Title: Abstract No. 159: Importance of the angiographic identification of the right gastric artery anatomic origin in the era of Yttrium-90 liver radioembolization
Abstract: Use of Yttrium-90 embolization for metastatic liver lesions has become part of current Interventional Radiology practice. A detailed understanding of the anatomic origin of the right gastric artery has become essential to perform safe embolization of this small vessel and prevent gastric complications. Our purpose is to evaluate the different types of right gastric artery (RGA) origin; it's relationship with different celiac trunk anatomic variations and the implications to clinical practice. We randomly selected and retrospective analyzed celiac and superior mesenteric artery arteriograms performed in 465 different patients between July 7, 200 and March 27, 2010, at our institution. Imaging evaluation was performed in standard radiology workstations by two interventional radiologists and data was created by consensus. The emphasis of this study was on the different origins of the RGA, how it correlates to other major celiac trunk anatomic variations and possible implications to clinical practice. The RGA was found in 410 patients. The remaining 55 patients were excluded from the sample. The most common sites of origin of the RGA were the proper hepatic artery (PHA) n=220 (53.65%), followed by the left hepatic artery (LHA) n=81 (19.75%), common hepatic artery (CHA) n=37 (9.02%), bifurcating with the gastro duodenal artery (GDA) n=30 (7.31%), arising from the GDA n=21 (5.12%), right hepatic artery (RHA) n=14 (3.41%), bifurcating with the LHA n=7 (1.70%). Replaced right or common hepatic arteries were found in 40 patients (9.75%). The incidence of other anatomic variants in the celiac trunk was much higher (35% vs. 10.73%) in patients with RGA originating from the RHA then from other sites. Patients with replaced hepatic arteries had a higher rate of RGA origin from the CHA (20% vs. 9.02%). The most common origin of the RGA is from the PHA, followed by the LHA. In patients with replaced hepatic arteries or other anatomic variations in the celiac trunk, other locations may raise in frequency.