Illustrations of clinically relevant celiacomesenteric trunk anatomic variants

I read the case report by Dr. Ritenour and Dr. Mousa1Ritenour A. Mousa A. Successful endovascular treatment of acute mesenteric and hepatic ischemia in patient with celiomesenteric trunk occlusion.J Vasc Surg Cases Innov Tech. 2023 Dec; 9101314PubMed Google Scholar with keen interest because it emphasizes that detailed understanding of celiomeseteric trunk (CMT) variants is paramount to surgical problem-solving in acute splanchnic ischemia. I would like to complement their work by providing a full illustration the endovascular technique employed and as well as to visually illuminate intricate vascular anatomy of this region and its variations. Furthermore, presentation of a clear visual reference may assist in wide spread adoption didactic dissemination of the classification system outlined byTang et al.2Tang W. Shi J. Kuang L.Q. Tang S.Y. Wang Y. Celiomesenteric trunk: New classification based on multidetector computed tomography angiographic findings and probable embryological mechanisms.World J Clin Cases. 2019 Dec 6; 7: 3980-3989Crossref PubMed Scopus (15) Google Scholar, 3Netter F. Netter Atlas of Human Anatomy: Classic Regional Approach. 9th ed. Philadelphia, PA: Elsevier; 2022.Google Scholar, 4https://www.kenhub.com/en [Internet]. Kenhub. [cited 2024 Jan 28]. Available from: https://www.kenhub.com/en.Google Scholar The five CMT types are categorized in Figure 1 as follows: Type I is a common hepato-splenic-gastric mesenteric trunk. Subtype IA can be further described as short or long depending on the length of the CMT before the second-order division of the arterial branches. Subtype IB is a variant of the long CMT but with a proximal, independent take off the gastric artery. Type II is hepatosplenic mesenteric trunk with a separate left gastric artery originating from the aorta. Type III is a gastrosplenic mesenteric trunk with common hepatic artery originating from the aorta. Type IV is hepatogastric-splenic mesenteric trunk with splenic artery emanating from the aorta. Type V variant is a single CMT trunk with a second order gastrosplenic trunk originating from the common hepatic artery. In Figure 2, I illustrate how the authors successfully treat a patient with an occluded Type IV CMT with a balloon expandable stent.Figure 2Endovascular treatment a patient with an occluded Type IV CMT with a balloon expandable stent. Illustration based on case described by Ritenour et al.1Ritenour A. Mousa A. Successful endovascular treatment of acute mesenteric and hepatic ischemia in patient with celiomesenteric trunk occlusion.J Vasc Surg Cases Innov Tech. 2023 Dec; 9101314PubMed Google ScholarView Large Image Figure ViewerDownload Hi-res image Download (PPT) I hope that this visual addition to this timely case report will enhance medical education and provider communication about this important and highly variable anatomy.