Selective Angiography of the Inferior Phrenic Arteries

Abstract

The inferior phrenic arteries are a major source of blood for the diaphragm and the adrenal glands and often give important branches to the esophagus, stomach, liver, inferior vena cava, and retroperitoneum. The development of selective catheterization technics of other small vessels, such as the bronchial arteries (2), has prompted this investigation of the feasibility and usefulness of selective angiography of the inferior phrenic arteries. Anatomic Considerations The inferior phrenic arteries develop in the meshwork of ventrolateral vessels supplying the mesonephros of the embryo (3), and, because of the early growth of the adrenal glands, they are initially primarily superior suprarenal arteries. With the relatively greater development of the diaphragm in late fetal and early extrauterine life, however, the phrenic branches become predominant (9). The arteries originate with almost equal frequency from the aorta and celiac axis, with an aortic origin slightly more frequent on the right side (46 per cent), and a celiac origin on the left (52 per cent). The right inferior phrenic artery sometimes originates from the right renal artery (9 per cent). Various other sites of origin, such as the left gastric, hepatic, superior mesenteric, and spermatic arteries account for a total of less than 4 per cent on each side. Although the two vessels more often arise separately, a common trunk is present in 31 per cent of cases. In the absence of a trunk there is no particular tendency to symmetry of origin (5). Accessory inferior phrenic arteries, either to the dome or to the crura, are not infrequent (11). The inferior phrenic arteries leave the aorta or celiac trunk anteriorly or laterally, just within or below the arch formed by the diaphragmatic crura around the aortic hiatus. With a high or lateral origin, they must first curve sharply downward to clear the medial crus on which they will ascend. During their upward course they give off superior adrenal arteries, as well as muscular branches to the crura. Behind the inferior vena cava on the right and the esophagus on the left, they branch into anterior and posterior divisions. The posterior trunk courses outward toward the lateral crura, sometimes giving off additional superior adrenal arteries on the way. The anterior trunk supplies the dome of the diaphragm, also giving branches on the left to the region of the esophagogastric junction, and on the right to the inferior vena cava and liver (10). The inferior phrenic arteries anastomose freely with the other vessels to the diaphragm: the pericardiophrenic and musculophrenic branches of the internal mammary arteries, the small superior phrenic arteries arising from the aorta, and branches of the lower intercostal arteries. The superior adrenal arteries are usually multiple, with an average of 7 on each side (4). Up to 27 have been counted on careful dissections (12).