Rare Hepatic Arterial Anatomic Variants in Patients Requiring Pancreatoduodenectomy and Review of the Literature

Smita Ramanadham,Rohit Sharma,John C Mansour,Adam C Yopp,Seth M Toomay,Glen C Balch,Roderich E Schwarz

doi:10.1155/2012/953195

Smita Ramanadham, Rohit Sharma + Show 5 more

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https://doi.org/10.1155/2012/953195

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Abstract

Normal hepatic arterial anatomy occurs in approximately 50–80% of cases; for the remaining cases, multiple variations have been described. Knowledge of these anomalies is especially important in hepatobiliary and pancreatic surgery in order to avoid unnecessary complications. We describe two cases of patients undergoing pancreatoduodenectomy for abnormalities in the head of the pancreas. Preoperative contrast-enhanced cross-sectional imaging demonstrated relevant, rare hepatic arterial variants: (1) a completely replaced hepatic arterial system with a gastroduodenal artery (GDA) arising directly from the celiac axis and (2) a replaced right hepatic artery originating from the superior mesenteric artery and traveling anterior to the pancreatic uncinate process and head. These findings were confirmed during pancreatoduodenectomy. Both of these variants have been rarely described with an incidence of <1.0%. In the present paper, we describe the hepatic arterial anomalies commonly encountered and clarify the important details associated with these variants as they pertain to pancreatoduodenectomy.

Highlights

The first description of aberrant hepatic arterial anatomy was published in 1756
We describe two patients with hepatic arterial anatomic variants: (1) a completely replaced hepatic arterial system with a gastroduodenal artery (GDA) arising directly from the celiac axis and the RHA arising from the SMA and (2) a replaced right hepatic artery originating from the superior mesenteric artery and traveling anterior to the pancreatic head
The most common variations include a replaced right hepatic artery (RHA) arising from the SMA in 10–15% of cases and a left hepatic artery originating from the left gastric artery in 3–10% of patients (Tables 1 and 2) [1, 2]

Summary

Introduction

The first description of aberrant hepatic arterial anatomy was published in 1756. Michels’ autopsy series of 200 dissections provided a classification scheme later updated in 1994 by Hiatt (Tables 1 and 2) [1, 2]. The origin of the common hepatic artery (CHA) lies anterior to the main portal vein and branches into the gastroduodenal artery (GDA) and the proper hepatic artery (PHA). In approximately 10% of patients, the right hepatic artery originates not from the common hepatic artery but from the superior mesenteric artery. When this occurs, the replaced right hepatic artery typically travels cephalad to the uncinate process. We describe two patients with hepatic arterial anatomic variants: (1) a completely replaced hepatic arterial system with a gastroduodenal artery (GDA) arising directly from the celiac axis and the RHA arising from the SMA and (2) a replaced right hepatic artery originating from the superior mesenteric artery and traveling anterior to the pancreatic head. We discuss the importance of an awareness of these arterial variants and implications of operative management

10 CHA from LGA

Findings

Discussion