Variations Of Hepatic Artery Research Articles

Laparoscopic Left Hemihepatectomy for Intrahepatic Cholangiocellular Carcinoma: An Adequate Lymphadenectomy is Also Possible in Artery Variation

BackgroundLaparoscopic liver resection (LLR) is becoming essential in the treatment of malignant liver tumors but only a few reports exist about LLR for intrahepatic cholangiocarcinoma (IHCC).MethodsWe present a video of a laparoscopic left hemihepatectomy with lymphadenectomy for IHCC.Case presentationA 67-year-old asymptomatic male underwent a routine abdominal ultrasound, revealing a 15 × 9 mm solid nodular iso-hyperechoic lesion, located in SIII, with SII/III biliary duct dilation. Magnetic resonance imaging confirmed a 32 × 22 mm lesion in SII/III, with mild hyper-intensity on T2-weighted images and strong hypo-intensity on T1-weighted images. After administration of contrast medium, the lesion showed light peripheral enhancement on the portal and delayed phases, and hypo-intensity on the hepatospecific phase. No relevant comorbidities were reported (KPS 100). Laboratory tests showed normal liver function and normal CA19-9 levels. A laparoscopic left hemihepatectomy was indicated.ResultsOperative time was 330 min. Four intermittent Pringle maneuver cycles were applied and no blood transfusions were administered. Intraoperative ultrasound confirmed preoperative findings and additionally highlighted involvement of the SIV duct. A full replacing right hepatic artery arising from the superior mesenteric artery was identified and was preserved during hilar dissection. Postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology report indicated cholangiocellular carcinoma pT1bN0. Twelve lymph nodes were retrieved.ConclusionsAccording to recent literature reports and our experience, laparoscopic surgery for intrahepatic cholangiocellular carcinoma should be considered feasible and safe in selected patients. Hepatic artery variations allow for adequate lymphadenectomy. Oncological long-term results require multicenter randomized studies in order to be validated.

Impact of the indocyanine green fluorescence method for anastomotic blood flow in robotic distal gastrectomy.

To evaluate the blood flow at the site of delta-shaped anastomosis during robotic distal gastrectomy and determine surgical outcomes and risk factors for ischemia at the anastomotic site from the perspective of clinical characteristics, surgical outcomes and perigastric vascular anatomy. We included 55 patients who underwent robotic distal gastrectomy with a blood flow evaluation in the duodenal walls using intravenous indocyanine green injection with the da Vinci Xi-equipped Firefly system. Additional resection was performed in patients with a poor blood flow. Clinical characteristics, surgical outcomes and perigastric vascular anatomy were compared between the 45 patients with sufficient blood flow (group S) and the 10 patients with insufficient blood flow (group I). Vascular anatomy was assessed by preoperative contrast-enhanced computed tomography according to Hiatt's classification. The patient characteristics and surgical outcomes were not significantly different. No patient developed anastomotic complications requiring intervention; more patients in group I had aberrant branching of the left hepatic artery than those in group S (p = 0.047). An indocyanine green-based blood flow evaluation might be an effective method of preventing anastomotic complications of delta-shaped anastomosis. Anatomical branching variations of the left hepatic artery might be a risk factor for impaired vascular perfusion of the anastomotic site.

Origin and Prevalence of the Retroportal Course of Hepatic Artery- A Retrospective Study

Introduction: Anatomical variations of celiac and hepatic arteries are relatively common and impact operative time and technique. Intraoperative identification of the entire course of these vessels can be a challenge due to limited surgical field and increases the chance of iatrogenic injury. Aim: To evaluate and describe the origin and prevalence of retroportal course of hepatic arteries seen in Computed Tomography (CT) angiography in a large series of patients. Materials and Methods: The present retrospective study was conducted in the Department of Radiology, affiliated to a tertiary cancer centre in Southern India. CT angiogram done between January 2020 to June 2021 were included. Total of 326 abdominal CT angiograms were studied for celiac axis variations, variations in the origin and branching pattern of hepatic arteries, trajectory of the hepatic artery and its relation to portal vein. The branching pattern of celiac axis was analysed with adherence to the modified definition of Common Hepatic Artery (CHA) and it was classified as normal/variant/ambiguous. Based on the origin and branching pattern, hepatic arteries were divided into standard/replaced/accessory and classic/variant divisions, respectively. Variant divisions include trifurcation, duplicate or double hepatic artery and late origin of Gastro Duodenal Artery (GDA). Retroportal hepatic arteries under each variation was identified separately and their prevalence calculated. Confidence interval was calculated using simple proportionfrequency analysis open Epi version 3 software. Results: The age of the patients varies from 3 to 83 years (mean age 53.7 years). 207 (63.49%) cases were male and 119 (36.5%) cases were female. 262 (80.37%) cases had a normal celiac axis anatomy. Eight specific types of celiac axis variations were observed in 48 (14.72%) cases. In the remaining 16 (4.91%) cases, the celiac axis anatomy was ambiguous. CHA originated from the celiac axis, Superior Mesentric Artery (SMA) and aorta in 294 (90.18%), 10 (3.07%) and 6 (1.84%) cases respectively. Out of the 52 replaced Right Hepatic Artery (rRHA), 48 (14.72%), 3 (0.92%) and 1 (0.30%) cases had Right Hepatic Artery (RHA) replaced to the SMA, aorta and GDA, respectively. Except for the one rRHA from GDA, all of them had a retroportal course. Classic branching pattern of hepatic artery was seen in 154 (47.24%). Trifurcation, early branching of RHA and early branching of LHA were found in 49 (15.03%), 4 (1.22%) and 8 (2.45%) respectively. 63 (70%) cases of variations in hepatic artery origin, 15 (16.67%) cases of variations in hepatic artery branching and 12 (13.33%) cases of variations in celiac axis contributed to a total of 90 cases with retroportal hepatic artery. Prevalence of retroportal hepatic artery in the present study is 27.61% (confidence interval 22.82- 32.8) and the most common cause was aberrant RHA origin. Conclusion: Knowledge about the origin and prevalence of retroportal course of hepatic artery will help the surgeon to approach it systematically. Preoperative knowledge of the variations in origin and branching patterns and its influence on the trajectory will help in a better intraoperative identification of these variant vessels.

An Aberrant Origin of the Right Hepatic Artery: A Rare Anatomic Variation. And Its Clinical Application

The right hepatic artery is an important arterial supply to right lobe of the liver. And the knowledge of the normal anatomy and anatomical variations of the right hepatic artery is essential to perfume, and will minimize morbidity, and also help to decrease the number of complications of hepatobiliary surgery. This study was conducted on eleven human cadavers, which were obtained from the routine autopsies at the dissection room of the Anatomy Department. During dissection of the eleven cadaveric livers, we found a case with an ex-ceptional anatomic variation; a replaced right hepatic artery (RRHA) coming off the superior mesenteric artery (SMA), directly to the hepatic right lobe passing through the Calot’s triangle, crossing behind the common hepatic duct (CHD). Our objective is to draw much attention to this particularly anatomic variation of the origin of the RRHA as well as its clinical importance in order to ensure that no damage will be made during gastrointestinal and hepatobiliary surgery.

Anatomical Variations of the Celiac Trunk and Hepatic Arteries with a New Classification, Based on CT Angiography.

To analyse the distribution of anatomical variations in both celiac trunk (CeT) and hepatic artery (HA) branching patterns on computed tomography (CT) angiography images; as well as to propose a new classification by unifying the already reported classifications of the CeT and HA vascular anatomy. Observational study. Department of Radiology, Faculty of Medicine, Selçuk University, Konya, Turkey, from February 2019 to March 2020. CT angiography-based evaluation of the CeT and HA branching patterns was performed in patient undergoing routine contrast-enhauced CT of abdomen. Types of variation were determined and classified into five types (1-5) and ten subtypes. Distribution was also sorted by age and gender. Type 1 (classic CeT and HA branching pattern) was detected in 240 (70.6%) out of 340 cases (126 females, 214 males). Sixty-five (19.12%) had Type 2 subtypes, in which HA branching pattern coexists with normal CeT configuration; whereas, Type 3a and 3d, Type 4 and 5 having anomalous CeT variants, with typical HA pattern, were observed in 5.87% (20/340) of the cases. The frequency of the concurrent variations (Type 3b and 3c) was 4.41% (15/340). The least frequent subtypes, Type 4 and 5, were observed in one (0.29%) and three (0.88%) cases, respectively. There was no significant differences in branching types frequency by gender and age (p>0.05). Awareness of the range of anatomical variation in both the CeT and HA branching patterns, especially concurrent variations, is vital when planning surgical and radiological interventions to prevent possible iatrogenic injury and complications. Key Words: Branching pattern, Celiac trunk, Concurrent variations, CT angiography, Hepatic artery.

Hepatic Artery and Portal Vein Variations using Contrast Enhanced Computed Tomography Abdominal Angiography

Introduction: Normal hepatic vascular anatomy and its variants carry considerable importance during liver transplants, laparoscopic surgeries, penetrating abdominal trauma, and radiological abdominal interventions. The occurrence of iatrogenic hepatic vascular injury increases in case of atypical anatomy and variations. Aim: To determine the prevalence of common hepatic artery and portal vein variants by using Multidetector Computed Tomography (MDCT). Materials and Methods: This is a hospital based retrospective study done in Sri Mankula Vinayagar Medical College and Hospital, Puducherry, India, between July 2019 and July 2020. The Contrast Enhanced Computed Tomography (CECT) abdominal angiography of 350 patients was taken for the study. The MDCT abdominal angiography was performed using 16 slice PHILIPS MX16 CT scanner with intravenous administration of non ionic iodinated contrast, having iodine content of 300 mg/mL at the dosage of 1.5 mL/kg body weight, using automated pressure injector at a rate of 3.5 mL/sec. Arterial phase and portal venous phase images were obtained at 25 and 55 seconds respectively. The hepatic artery anatomical types were classified according to Michel's classification and the portal vein according to Covey AM et al., classification. Data obtained was entered in EPI INFO version 7.2.1.0 and analysed using Statistical Package for the Social Sciences (SPSS) software version 24.0. Results: Hepatic artery proper (right and left hepatic arteries arising from common hepatic artery) (Type I) was seen in 222 (63.4%) of cases. The most common variant was replaced Left Hepatic Artery (LHA) from the left gastric artery (Type II) with a prevalence of 46 (13.1%). A normal portal vein branching pattern (Type I) was seen in 201 (57.4%) of cases. The most common variation was trifurcation (Type II) with a prevalence of 68 (19.4%). Conclusion: Knowledge about normal hepatic artery, portal vein, and its variants is important in hepatic interventions and CT angiography is the modality of choice for evaluating the vascular anatomy.

Efficacy of Hepatic Arterial Infusion Chemotherapy and Radiofrequency Ablation against Hepatocellular Carcinoma Refractory to Transarterial Chemoembolization and Vascular Variation: A Case Study

<p>Transarterial chemoembolization is often the first-line treatment for multiple hepatocellular carcinomas. However, hepatic arterial infusion chemotherapy is a treatment option for hepatocellular carcinoma refractory to multiple sessions of transarterial chemoembolization. Hepatic arterial infusion chemotherapy requires implantation of an appropriate port into the hepatic artery. However, it may be impossible to implant a port due to hepatic artery variation. We report a case of hepatocellular carcinoma refractory to transarterial chemoembolization and hepatic artery variation treated successfully with hepatic arterial infusion chemotherapy and radiofrequency ablation with complete response after implantation of ports in both liver lobes.</p>

Unraveling Variations in Celiac Trunk and Hepatic Artery by CT Angiography to Aid in Surgeries of Upper Abdominal Region.

Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region.

Relationship of vascular variations with liver remnant volume in living liver transplant donors.

In this study, we investigated the relationship between the portal vein and hepatic artery variations and the remaining liver volume in living donors in liver transplantation. In the study, triphasic abdominal computed tomography images of 180 live liver donor candidates were analysed retrospectively. Portal veins were divided into four groups according to the Nakamura classification and seven groups according to the Michels classification. The relationship between vascular variations and remnant liver volume was compared statistically. According to the Nakamura classification, there were 143 (79.4%) type A, 23 (12.7%) type B, 7 (3.9%) type C and 7 (3.9%) type D cases. Using the Michels classification, 129 (71%) type 1, 12 (6.7%) type 2, 24 (13%) type 3, 2 (2.2%) type 4, 10 (5.6%) type 5, 1 (0.6%) type 6, and 2 (1.1%) type 7 cases were detected. There was no significant difference in the percentage of the remaining volume of the left liver lobe between the groups (p = 0.055, p = 0.207, respectively). Variations in the hepatic artery and portal vein do not affect the remaining liver volume in liver transplantation donors.

Influence of arterial variation and reconstruction of the donor hepatic artery in liver transplantation on early postoperative arterial complications

Influence of arterial variation and reconstruction of the donor hepatic artery in liver transplantation on early postoperative arterial complications

Anatomic Variations of the Hepatic Artery in 5625 Patients.

To analyze the origin and anatomic course of the hepatic arteries by using digital subtraction angiography (DSA) and multidetector CT in a large study sample. This retrospective study included 5625 patients who underwent liver CT and chemoembolization between January 2005 and December 2018 (mean age, 60 years ± 11 [range, 11-99 years]; 4464 males). The CT and DSA images were reviewed to evaluate the visceral arterial anatomy for variations in the celiac axis and hepatic arteries. Aberrant right hepatic arteries (aRHAs) and aberrant left hepatic arteries (aLHAs) were defined on the basis of their origin and anatomic course. Statistical analyses were performed to evaluate the association between aRHAs and aLHAs and the association between variations in the hepatic artery and celiac axis. Right hepatic arteries were categorized as being aRHAs (if originating from the proximal to middle common hepatic artery, gastroduodenal artery, superior mesenteric artery [SMA], celiac axis, aorta, splenic artery, or left gastric artery [LGA]) or as being aLHAs (if arising from the LGA, celiac axis, aorta, or SMA). The prevalence of aRHAs (15.63%; 879 of 5625) and the prevalence aLHAs (16.32%; 918 of 5625) were similar. Patients with an aRHA were more likely to have an aLHA than those without an aRHA (29.01% vs 13.97%; P < .001), and patients with an aLHA were more likely to have an aRHA than those without an aLHA (27.78% vs 13.26%; P < .001). There was no association between the hepatic arterial variations and celiac axis variations. A hypothetical anatomic model summarizing the observed variations was created. A comprehensive list of hepatic arterial variations and a three-dimensional hypothetical model for the observed variations were described.Keywords: CT, Angiography, Liver, Anatomy, Arteries© RSNA, 2021 Supplemental material is available for this article. See also commentary by Sutphin and Kalva in this issue.

Application value of three-dimensional reconstruction in preoperative evaluation of precise hepatectomy for complex primary liver cancer

Objective: To explore the application value of three-dimensional reconstruction of liver based on computer software in preoperative evaluation of precise hepatectomy for complex primary liver cancer. Methods: The clinical data of patients in Peking University People's Hospital Hepatobiliary surgery with complicated primary liver cancer from September 17, 2019 to December 20, 2020 were analyzed retrospectively. Preoperative enhanced CT/MR data of patients were collected, and 3D reconstruction of liver was performed in IQQA􀳏-3D Liver system. The liver volume of patients was calculated, the size and location of tumor were described, and the relationship between tumor and intrahepatic bile duct, portal vein, hepatic artery and inferior vena cava was described. Preoperative decision-making and treatment plan were made to compare the compliance of the actual operation plan with the planned operation plan under the guidance of three-dimensional reconstruction. Results: Among all 10 patients, there were 6 males and 4 females, aged 36 to 75 years. There were 6 cases of Child-Pugh grade A and 4 cases of B liver function. There were 5 cases of portal vein variation and 5 cases of hepatic artery variation. The range and M(Q1,Q3)of actual liver volume measured by 3D reconstruction in 10 patients was 895- 2 477 cm3 and [1 444(1 001, 1 854)] cm3;the nodule volume was 7-1 808 [133(50, 566)] cm3;the nodule volume in the liver was 0.8%-73.0% [11.0(3.3,32.7)]% and the number of suspected lesions was 1-7. In the end, 6 patients received surgical treatment;3 received chemotherapy, and 1 received conservative treatment. The preoperative three-dimensional reconstruction of liver anatomy and tumor location of the patients receiving surgical treatment were basically consistent with the intraoperative situation. There was no case of liver failure or death during perioperative period. Conclusion: In the preoperative evaluation of precise hepatectomy for complex primary liver cancer, 3D reconstruction can improve the rationality of treatment and the surgeon's understanding of the anatomical characteristics of the liver, so as to select the best treatment for patients, which has great application value.

Moynihan's Lump as an unusual variant of right hepatic artery during a laparoscopic cholecystectomy approach. A case report.

Introduction and importanceOne of the most important measures during the cholecystectomy procedure is based on a “Culture for Safe Cholecystectomy (CSC)”. Vascular injury reports an open surgery conversion rate of 0 to 1.9% and a mortality of less than 0.02%. The caterpillar or Moynihan's hump configuration is characterized by a tortuous right hepatic artery (RHA) running proximal and/or parallel to the cystic duct and predisposes to a small and/or short cystic artery (CA).Case presentationA 65-year-old woman with no relevant clinical history underwent a laparoscopic cholecystectomy (LC) for cholelithiasis; during the procedure a caterpillar or Moynihan's hump was identified.Clinical discussionAnatomical variations represent 20-50% of all cases; therefore, CVS is required. The incidence of caterpillar or Moynihan's hump varies between 1% and 13% of all cases. To date, the scientific literature on this topic is limited. The most accepted etiology is related to embryological formation.ConclusionBiliary and arterial variations are more frequent than we think, so an anatomical knowledge, CSC and CVS represent a fundamental rule, increasing the safety of the surgical procedure.

The Impact of Hepatic Arterial Variations and Reconstructions on Arterial Complications in Liver Transplantation

Background: The purposes of the study were to determine the variations in hepatic arterial supply, to delineate the optimal methods of arterial anastomoses and reconstructions in liver transplantation and to analyse the incidence of arterial complications. Methods: The surgical anatomy of the extrahepatic arterial vascularization was investigated retrospectively in 209 donors and patients who underwent liver transplantation at Fundeni Clinical Institute (Bucharest, Romania) from January 1, 2015 to December 31, 2017. The vascular anatomy of the hepatic grafts was classified according to Michels’ description and other rare variations. Results: Anatomical variants of the classical pattern were detected in 26.3% of the livers (n = 55). The most common variant was a replaced right hepatic artery arising from the superior mesenteric artery (n = 17; 8.13%), followed by a common hepatic artery from superior mesenteric artery (n = 6; 2.87%). Arterial reconstructions were reported in 97 cases (45.5%). In recipients, used sites were intermediate: common hepatic artery (CHA) in 73.8% (n = 158), distal: proper hepatic artery (PHA) or common hepatic artery/gastro-duodenal artery bifurcation (CHA/GDA bifurcation) in 16.4% (n = 35) and proximal: coeliac trunk-splenic artery-aorta (CT–SA–A) in 9.3% (n = 20) of patients. Most common reconstructions were short graft artery (CT) on the recipient CHA (n = 33, 34.02%) and long graft artery: complex reconstruction between CT and superior mesenteric artery (SMA) - accessory right hepatic artery (RHA) from SMA on CHA (n = 12, 12.37%) and right hepatic graft artery on PHA or CHA/GDA bifurcation (n = 16, 16.49%). Conclusion: The information about the different hepatic arterial patterns, as well as establishing specific methods for arterial anastomoses and reconstructions is important in the determination of better outcomes.

Unusual variations in the branching pattern of the coeliac trunk and their clinical significance.

The anatomical variations of the coeliac trunk are due to developmental changes in the ventral segmental arteries. Multidetector computed tomography (MDCT) has been used to investigate vascular anatomy for scientific and diagnostic purposes. These studies allow for much larger sample sizes than traditional cadaveric studies. The aim of this research was to isolate rare anatomical variants of the coeliac trunk and emphasize their clinical significance. A descriptive, retrospective study was carried out on MDCT angiographies performed from January 2020 till March 2020 in Polish patients. Coeliac trunk was studied and normal and anatomical variations were identified. Out of total 350 patients, hepatogastrosplenic trunk was predominant. However, we observed: coeliaco-mesenteric and hepatogastric trunk type, hepatic artery variations and coeliac axis stenosis with collateral mesenteric circulation. Rare variations of the coeliac trunk should always be anticipated before radiological and surgical interventions. Knowledge of unusual coeliac trunk anatomy is important in hepatopancreatobiliary surgery, transplantology, and interventional radiology.

Anatomical variations of cystic artery: A digital subtraction angiography study

Background/Aim: Branching variations in the cystic and hepatic arteries may lead to bleeding and mortal complications during surgery. This study aimed to demonstrate the relationship between cystic artery (CA) variations and hepatic artery branching patterns among an Anatolian population using Michel’s classification and compare the distribution of these variations among genders. Methods: Angiographies performed between 2014-2017 were retrospectively evaluated and DSA images of 303 patients (84 females and 219 males) were included in this cross-sectional study. Michel’s classifications of the hepatic arteries and CA variations of the patients were noted, and each was analyzed separately, along with gender-related branching differences. Results: Hepatic arteries of 256 patients could be evaluated according to Michel’s classification, the most frequent being Michel’s class I (69.9 %). Thirty patients (9.9%) were excluded from CA-related statistical analyses since they had undergone a cholecystectomy. CAs were not visualized in fifty-five (18.2%) of the remaining patients. Of the 218 patients with apparent CAs, eleven females (19.3%) and twenty males (12.4%) had double cystic arteries (P=0.201). Two hundred and twelve (85.1%) CAs originated from the right hepatic artery (RHA), which was the most common parent artery. No significant relationship was found between Michel’s classification and CA origin among different genders (P=0.532). Conclusion: An overlooked anatomic variation could lead to many iatrogenic complications during diagnostic and therapeutic interventions; thus, variations of the vascular structures have attracted medical professionals’ interest. This study focuses on the variations of the cystic artery and its relationship with hepatic arterial branching variations.

Conventional hepatic arterial anatomy? Novel findings and insights of a multi-disciplinary hepatic arterial infusion pump program

IntroductionVariant hepatic arterial anatomy (vHAA) is thought to occur in 20–30% of patients. Hepatic arterial infusion (HAI) pump placement for liver cancers requires thorough hepatic artery dissection; we sought to compare vHAA identified during pump placement with established dogma. MethodsBetween 2016 and 2020, n = 30 patients received a HAI pump. Intra-operatively identified vHAA was characterized and compared with published data. ResultsvHAA was identified in 60% (n = 18) of patients, significantly higher than 19% (3671 of 19013) in the largest published series (P < 0.001). The most common variations were accessory left (n = 12; 40%) and replaced right (n = 6; 20%) hepatic arteries; six (20%) had ≥2 variants. Pre-operative imaging correctly identified 67% of variant hepatic arteries. DiscussionMeticulous operative dissection of the hepatic arterial tree reveals vHAA not captured by imaging or cadaveric dissection. vHAA likely has a higher prevalence than previously reported and should be addressed to optimize therapeutic efficacy of HAI pump therapy.

Hepatic Arterial Variations and Its Implication During Pancreatic Cancer Surgeries.

Aberrant hepatic artery anatomy is a considerable challenge during pancreatic surgery as it warrants extreme caution for the preservation of vascular supply as well as achievement of R0 resection margin. We reviewed the literature about the aberrant anatomical variations of the hepatic artery and its relevance during pancreatoduodenectomy and distal pancreatectomy. Preoperative deliberation of peri-pancreatic vascular anatomy using advanced imaging methods is crucial for surgeons. At the same time, intra-operative suspicion and early identification of aberrant anatomy may help to prevent vascular injury and related complications. Yet, vascular reconstruction may be needed in many situations; several techniques like pre-operative embolization provide new options for management in specific situations. We have provided here an overview of the anatomical variants of the hepatic artery and their implicationduring pancreatoduodenectomy and distal pancreatectomy.

An aberrant right hepatic artery arising from the gastroduodenal artery: a pitfall encountered during pancreaticoduodenectomy.

Among the variations of the right hepatic artery (RHA), the identification of an aberrant RHA arising from the gastroduodenal artery (GDA) is vital for avoiding damage to the RHA during surgery, since ligation of the GDA is necessary during pancreaticoduodenectomy (PD). However, this variation is not frequently reported. The purpose of this study was to focus on an aberrant RHA arising from the GDA, which was not noted in the classifications reported by Michels and Hiatt. A total of 574 patients undergoing a PD between Jan 2001 and Dec 2015 at a tertiary care hospital in Switzerland (n = 366) and between Jan 2009 and May 2015 at a hospital in Japan (n = 208) were included in the analysis. Of these, preoperative CT angiography or/and MRI angiography findings were available for 532 patients. We retrospectively analyzed the hepatic artery variations, patient demographics, and surgical outcomes. Among the 532 patients who received a PD, an RHA originating from the GDA was observed in 19 cases (3.5%). Eleven patients (2.1%) had both an aberrant RHA and an aberrant left hepatic artery (LHA) (Hiatt Type 4). Six patients (1.2%) had a replaced CHA arising from the SMA (Hiatt Type 5). We could, therefore, correctly identify the aberration in all cases. We observed rarely reported but important aberrant RHA variations arising from the GDA. To prevent injury during PD in patients with this type of aberrant RHA, intensive preparations using CT and/or MRI imaging before surgery and intraoperative liver Doppler ultrasonography are considered to be essential.

Evaluation of Celiac Trunk, Hepatic Artery Variations, and Their Collateral Arteries by Multi-Slice Computed Tomography.

Objectives:Celiac Trunk (CT) is a vital artery and the first unmatched branch of the abdominal aorta, providing blood to upper abdominal structures, particularly the liver, stomach, and spleen. It is essential to know its anatomy in terms of pancreas, spleen, gallbladder, liver surgeries, and interventional radiological procedures such as chemoembolization. The aim of our study is to contribute to the literature with the measurements of distances between the diaphragmatic crus and vascular structures with their diameters, which have been studied insufficiently, and to detect the possible relationships between vascular variations and collateral branches.Methods:Imaging findings of 200 patients (114 males and 86 females), who underwent Multi-Section Computed Tomography examination with various indications in our center between June 2016 and July 2020, were retrospectively analyzed. The statistical relations between CT and Hepatic Artery variations, collateral formations, age, and gender were evaluated with the Spearman’s Rho Correlation Coefficient Test.Results:The distance between the crus of diaphragm and CT was 4–60 mm (mean 24.3 mm), the distance between CT and superior mesenteric artery (SMA) was 2.5–35 mm (mean 8.6 mm), CT diameter was 4.6–9.4 mm (mean 7.3 mm), and the main hepatic artery diameter was 2.4–5.8 mm (mean 4.1 mm). There was no correlation in our study between CT, Hepatic Artery variations, and their collaterals (r in range of −20,124–0.116, p>0.05). It can be said that in cases of the single accessory left hepatic artery originating from the left gastric artery, such as Michel’s Type V and Type VIII, collaterals between common hepatic artery and SMA were relatively more frequent (p=0.1).Conclusion:Our study contributed to the literature by measuring the distance between diaphragmatic crus-vascular structures, which has been little studied in the past. Frequencies of CT and Hepatic Artery variations that have been detected in our study are similar to the results of the previous studies with non-malignancy patient groups.