Anatomic Variations Of Hepatic Artery Research Articles

CT angiographic study of hepatic arteries variants in Iranian subjects

This retrospective study aimed to assess the anatomical variations of hepatic arteries (HAs) in Iranian subjects referred to the Baqiyatallah Hospital (Tehran, Iran) as a reference medical center. The presence of anatomical variations such as hepatic arteries (HA) is approved among different societies. Classification of common patterns and probable variants of HA seems necessary in preoperative precautions of hepatosurgeries. Multidetector computed tomography angiography scans were prepared from the patients referred to the Baqiyatallah Hospital from January 2019 to January 2020. Inclusion and exclusion criteria were assessed, and all patterns of hepatic arterial supply were evaluated in 240 cases based on Michels’ classification of HA. Following the assessment of 240 patients, HA variants with aberrant origin (types of II-VIII) were detected in 55 cases (22.92%). Besides, no patients were reported as types of XI and X variants (n=0). Also, no relationship was found between the HA and gender. Detection of common patterns along with abnormal variations of HA variants is necessary for hepatosurgical procedures. We found that 22.92% of Iranian patients referred to the Baqiyatallah hospital represented HA variation which must be considered in hepatic surgeries.

Anatomical variations of hepatic artery using the multidetector computed tomography angiography.

The frequency of normal and aberrant hepatic arteries differs among ethnicities. The aim of our work was to study the frequency of normal and aberrant hepatic arteries among Egyptians using multidetector computed tomography (MDCT) and to compare our prevalence with the prevalence of other nationalities. In addition, the gender differences of such variations were clarified. Moreover, the arterial feeding of hepatic segment IV was determined. The present study was carried out on 500 patients (409 males and 91 females). Abdominal CT was performed using two MDCT systems, a 64-row, and a 256-slice system. According to Michel's classification, the normal anatomy (type I) was observed in 369 (73.8%) cases, while anomalous hepatic arterial pattern was detected in 131 (26.2%) cases. These anomalies were distributed as follows: type II in 36 (7.2%) cases, type III in 60 (12%) cases, types IV and V in 5 cases for each (1% each), type VI in 14 (2.8%) and types VIII and IX in a single case for each (0.2% each). Neither type VII nor type X was detected. Nine (1.8%) unclassified cases were observed. According to Hiaat's classification, the anomalies were distributed as follows: type II in 41 (8.2%) cases, type III in 74 (14.8%) cases, type IV in 6 (1.2%) cases, type V in a single case (0.2%) and type VI in 2 (0.4%) cases. Finally, 7 (1.4%) unclassified cases were observed. Common hepatic artery (CHA) originated from coeliac trunk in 98% (79.8% males and 18.2% females). It originated from the abdominal aorta in 0.4% and from the superior mesenteric artery (SMA) in 0.4%. It was absent in 1.2%. Right hepatic artery (RHA) originated from the CHA in 86.6% (69.8% males and 16.8% females) and from the SMA in 13.2% (11.8% males and 1.4% females) and from the abdominal aorta in 0.2% (a single male case). Left hepatic artery (LHA) originated from the CHA in 91.2% and from the left gastric artery (LGA) in 8.8%. The most common origin of the segment IV blood supply was the LHA in 60.8%, followed by the RHA in 35%. Less commonly, blood supply derived from the hepatic artery proper (HAP) in 1%. Combined supply derived from RHA and LHA in 0.8%, from the LHA and HAP in 2% and the least encountered was from the RHA and HAP in 0.4%. Hepatic artery variations among Egyptians have a different distribution when compared to such variations among other species. The normal hepatic arterial pattern was observed in 73.8%, while the anomalous was detected in 26.2%. The CHA originated from the coeliac trunk in 98%, the RHA originated from the CHA in 86.6% and the LHA originated from the CHA in 91.2%. The most common arterial supply of the hepatic segment IV is derived from the LHA (60.2%).

Cadaveric Study of Anatomical Variations of Hepatic artery in Sudanese 2014

Cadaveric Study of Anatomical Variations of Hepatic artery in Sudanese 2014

Successful radical resection of pancreatic head carcinoma in a patient with replaced right hepatic artery originating from posterior inferior pancreaticoduodenal artery: a case report

Anatomical variations of hepatic arteries may be problematic in pancreaticoduodenectomy (PD). We experienced pancreatic head cancer in a patient with rare variation of hepatic artery and performed PD successfully with the resection of this artery. A 75-year-old woman showed pancreatic head tumor on CT. Preoperative CT detected rare variation of hepatic artery; posterior segmental branch of right hepatic artery (RHA-PB) originating from posterior inferior pancreaticoduodenal artery. The image also demonstrated that there was a junction between RHA-PB and anterior branch of right hepatic artery (RHA-AB). We performed PD for suspected pancreatic head cancer. We divided RHA-PB for complete resection of cancer because we preoperatively knew that there was the junction between RHA-PB and RHA-AB. She was discharged uneventfully, and there was no evidence of local recurrence throughout the whole course. Careful preoperative assessment of hepatic blood supply is the key to perform successful PD even in this troublesome situation.

ANATOMIC VARIATIONS OF HEPATIC ARTERY: A STUDY IN 479 LIVER TRANSPLANTATIONS.

ABSTRACTBackground:The incidence of anatomic variations of hepatic artery ranges from 20-50% in different series. Variations are especially important in the context of liver orthotopic transplantation, since, besides being an ideal opportunity for surgical anatomical study, their precise identification is crucial to the success of the procedure. Aim:To identify the anatomical variations in the hepatic arterial system in hepatic transplantation. Methods: 479 medical records of transplanted adult patients in the 13-year period were retrospectively analyzed, and collected data on hepatic arterial anatomy of the deceased donor. Results:It was identified normal hepatic arterial anatomy in 416 donors (86.84%). The other 63 patients (13.15%) showed some variation. According to the Michels classification, the most frequently observed abnormalities were: right hepatic artery branch of superior mesenteric artery (Type III, n=27, 5.63%); left hepatic artery branch of the left gastric artery (Type II, n=13, 2.71%); right hepatic artery arising from the superior mesenteric artery associated with the left hepatic artery arising from the left gastric artery (Type IV, n=4, 0.83%). Similarly, in relation to Hiatt classification, the most prevalent changes were: right hepatic accessory artery or substitute of the superior mesenteric artery (Type III, n=28, 6.05%)), followed by liver ancillary left artery or replacement of gastric artery left (Type II, n=16, 3.34. Fourteen donors (2.92%) showed no anatomical abnormalities defined in classifications, the highest frequency being hepatomesenteric trunk identified in five (01.04%). Conclusion:Detailed knowledge of the variations of hepatic arterial anatomy is of utmost importance to surgeons who perform approaches in this area, particularly in liver transplantation, since their identification and proper management are critical to the success of the procedure.

Impact of Very Advanced Donor Age on Hepatic Artery Thrombosis After Liver Transplantation

The impact of advanced donor age on hepatic artery thrombosis (HAT) after liver transplantation (LT) is controversial. We analyzed the incidence of and risk factors for HAT in LT with donors aged 70 years or older. Eighty patients were transplanted between 1998 and 2002 (group A) and 132 between 2003 and 2008 (group B). In the more recent approach to hepatic artery (HA) reconstruction, the donor HA was systematically preferred to the Carrel patch/celiac trunk, the reconstruction of donor accessory right HA on the donor gastroduodenal artery significantly increased, and the use of interposition grafts was minimized. Group B showed higher Model for End-stage Liver Disease score, lower ischemia time, and lower use of the folding technique/mesenteric conduits. There were 10 cases of HAT (4.7%): 8 (10%) in group A and 2 (1.5%) in group B (P=0.007). Early HAT occurred in 7 (8.8%) patients in group A and in 2 (1.5%) in group B (P=0.02). Group A (P=0.01), anatomical variations of HA (P=0.005), and the use of interposition grafts (P=0.004) were all factors independently affecting HAT. A low incidence of late HAT was observed in single-center LTs with very old donors. Early HAT decreased over time to largely acceptable rates because of more appropriate technical management.

Relationship between variation of donor hepatic artery injury and different procurement methods

Objective To investigate the incidence of anatomic variations of hepatic artery and methods of procurement and reconstruction to prevent the accidental injury of the hepatic artery.Methods The clinical data of 843 patients receiving orthotopic liver transplantation (OLT) in our hos-pital from June 2001 to July 2006 were retrospectively analyzed. Liver and kidney separate procure-ment was performed for 148 cases and abdominal organ combined procurement in 695. The variations of the hepatic artery as well as the relationship between the anomalous hepatic artery and accidental in-jury of the hepatic artery were analyzed. Results Anatomic variations of hepatic artery which were most frequently observed, were the right hepatic artery originating from the superior mesenteric artery and left hepatic artery originating from left gastric artery. The rate of the anomalous hepatic artery concomitancy increased along with elevation in the rate of accidental injury. Conclusion Abdominal or-gan combined procurement can reduce the incidence of accident injury of hepatic artery. Familiarity of the he-patic arterial variation and careful anastomosis are important to reduce injury of the hepatic artery. Key words: Liver transplantation; Arterial variation

The significance of anatomical variations of hepatic artery and multiple arterial supplies in embolization of liver tumors.

A new therapeutic measure-step by step-embolization of every feeding vessel in dealing with liver cancer has been proposed on the base of the following criteria after reviewing the coeliac and superior mesenteric arteriographies in 100 cases of liver cancer. The emphasis is put on: 1. Anatomic variation of hepatic arteries. 2. Multiple feeding vessels, and 3. The importance of the presence of stenosis after embolization and the formation of collateral circulation.