Are liver vascular anomalies a rare find? presentation of our series and review of the literature

Abstract

Introduction: Liver and pancreatic surgery is a key part in the treatment of multiple pathological processes in these organs, both benign and malignant. Knowledge of the vascular anatomy involved is crucial, not only in surgery, but also in other types of invasive abdominal procedures (radiological, endovascular). Methods: The objective of our work was to know the incidence of hepatic vascular anomalies and to carry out a bibliographic review. The vascular anatomy of the celiac trunk and its branches and variants of the hepatic arterial supply of all patients diagnosed with pancreatic or liver cancer from January 2016 to January 2020, with a total of 333 patients, were evaluated. Results: Of the total, and following the Michels Classification, 183 (54.9%) had a right hepatic artery originating in the superior mesenteric artery (Type III), and 22 (6.6%) a left hepatic artery originating in the left gastric (Type II). In one case, the left hepatic artery originated directly from the celiac trunk, and from this the gastroduodenal artery, with the right hepatic artery directly from the aorta (Type IV). In the rest of the cases (38.5%) the hepatic arterial anatomy complied with a normal pattern (Type I). Conclusion: The literature describes a percentage of variations in liver vascularization of around 25-45%, however, in our series a higher percentage of cases was observed. Their knowledge and preoperative evaluation by imaging study is essential to plan the surgical act and avoid iatrogenic injuries, thus reducing the associated postoperative morbidity and mortality.