The clinical anatomy of the posterior gastric artery revisited.

A consensus concerning the incidence, course and distribution of the posterior gastric artery (PGA) has yet to be reached. Recent literature has explored and subsequently demonstrated the importance of the identification of this vessel in surgical procedures such as subtotal gastrectomy, splenectomy and pancreatic transplantation. The gross anatomy of the PGA was examined in 120 adult human cadavers. The PGA was identified as that artery which provided the predominant arterial supply to the posterior wall of the superior portion of the gastric body near the cardiac region and fundus. A PGA was identified in 81.6% of specimens. The most common origin of the PGA was from the left gastric artery (type I), occurring in 41.8% of specimens. In decreasing order of prevalence, were origins from the splenic artery (Type II), occurring in 25.5%; from both the left gastric and splenic arteries as double PGAs (Type III) in 22.4%; and from the celiac trunk (Type IV) occurring in 10.2%. The importance of accurate delineation of the PGA is crucial for pancreatic transplantation and gastric tumor removal. In addition, knowledge of variations in this vessel's origin could prove useful in transcatheter arterial embolization for the treatment of chronic bleeding from gastric ulcers. Furthermore, ligation of this vessel during partial gastrectomy, pancreaticoduodenectomy, and parietal cell vagotomy may result in gastric wall necrosis and gastric stump leak.