 Good morning everyone. My name is Dr. Manisha Lujandani. I am second year post-graduate resident at Maharshi Makharneshwar Institute of Medical Science, Mulana. So the topic of my paper that I will be presenting today is a study of variant of celiac trunk hepatic artery and renal arteries by city angiography in local body region. So in the modern era of imaging and intervention due to the advancement of surgeries and radiological intervention, there is an utmost importance of knowing the variation in hepatic artery, celiac axis and renal artery to avoid the heterogenic injuries to this visit. The variation in the anatomy of celiac axis and hepatic artery carry a significant importance in procedures such as liver transplant, laparoscopic surgery or abdominal radiological intervention. In fact, an identification of renal artery variation holds a considerable importance in renal transplantation or interventional treatment of renal vascular hypertension or in case of nephrectomy. Although the gold standard procedure for evaluating the vascular structure is digital subtraction angiography, but due to its invasive nature it has limited rule. So nowadays, MD city is used in place of DSA for evaluation of vascular structure due to its less invasive nature and excellent image quality. So the aim of my study is to evaluate the examination of anatomical variation of celiac trunk, hepatic arterial system and renal arteries. So the methods we have gone through is I have done the retrospective analysis of 200 patients who have undergone contrast enhanced city abdomen in a Maharshi-Mercurundation Institute of Medical Science for various reasons in the last one year. So the vascular system analysis was done. In the celiac axis, hepatic artery and renal arterial anatomy was analyzed using the axial coronal sag MIP and 3D volume rendered image. Celiac axis variation was analyzed using O'Flacker classification system. Hepatic artery variation were analyzed using Michel classification along with Hayat classification. The renal arteries were assessed with respect to their origin and the number of arteries and laterality. So the results were obtained. The first celiac trunk variation in which we have used the O'Flacker classification. There are total eight types. The most common type is the normal classic celiac trunk which we have seen in 90% of the population. In type 2, we have hepato splenic trunk. In type 3, we have hepato gastric trunk. In type 4, we have hepato splenic mesentric trunk. And in type 5, we have gastro splenic trunk. Type 6, celiac mesentric trunk. And type 7 is celiac colic trunk. And type 8 is no celiac trunk. So here is a diagrammatically representation of a celiac trunk variation. Here we can see that this is a type 1 which is the classic celiac trunk. Then we have type 2 which is hepato splenic trunk. Then we have type 3 which is hepato gastric trunk. Then we have type 4 which is hepato splenal mesentric trunk. Then we have type 5 which is plenogastric trunk. Then we have type 6 which is celiac mesentric trunk. So here is a 3D reconstructed image showing the normal origin of the celiac trunk. This is the normal origin of celiac trunk. Then it's branches. We can see this is a gastric artery. Then we have the hepatic artery. And here is the splenic artery. So a 3D reconstructed view image showing hepatic artery, splenic artery. Then this is a celiac trunk. And here is a mesentric artery. And we can see that there is a separate origin of the gastric artery. So hepato splenal mesentric trunk. We can see that. So this is type 4 of flakker classification. Then this is a 3D reconstructed view showing the common origin of the celiac trunk and hepatic artery. So this is the celiac mesentric trunk. Then we come to the hepatic artery variation. In hepatic artery variation we use two classification, meshyl and hyal classification. So the normal anatomy is the type 1 of both classification. Then if the left artery is replaced and it is originating from the left gastric artery. Then the replaced right hepatic artery originating from the superior mesentric artery that is type 3 meshyl classification which we see in the 9% of the population. Then we can see the coexistence of the type 2 and 3 that is type 4 meshyl classification. Then we can also see the necessary left hepatic artery originating from the left gastric artery which is the type 5 meshyl classification which we see in 5.5% of the population. Then we have the necessary right hepatic artery originating from the superior mesentric artery which is type 6 meshyl classification which we see in 1.5% of the population. So here is a 3D reconstructed view shows the necessary left hepatic artery originating from the left gastric artery. So this is the meshyl type 5 classification. Then this is a 3D reconstructed view showing the necessary right hepatic artery originating from the superior mesentric artery. So this is the meshyl type 6 classification. Then this is a 3D reconstructed view shows the replaced right hepatic artery and it is originating from the superior mesentric arteries and this is the common hepatic artery continues as a left gastric artery. Now this is the again 3D reconstructed view shows the replaced right hepatic artery arising from originating from the superior mesentric artery and we can see that there are the two renal arteries on the left side on blue. Then we come to the renal artery variations. One renal artery on each side we have seen in 158 patient and two renal arteries on left we have seen on 21 patient and two renal arteries on right side we have seen 15 number of patient and two renal arteries on each side we have seen in 6 number of patient. So here is a 3D reconstructed view shows the two renal artery on left side. Then we have another 3D view showing the two renal artery on right side one is seen from the posterior aspect. So the gastrointestinal system received its blood supply from the three vessel arising at three different level in abdominal aorta. There may be variation in these vessels due to the difference during embryonic development. Celiac trunk with normal trifocations have a frequency of 72 to 90 percent in the normal population as per previous study. So the study of renal artery variation is also important as create the problems for the surgeons. So what we concluded that the variation in celiac access, hepatic artery and renal artery are common in day-to-day practice. So we should be aware of these things and to avoid the complications and injuries during the surgical procedure and radiological intervention. With the use of MDCT these variation can be easily seen and understood therefore must be assessed in each case pre-operatively. Thank you.