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Abstract

Common hepatic artery, normally is one of the three branches of coeliac trunk, gives off gastroduedonal artery and proper hepatic artery at the upper face of the first part of the duedonum. Renal arteries are two thick arteries which are located just below the mesenteric superior artery and separated by a right angle to the sides of the aorta. 64 year-old male patient with suspected adenocarcinoma of the fundus of the stomach was taken spiral computed upper abdominal CT. Right hepatic artery as a variational is originated from the superior mesenteric artery proximally and left hepatic artery is originated from coeliac trunk. In our case double left renal arteries were observed. Due to growing interventional radiological procedures, transplantation and vascular surgical procedures, variations of the renal arteries and the hepatic arteries are becoming more and more important. This is why patients who undergoing gastrectomy and lymphadenectomy in gastric carcinoma like our patient, a good knowledge of the anatomy and variations of the arteries leaving the abdominal aorta is required

Keywords

• Variation, right hepatic artery, superior mesenteric artery, accessory left renal artery

Süperior Mezenterik Arter Kaynaklı Sağ Hepatik Arter ve Aksesuar Sol Renal Arter Olgusu

Abstract

Normalde truncus coeliacus’un üç dalından biri olan arteria hepatica communis, duedonum’un birinci kısmının üst yüzünde arteria hepatica propria ve arteria gastroduedonalis dallarını verir. Arteria renalis ise AMS’un hemen aşağısında, aorta’nın yan taraflarından dik açı ile ayrılan iki adet kalın arterdir. Mide fundusu adeno karsinomu şüphesi ile takip edilen 64 yaşındaki erkek hastaya çekilen Spiral Bilgisayarlı Üst Abdominal BT’sinde a. hepatica dextra, varyasyonel olarak a. mesenterica superior’un proksimalinden, arteria hepatica sinistra ise truncus coeliacus’tan orjin almaktaydı. Olgumuzda çift arteria renalis sinistra varyasyonu da izlendi. Hem arteria renalis hem de arteria hepatica’lardaki varyasyonlar, giderek artan girişimsel radyolojik işlemler, transplantasyon ve vasküler cerrahi işlemler nedeniyle daha fazla önem kazanmaktadır. Bu yüzden hastamızdaki gibi mide karsinomu olup gastrektomi ve lenfadenektomi planlanan olgularda aorta abdominalis’ten ayrılan arterlerin anatomisi ve varyasyonlarının iyi bilinmesi gereklidir.

Keywords

• Varyasyon, arteria hepatica dextra, arteria mesenterica superior, arteria renalis accessoria sinistra

References

1. Arıncı K, Elhan A. Anatomi (1. Cilt), 3. Baskı. Ankara:
2. Güneş Kitabevi, 2001;56.
3. Abdullah SS, Mabrut JY, Garbit V, ve ark. Anatomical variations of the hepatic artery: study of 932 cases in liver transplantation. Surg Radiol Anat. 2006;28: 468- 473.
4. Koplay M, Kantarci M. Common hepatic artery arising from the aorta - demonstration with multidetector CT angiography and its clinical importance. Arch Med Sci. 2011;7(1):176-177.
5. Parimala NB. Bilateral aberrant renal arteries with abnormal left renal vein: a case report. J Clin Diagn Res. 2013;7(7):1425-1426.
6. Satyapal KS, Haffajee AA, Singh B, ve ark. Additional renal arteries incidence and morphometry. Surg Radiol Anat. 2001;23: 33-38.
7. Hoeltl W, Hruby W, Aharinejad S. Renal vein anatomy and its implications for retroperitoneal surgery. J Urol. 1990;143:1108-1114.
8. Halpern EJ, Nazarian LN, Wechsler RJ, ve ark. US, CT, and MR evaluation of accessory renal arteries and proximal renal arterial branches. Acad Radiol. 1999;6(5):299-304.

9. Kastamoni Y, Albay S. Arteria hepatica sinistra duplikasyonu ve arteria mesenterica superior’dan çıkan “replaced“ arteria hepatica dextra: Olgu Sunumu. S.D.Ü. Tıp Fak. Derg. 2012;19(4):148-150.
10. Nakanishi R, Endo K, Yoshinaga K, ve ark. Unique variation preoperative three-dimensional computed tomography angiography in surgery for gastric cancer: report of a case. Surg Today. 2010;40(10):967-971.
11. Hlaing KP, Othman F. Complex pattern of a variant hepatic artery. Singapore Med J. 2012;53(9):186-188.
12. Moon JJ, Wijdicks CA, Williams JM. Right hepatic artery branching off the superior mesenteric artery and its potential implications. International Journal of Anatomical Variations. 2009;2:143-145.
13. Huang Y, Liu C, Lin JL. Clinical significance of hepatic artery variations originating from the superior mesenteric artery in abdominal tumor surgery. Chin Med J. (Engl) 2013; 126(5):899-902.
14. Raikos A, Paraskevas GK, Natsis K, ve ark. Multiple variations in the branching pattern of the abdominal aorta. Rom J Morphol Embryol. 2010;51(3):585-587.
15. Shivarama CH, Shivarama B, Shetty RK, ve ark. Multiple Variations of Branches of Abdominal Aorta: A Case Study. NUJHS. 2012;2(2): 48-50.