Classification of Hepatic Artery Anatomical Variations Using Hiatt, Michels and CRL in a Pancreaticoduodenectomies Retrospective Cohort

Abstract

Introduction Hepatic arterial supply could present several variations. When surgeons are performing a pancreatoduodenectomy is crucial to know preoperatively these anomalies to avoid complications. In 1966 Michels, and later in 1994 Hiatt developed a classification chart for different patterns of arterial blood supply of the liver. Lately, in 2020, Yan et al, published a hepatic artery classification based on CT studies named CRL. Our goal is to assess the feasibility of applying Michels-Hiatt and CRL classifications in our PD series. Methods: Retrospective cohort study from a prospective database about pancreaticoduodenectomies. Period: 2014-2020. We analyzed hepatic arterial blood supply using CT studies and classified our findings using Michels-Hiatt and CRL classifications. Results: 101 patients were studied. Using Michels’ classification, 2 patients could not be classified (2%): The remaining cases were classified as: Type 1 (79,2%), Type 2 (0,99%), Type 3 (5,94%), Type 5 (4,95%), Type 6 (2,97%), Type 8 (0,99%) and Type 9 (2,97%). Using Hiatt classification every subject was classified as follows: Type 1 (79,2%), Type 2 (5,94%), Type 3 (9,9%), Type 4 (1,98%) and Type 5 (2,97%). Using CRL classification we were able to classify every subject: Type 1 (79.2%), Type 2 (6.93%), Type 3 (2.97%), Type 4 (0.99%), Type 5 (4.95%), Type 6 (0.99%), Type 7 (0.99%) and Type 9 (2.97%). Conclusion: All 3 classifications showed a high feasibility range: Hiatt and CRL were a 100% applicable and Michel’s was 98%. However, it is our belief that CRL classification provides better information regarding the anatomical variations.