The inferior phrenic arteries are the first paired branches of the abdominal aorta, arising just below the aortic hiatus at T12. They ascend on the inferior surface of the diaphragm, dividing into anterior and posterior branches that supply the diaphragmatic musculature and the adrenal glands through superior adrenal arteries. Their course varies and they may arise from the celiac trunk or renal arteries rather than directly from the aorta.
The inferior phrenic arteries are important collateral pathways in hepatocellular carcinoma embolisation, where they may reconstitute tumour blood supply after hepatic artery embolisation via phrenic feeders to the right lobe. They are encountered during laparoscopic adrenalectomy and diaphragmatic hiatal repair procedures. Bleeding from the inferior phrenic arteries during laparoscopic crural repair or oesophageal hiatal approach can be difficult to control. Their superior adrenal branches are ligated during adrenalectomy.
Hepatocellular carcinoma in the right hepatic lobe can be supplied by inferior phrenic artery feeders that require separate embolisation when conventional hepatic artery chemoembolisation fails to devascularise the tumour adequately, identified by selective angiography.
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