Anat Cell Biol.  2014 Sep;47(3):188-195. 10.5115/acb.2014.47.3.188.

Variations in the origin of middle hepatic artery: a cadaveric study and implications for living donor liver transplantation

• Ghosh SK

• KMID: 1882594
• DOI: http://doi.org/10.5115/acb.2014.47.3.188

Abstract

Living donor liver transplantation has been associated with severe vascular complications like hepatic artery thrombosis, which commonly involves the hepatic segment 4. Most authors have defined the artery to this segment as the middle hepatic artery. The present study was undertaken to characterize the origin of middle hepatic artery and classify the variations observed in cadaveric livers, and also to analyze the significance (if any) of the findings in relation to living donor liver transplantation. The study was conducted on 125 adult livers, without macroscopic abnormalities, retrieved from human cadavers (age, 55-78 years; male, 77; female, 48) obtained from clinical wards. The hepatic arterial system was exposed, the origin of the middle hepatic artery was identified in each liver specimen and the variations observed in its origin were noted across all the specimen. Six types of hepatic arterial configurations were observed based on variations in the origin of middle hepatic artery, taking into consideration the presence of accessory hepatic arteries. It was noted in 19 (15.2%) livers that in the presence of an accessory left hepatic artery, the middle hepatic artery arose as a sub-branch of the right hepatic artery. Presence of the above hepatic arterial configuration in the donor could possibly be associated with an increased risk of intra-operative injury to the middle hepatic artery during right/left lobe living donor liver transplantation and this may subsequently lead to serious post-operative vascular complications like hepatic artery thrombosis.

Keyword

Quadrate lobe; Middle hepatic artery; Embryological origin; Living donor liver transplantation; Hepatic artery thrombosis

MeSH Terms

Adult
Arteries
Cadaver*
Female
Hepatic Artery*
Humans
Liver
Liver Transplantation*
Living Donors*
Male
Thrombosis
Tissue Donors

Figure

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  Fig. 1 Illustrative representation of the types of hepatic arterial configuration observed in the study based on the variations in the origin of middle hepatic artery (MHA), taking into consideration the presence of accessory hepatic arteries. AA, abdominal aorta; aLHA, accessory left hepatic artery; aRHA, accessory right hepatic artery; ASA, anterior segmental artery; CHA, common hepatic artery; CT, celiac trunk; GDA, gastro-duodenal artery; HMT, hepato-mesenteric trunk; LGA, left gastric artery; LHA, left hepatic artery; LSA, lateral segmental artery; MHA, middle hepatic artery; MSA, medial segmental artery; PHA, proper hepatic artery; PSA, posterior segmental artery; RHA, right hepatic artery; SA, splenic artery; SMA, superior mesenteric artery.

• 

  Fig. 2 Illustration showing the origin of the three hepatic arteries in embryonic life with the respective Couinaud's segments in the liver (represented by numbers) supplied by each of the three hepatic arteries. In this figure, Couinaud segmentation system was followed, which is based on the distribution in the liver of both the portal vein and the hepatic veins. Fissures of the three hepatic veins (portal scissurae) longitudinally divide the liver into four sectors. The planes containing the right and left portal pedicles (hepatic scissurae) transversely divide the sectors into eight segments. AA, abdominal aorta; CA, celiac artery; CHA, common hepatic artery; eLHA, embryonic left hepatic artery; eMHA, embryonic middle hepatic artery; eRHA, embryonic right hepatic artery; HS, hepatic scissura; IVC, inferior vena cava; LF, left fissure; LGA, left gastric artery; LHV, left hepatic vein; LLPV, left lobar portal vein; MF, median fissure; MHV, middle hepatic vein; PV, portal vein; RF, right fissure; RHV, right hepatic vein; RLPV, right lobar portal vein; SA, splenic artery; SMA, superior mesenteric artery.

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