Celiac Artery

COELIACA ARTERIA, celiac (visceral) artery, s. truncus coeliacus, s. tripus coeliacus Halleri (Haller's tripod) (Figures 1 and 2), unpaired, median, originates from the anterior circumference of the abdominal aorta at the upper angle of the aortic opening of the diaphragm, immediately below the inferior phrenic arteries and above the superior mesenteric artery. The origin of the celiac artery corresponds to the level of D_XII and L_I. Embryologically, the celiac artery develops as the arterial vessel of the upper gastro-duodenal segment of the digestive tube and the posterior section of the mesogastrium, in which the pancreas and spleen develop. Variations in the site of origin of the celiac artery: its origin may be deviated from the median line of the aorta to the right or left; it may arise by a common trunk from the inferior phrenic arteries. The length of the celiac artery trunk is 10-15 mm, the diameter is about 6 mm; from its very beginning, the celiac artery is directed downwards and slightly to the right. The celiac artery divides into three branches: 1) a. gastrica sin. (also called the superior left coronary artery of the stomach - a. coronaria ventriculi sup. sinistra), 2) a. hepatica, and 3) a. lienalis; however, such division is rare. Much more frequently, the origin of a. gastricae sin. from the anterior surface of the celiac artery is observed, and further down, slightly lower, the division of the celiac artery into a. hepatica and a. lienalis; sometimes a. gastrica sin. arises directly from the aorta, and the celiac artery then gives off only the latter two branches; finally, extremely rarely, the celiac artery is absent, and its branches arise directly from the aorta (Figure 3). In addition to the main three trunks, the celiac artery gives off small collateral branches: 1) to the solar plexus, 2) an accessory hepatic artery, 3) inferior phrenic arterial branches, and 4) the superior pancreatic artery. Topographical relationships of the celiac artery (its syntopy). The celiac artery is located in the retroperitoneal space, in the center of the so-called regionis coeliacae Luschka (Figure 4). Posteriorly, the celiac artery rests on the osteomuscular base of the region, i.e., on D_XII-L_I-II and the crura of the diaphragm; from this layer, the celiac artery is separated by the abdominal aorta. Figure 1. Celiac artery and its branches: 1 - a. diaphragmatica inf.; 2 - a. gastrica sin.; 3 - a. lienalis; 4 - a. mesenterica sup.; 5 and 7 - aa. renales; 6 - aorta; 8 - crura of the diaphragm; 9 - a. hepatica; 10 - a. coeliaca. Above the celiac artery lies the origin of the inferior phrenic arteries. Anteriorly, the celiac artery crosses v. gastrica sin. Below the celiac artery lies

Figure 2. Celiac artery and vessels of the stomach: 1 - a. cystica; 2, 3, 4 - branches of a. hepaticae; 5 - a. hepatica; 6 - a. gastrica sin.; 7 - a. coeliaca; 8, 9, 10, 12 - branches of a. gastricae sin. to the esophagus, cardiac part of the stomach, and lesser curvature; 11 - aa. gastricae breves; 13 - a. gastro-epiploica sin.; 14 - a. lienalis; 15 - a. gastrica dext. with a branch to the pylorus; 16 - a. gastro-duodenalis; 17 - a. gastro-epiploica dext. - the stomach gland, its tuber omentale; the height of the gap between the celiac artery and the upper edge of the pancreas is about 1.5 cm.

BCD Figure 3. Variant of branching of a. coeliacae: 1 - a. gastrica sin.; 2 - a. hepatica; 3 - a. lienalis; 4 - a. mesenterica sup.; A - a. gastrica - branch of a. coeliacae (in 46%); B - classical branching of a. coeliacae (in 42%); C - a. gastrica sin. arises from an accessory a. coeliaca, originating above the division of a. hepatica and a. lienalis (in 10%); D - a. lienalis arises from a. mesenterica sup. (in 2%). (Descomps). In this gap is located the origin of the superior mesenteric artery (a. mesenterica superior). To the right, at a considerable distance from the celiac artery, runs v. cava inf. (inferior vena cava). Between v. cava inf. and... [text interspersed with figure captions and anatomical labels]

the diaphragm into the thoracic cavity, and the right sympathetic trunk. To the left of the celiac artery are located the left ascending lumbar vein and the left sympathetic trunk. In this region is located the main center of innervation of the abdominal cavity viscera - the celiac plexus (plexus coeliacus); on each side

Figure 5. Celiac region; solar plexus; a. coeliaca; plexus Solaris: 1 - ductus choledochus; 2 - v. portae; 3 - v. cava inf.; 4 and 13 - nn. splanchnici (dext. et sin.); 5 and 10 - aa. diaphragmaticae inf.; 6 and 7 - branches (right and left) of n. vagi; 8 - n. vagus; 9 - a. gastrica sin.; 11 - a. coeliaca; 12 - anastomosis between two semilunar ganglia (gangl. semilunare); 14 and 21 - gangl. semilunare (sin. et dext.); 15 - a. lienalis; 16 and 20 - gangl. aorto-renale; 17 and 18 - gangl. mesenteric. sup.; 19 - median branch of the solar plexus; 22 - a. hepatica; 23 - a. gastro-duodenalis; 24 - a. cystica. From the aorta and the celiac artery there is located one semilunar ganglion (ganglion semilunare) on each side (Figure 5), where the vagus and splanchnic nerves connect with them; to this wealth of anatomical formations of this region, it is also necessary to add the presence of a large number of lymphatic glands - para-aortic glands. The region of the celiac artery is covered by the parietal peritoneum, i.e., the posterior leaf of the peritoneum of the omental bursa (bursa omentalis). The celiac artery is always projected to the right of the lesser curvature of the stomach and at various heights along it (Figure 6). To approach the region of the celiac artery surgically, it is necessary, after opening the abdominal wall along the midline in the epigastrium, to go deeper through the lesser omentum, i.e., above the lesser curvature of the stomach, retracting the latter downwards.