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Collateral Pathways in Patients with Celiac Axis Stenosis: Angiographic–Spiral CT Correlation¹

¹ From the Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center and Clinical Research Institute, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Korea. Presented as an education exhibit at the 2000 RSNA scientific assembly. Received March 13, 2001; revision requested May 10 and final revision received December 13; accepted January 23, 2002. Address correspondence to J.W.C. (e-mail: chungjw@radcom.snu.ac.kr).

Although celiac axis stenosis is a frequently encountered occlusive vascular disease, clinically significant ischemic bowel disease caused by celiac axis stenosis is rarely reported due to rich collateral circulation from the superior mesenteric artery (SMA). The most important and frequently encountered collateral vessels from the SMA in patients with celiac axis stenosis are the pancreaticoduodenal arcades and the dorsal pancreatic artery. Subtypes of collateral pathways via the dorsal pancreatic artery include a longitudinal pathway between the celiac branches and the SMA or its branches and a transverse pathway to either the splenic or gastroduodenal artery. A communicating channel between the right hepatic artery and the SMA can be a route for collateral circulation. Hepatic artery variants cause the development of unique collateral pathways that have different characteristics depending on the type of variant. These collateral pathways include intrahepatic interlobar collateral vessels, right gastric to left gastric arterial anastomoses, left hepatic to left gastric arterial anastomoses, and peribiliary arterial plexuses. Major collateral pathways in patients with celiac axis stenosis can be identified with spiral CT, and knowledge concerning this collateral circulation may be important for certain medical procedures such as interventional procedures for the management of hepatic tumors, pancreaticobiliary surgery, and liver transplantation.

© RSNA, 2002

Index Terms: Angiography, 95.12 • Arteries, celiac, 951.721 • Arteries, CT, 95.12915 • Arteries, pancreatic, 959.721 • Arteries, stenosis or obstruction, 9*.721 • Arteries, superior mesenteric, 955.721 • Hepatic arteries, 952.13, 952.721

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