic veins, as follows: anomalous drainage of both EIV and IIV in 8.5% of the specimens (5/59, Type I); variations of the IVC in 3.4% (2/59, Type II); duplication of the IIV (1/59=1.7%, Type III); anastomotic branch between the right IIV and the left CIV (1/59=1.7%, Type IV). ALV drained either into the CIV (8/18 sides, 44.4%) or in EIV (5/18 sides, 27.8%), while absence of ILV was the most frequent pattern (8/18 sides, 44.4%). A common trunk, joining the two veins, was observed in 5/18 sides (27.8%). Those drainage patterns were in accordance with the ones discovered in our previous study. In Type I the two veins always drained into the EIV. Knowledge of the surgical anatomy of all studied veins may prevent injury to these veins during operations in the retroperitoneal space and pelvis or malposition of venous catheters placed from the groin.

An Unusual Termination of Seven Veins in the Jugulo-Subclavian Junction

SUMMARY: During anatomical dissection of a female Caucasian cadaver in our department, we observed an unusual terminationof seven veins at the jugulo-subclavian junction. Normally, the jugulo-subclavian junction is formed by the union of the intern al jugularvein and the subclavian vein, and gives rise to the brachionocephalic vein. In our case, except from these two, five additional veins,namely the cephalic vein, the transverse cervical vein, the external jugular vein, the anterior jugular vein, and the vertebral vein, werealso joined at the level of the jugulo-subclavian junction, in order to form the brachionocephalic vein. Such a variation has n ot yet beenreported in the literature. KEY WORDS: Subclavian vein; Brachiocephalic vein; Cephalic vein; Interior jugular vein; External jugular vein. INTRODUCTION The jugulo-subclavian junction is formed at the baseof the neck bilaterally, posterior to the sternal end of theclavicle, by the union of the internal jugular vein (IJV)and the subclavian vein (SCV) (Calen

A rare double profunda femoris artery in a female cadaver

The profunda femoris artery (PFA) represents the first and largest branch of the femoral artery in the thigh. A series of anatomical variations are reported, mostly concerning its point of origin and its altered trajectories within the lower limb. We present a rare case of a double PFA, where each separate branch followed the expected arterial pattern. Our case aim to alert surgeons and radiologists for the possibility to encounter an unexpected vascular alternation. Knowledge of topographical anatomy of the PFA and its variations is essential for possible complications after interventional procedures to be avoided.

Bilateral Origin of the Testicular Arteries from the Lower Polar Accessory Renal Arteries

Las arterias gonadales (testiculares o ovaricas) se originan normalmente de la parte lateral de la parte abdominal de la aorta, distal a las arterias renales. Se han registrado otros lugares de origen de estas arterias, entre ellos, los mas comunes en las arterias renales y renales accesorias. En el presente caso, las arterias testiculares se originaron bilateralmente desde las arterias renales polares inferiores accesorias. Las venas testiculares siguieron el origen y curso habitual, mientras que una vena renal accesoria solo se observo en el lado derecho. Estas anomalias se combinaron con un ureter izquierdo anormal que salia desde el polo inferior del rinon. Solo un cadaver de sexo masculino, de origen caucasico, entre los 77 cadaveres humanos adultos, presentaba este conjunto de variaciones (frecuencia: 1,3%). Las variaciones de los vasos renales y gonadales son importantes. Su presencia, si el cirujano no los identifica, puede resultar en lesiones vasculares de algun vaso accesorio o aberrante.