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A comprehensive study of right and left inferior phrenic artery variations in 1000 patients with multidetector computed tomography angiography: an important study for HCC

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Abstract

Purpose

To investigate the anatomic variations in the origins of the right and left inferior phrenic arteries (IPAs) using multidetector computed tomography and to classify their combined variations.

Methods

This retrospective study included patients undergoing abdominal aorta angiography between January 2015 and October 2019. The RIPA and LIPA origins were evaluated both separately and combined on three-dimensional images. The variant patterns of the IPAs were determined and classified. The numerical evaluation of the data was performed with SPSS 21.

Results

In total, 1000 patients (478 women, 522 men) were evaluated. The IPAs originated from a common trunk or a common root in 360 (36.00%) patients, while the IPAs originated independently without a common trunk in 609 (60.90%) patients. The most common combined variant detected in the present study was IPAs originating as a common trunk from the coeliac trunk in 197 (19.70%) patients; 14 (1.40%) patients had no inferior phrenic artery (IPA), and 17 (1.70%) patients had only one IPA.

Conclusion

Fifty-two different types of variations in the combined origin of the inferior phrenic arteries were described in this study for the first time in the literature. Awareness of the anatomic variations in the IPAs, which is critical for hepatocellular carcinoma origins, may benefit various clinical procedures, such as transcatheter arterial chemoembolization, organ transplantations, laparoscopic surgical procedures, and radiological procedures.

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Data availability

Availability of data and materials.

Code availability

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Funding

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Author information

Authors and Affiliations

  1. Vocational High School of Health Services, Batman University, Batman, Turkey

    Arzu Ekingen

  2. Department of Radiology, Medical School, Dicle University, Diyarbakir, Turkey

    Mehmet Güli Çetinçakmak

Authors
  1. Arzu Ekingen
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  2. Mehmet Güli Çetinçakmak
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Contributions

AE: project development, data collection, and manuscript writing and editing. MGÇ: protocol/project development and data management.

Corresponding author

Correspondence to Arzu Ekingen.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This study followed the principles of the Declaration of Helsinki, and the procedure was approved by the Medical School Non-Interventional Clinical Research Ethics Committee (approval number: 2019/51).

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Supplementary Information

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276_2021_2805_MOESM1_ESM.tif

Supplementary Figure 1. RIPA and LIPA originate as a common trunk (inferior phrenic trunk) from the abdominal aorta (71 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), inferior phrenic arteries (IPAs) (TIF 490 KB)

276_2021_2805_MOESM2_ESM.tif

Supplementary Figure 2. RIPA and LIPA originate separately from the celiac trunk (60 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 538 KB)

276_2021_2805_MOESM3_ESM.tif

Supplementary Figure 3. RIPA originates from the abdominal aorta, and LIPA originates from the celiac trunk (70 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 443 KB)

276_2021_2805_MOESM4_ESM.tif

Supplementary Figure 4. RIPA originates from the celiac trunk, and LIPA originates from the abdominal aorta (75 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 474 KB)

276_2021_2805_MOESM5_ESM.tif

Supplementary Figure 5. RIPA, LIPA, and CT originate from a common root of the abdominal aorta (18 years, female). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 570 KB)

276_2021_2805_MOESM6_ESM.tif

Supplementary Figure 6. RIPA originates directly from the abdominal aorta, and LIPA and CT originate from a common root of the abdominal aorta (43 years, female). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 468 KB)

276_2021_2805_MOESM7_ESM.tif

Supplementary Figure 7. RIPA originates from the celiac trunk, and LIPA and CT originate from a common root of the abdominal aorta (33 years, female). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 655 KB)

276_2021_2805_MOESM8_ESM.tif

Supplementary Figure 8. RIPA and CT originate from a common root of the abdominal aorta, and LIPA originates from the celiac trunk (23 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 666 KB)

276_2021_2805_MOESM9_ESM.tif

Supplementary Figure 9. RIPA and CT originate from the common root of the abdominal aorta, and LIPA originates from the abdominal aorta (80 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 417 KB)

276_2021_2805_MOESM10_ESM.tif

Supplementary Figure 10. RIPA originates from the LGA arising from the celiac trunk, and LIPA originates from the abdominal aorta (28 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), left gastric artery (LGA) (TIF 420 KB)

276_2021_2805_MOESM11_ESM.tif

Supplementary Figure 11. RIPA originates from the abdominal aorta, and LIPA originates from the LGA arising from the celiac trunk (49 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), left gastric artery (LGA) (TIF 345 KB)

276_2021_2805_MOESM12_ESM.tif

Supplementary Figure 12. (a) RIPA originates from the celiac trunk, and LIPA and LGA originate from a long common trunk arising from the celiac trunk (63 years, male). (TIF 493 KB)

276_2021_2805_MOESM13_ESM.tif

Supplementary Figure 13. (b) RIPA originates from the CT, and LIPA and LGA originate from a short common trunk arising from the CT (75 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), left gastric artery (LGA) (TIF 294 KB)

276_2021_2805_MOESM14_ESM.tif

Supplementary Figure 14. RIPA and LGA originate from a common root from the celiac trunk, and the LIPA originates from the celiac trunk (48 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), left gastric artery (LGA)(TIF 376 KB)

276_2021_2805_MOESM15_ESM.tif

Supplementary Figure 15. The RIPA and LGA originate from a common root from the celiac trunk, and LIPA originates from the abdominal aorta (28 years, female). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), left gastric artery (LGA) (TIF 457 KB)

276_2021_2805_MOESM16_ESM.tif

Supplementary Figure 16. RIPA originates from the LGA arising from the celiac trunk, and LIPA and LIPA(acc.) originate separately from the celiac trunk (23 years, female). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), accessory left inferior phrenic artery (LIPA(acc.)), left gastric artery (LGA) (TIF 417 KB)

276_2021_2805_MOESM17_ESM.tif

Supplementary Figure 17. RIPA originates from the abdominal aorta, and LGA and LIPA originate from a common trunk of the abdominal aorta (30 years, female). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), left gastric artery (LGA) (TIF 518 KB)

276_2021_2805_MOESM18_ESM.tif

Supplementary Figure 18. LGA and RIPA originate from a common trunk of the abdominal aorta, and LIPA originates from the abdominal aorta (66 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), left gastric artery (LGA) (TIF 529 KB)

276_2021_2805_MOESM19_ESM.tif

Supplementary Figure 19. RIPA originates from the LGA arising from the abdominal aorta, and LIPA originates from the hepatosplenic trunk arising from the abdominal aorta (75 years, male). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), left gastric artery (LGA) (TIF 458 KB)

276_2021_2805_MOESM20_ESM.tif

Supplementary Figure 20. RIPA originates from the hepatosplenic trunk arising from the abdominal aorta, and LIPA originates from the LGA arising from the abdominal aorta (33 years, male). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), left gastric artery (LGA) (TIF 532 KB)

276_2021_2805_MOESM21_ESM.tif

Supplementary Figure 21. RIPA originates from the RRA, and LIPA originates from the left gastric artery arising from the CT (40 years, male). Abdominal aorta (AA), celiac trunk (CT), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), right renal artery (RRA), left gastric artery (LGA) (TIF 442 KB)

276_2021_2805_MOESM22_ESM.tif

Supplementary Figure 22. (a) RIPA originates from the right renal artery, and CT and LIPA originate from a common root of the abdominal aorta (82 years, male) (TIF 448 KB)

276_2021_2805_MOESM23_ESM.tif

Supplementary Figure 23. (b) RIPA originates from the right renal artery, and LIPA originates as a branch of the celiac trunk (72 years, male). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 403 KB)

276_2021_2805_MOESM24_ESM.tif

Supplementary Figure 24. RIPA originates from the right renal artery, and LIPA originates from the abdominal aorta (45 years, female). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 309 KB)

Supplementary Figure 25. (a) RIPA and RRA originate from a common root of the abdominal aorta (TIFF 623 KB)

276_2021_2805_MOESM26_ESM.tiff

Supplementary Figure 26. (b) LIPA originates from the splenic artery arising the abdominal aorta (58 years, male). Abdominal aorta (AA), superior mesenteric artery (SMA), right renal artery (RRA), splenic artery (SpA), common hepatic artery (CHA); right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIFF 587 KB)

276_2021_2805_MOESM27_ESM.tif

Supplementary Figure 27. The common trunk of IPAs and RRA originate from a common root of the abdominal aorta (38 years, male). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), right renal artery (RRA), inferior phrenic arteries (IPAs), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 640 KB)

276_2021_2805_MOESM28_ESM.tif

Supplementary Figure 28. The common trunk of IPAs and LRA originate from a common root of the abdominal aorta (40 years, male). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), left renal artery (LRA), inferior phrenic arteries (IPAs), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 523 KB)

276_2021_2805_MOESM29_ESM.tif

Supplementary Figure 29. The common trunk of IPAs and RRA (acc.) originate from a common root of the abdominal aorta (74 years, male). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), right renal artery (RRA); = accessory right renal artery (RRA (acc.)), inferior phrenic arteries (IPAs), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 661 KB)

276_2021_2805_MOESM30_ESM.tif

Supplementary Figure 30. RIPA and the RRA (acc.) originate from a common trunk of the abdominal aorta, and LIPA originates from the abdominal aorta (47 years, female). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), right renal artery (RRA), accessory right renal artery (RRA (acc.)), inferior phrenic arteries (IPAs), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 590 KB)

276_2021_2805_MOESM31_ESM.tif

Supplementary Figure 31. RIPA originates from the abdominal aorta, and LIPA originates from the left renal artery (50 years, female). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 504 KB)

276_2021_2805_MOESM32_ESM.tif

Supplementary Figure 32. RIPA originates from the RRA (acc.), and LIPA originates from the LRA (acc.) (39 years, male). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), accessory right renal artery (RRA (acc.)), accessory left renal artery (LRA (acc.)), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 504 KB)

276_2021_2805_MOESM33_ESM.tif

Supplementary Figure 33. RIPA originates from the right renal artery, and LIPA originates from the GDA arising from the common hepatic artery (45 years, female). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), common hepatic artery (CHA), splenic artery (SpA), gastroduodenal artery (GDA), right renal artery (RRA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 412 KB)

276_2021_2805_MOESM34_ESM.tif

Supplementary Figure 34. RIPA originates from the abdominal aorta, and LIPA originates as a branch of the SpA arising from the abdominal aorta (62 years, female). Abdominal aorta (AA), superior mesenteric artery (SMA), splenic artery (SpA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 477 KB)

276_2021_2805_MOESM35_ESM.tif

Supplementary Figure 35. RIPA and LIPA originate as a common root from the splenic artery arising from the abdominal aorta (60 years, male). Abdominal aorta (AA), superior mesenteric artery (SMA), common hepatic artery (CHA), splenic artery (SpA), inferior phrenic arteries (IPAs), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 448 KB)

276_2021_2805_MOESM36_ESM.tif

Supplementary Figure 36. RIPA and LIPA originate separately from the splenic artery arising from the abdominal aorta (70 years, male). Abdominal aorta (AA), common hepatic artery (CHA), splenic artery (SpA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 456 KB)

276_2021_2805_MOESM37_ESM.tif

Supplementary Figure 37. RIPA originates from the abdominal aorta, and LIPA originates as a branch of the common hepatic artery arising from the abdominal aorta (34 years, female). Abdominal aorta (AA), common hepatic artery (CHA), splenic artery (SpA), left gastric artery (LGA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 508 KB)

276_2021_2805_MOESM38_ESM.tiff

Supplementary Figure 38. IPAs originate as a common trunk from the gastroduodenal-splenic trunk (63 years, male). Abdominal aorta (AA), splenic artery (SpA), left gastric artery (LGA), gastroduodenal artery (GDA), inferior phrenic arteries (IPAs), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIFF 706 KB)

276_2021_2805_MOESM39_ESM.tiff

Supplementary Figure 39. RIPA originates from the abdominal aorta, and LIPA originates from the hepato-gastro-splenic trunk (35 years, female). Abdominal aorta (AA), splenic artery (SpA), left gastric artery (LGA), gastroduodenal artery (GDA), left hepatic artery (LHA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIFF 698 KB)

276_2021_2805_MOESM40_ESM.tif

Supplementary Figure 40. RIPA originates as a branch of the hepatosplenic trunk arising from the abdominal aorta, and LIPA originates from the abdominal aorta (61 years, male). Abdominal aorta (AA), splenic artery (SpA), common hepatic artery (CHA), left gastric artery (LGA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 452 KB)

276_2021_2805_MOESM41_ESM.tif

Supplementary Figure 41. RIPA and DPA originate as a common trunk of the abdominal aorta, and LIPA originates independently from the abdominal aorta (25 years, female). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), dorsal pancreatic artery (DPA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA) (TIF 496 KB)

276_2021_2805_MOESM42_ESM.tif

Supplementary Figure 42. (a) RIPA originates from the coeliac trunk, and LIPA originates from the abdominal aorta + (TIF 547 KB)

276_2021_2805_MOESM43_ESM.tif

Supplementary Figure 43. (b) LIPA(acc.) originates from the gastroduodenal artery (49 years, female). Abdominal aorta (AA), celiac trunk (CT), superior mesenteric artery (SMA), splenic artery (SpA), common hepatic artery (CHA), left gastric artery (LGA), gastroduodenal artery (GDA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), accessory left inferior phrenic artery (LIPA(acc.)) (TIF 574 KB)

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Ekingen, A., Çetinçakmak, M.G. A comprehensive study of right and left inferior phrenic artery variations in 1000 patients with multidetector computed tomography angiography: an important study for HCC. Surg Radiol Anat 43, 1471–1480 (2021). https://doi.org/10.1007/s00276-021-02805-7

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