The inferior phrenic arteries: A systematic review and meta-analysis

The inferior phrenic artery is a paired artery that supplies the diaphragm from its inferior aspect. It may arise as a common trunk, the common inferior phrenic artery (CIPA), or as two individual arteries, the right and left inferior phrenic arteries (RIPA and LIPA, respectively). The aim of this study was to perform a systematic review and meta-analysis to create pooled prevalence data on the various origins of the inferior phrenic arteries and to discuss their clinical importance.

Major electronic medical databases were reviewed to identify articles with anatomical prevalence data on the origin of the inferior phrenic arteries. Data on the origin of the left, right and common inferior phrenic arteries were extracted and quantitatively synthesized.

The CIPA was present in 24.2% of cases and most commonly originated from the aorta, with a pooled prevalence 57.2% (95% CI 52.4-62.0%), and the coeliac trunk, with a pooled prevalence of 41.3% (95% CI 36.8-45.9%). Other origins were much less common (1.00% (95% CI 0.28-1.71%)). Independent origin of the RIPA and LIPA were present in 75.8%. The RIPA arose from the aorta (49.6%, 95% CI 43.2%-55.9%), coeliac trunk (35.7%, 95% CI 28.7-42.6%), right renal artery (10.3%, 95% CI 7.27-13.3%) and left gastric artery (2.07%, 95% CI 0.97-3.16%). Other less common origins had a pooled prevalence of 2.07% (95% CI 0.97-3.16%). The LIPA arose from the aorta (46.8%, 95% CI 39.1-54.6%), coeliac trunk (46.1%, 95 CI 38.6-53.5%), left renal artery (1.47%, 95% CI 0.78-2.15%) and left gastric artery (1.07%, 95% CI 0.25-1.89%). Other less common origins had a pooled prevalence of 1.29% (95% CI 0.44-2.14%).

The inferior phrenic arteries express a wide range of variations in origin. Knowledge of their origins are important in interventional radiology, gastroenterology, surgery and traumatology.