I read the case report by Ritenour and Mousa1 with keen interest because it emphasizes that a detailed understanding of celiacomesenteric 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 of the endovascular technique used and to visually illuminate the intricate vascular anatomy of this region and its variations. Furthermore, the presentation of a clear visual reference could assist in the widespread adoption and didactic dissemination of the classification system outlined by Tang et al2 and others.3,4
The five CMT types are categorized in Fig 1 as follows. Type I is a common hepatosplenic-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 takeoff from 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 a common hepatic artery originating from the aorta. Type IV is hepatogastric-splenic mesenteric trunk with the splenic artery emanating from the aorta. Type V is a single CMT trunk with a second order gastrosplenic trunk originating from the common hepatic artery. Fig 2 shows an illustration of how the authors successfully treated a patient with an occluded type IV CMT with a balloon expandable stent.
Fig 1.
Illustrations of common celiacomesenteric trunk (CMT) anatomic variants and related classification.
Fig 2.
Endovascular treatment a patient with an occluded type IV celiacomesenteric trunk (CMT) with a balloon expandable stent. Illustration based on a case described by Ritenour and Mousa.1
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.
References
- 1.Ritenour 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;9 doi: 10.1016/j.jvscit.2023.101314. [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 4.Kenhub. 2024. https://www.kenhub.com/en