Anat Cell Biol.  2022 Sep;55(3):269-276. 10.5115/acb.22.043.

Anatomical variations of the hepatic artery in it’s extra hepatic journey: a cadaveric study with its clinical implications

• Sukumaran TT
• Joseph S
• Ramakrishnan S
• Mathew AJ

• KMID: 2533349
• DOI: http://doi.org/10.5115/acb.22.043

Abstract

Vascular anomalies are a serendipitous finding during surgeries and diagnostic angiography. Such variations are frequently encountered in the abdominal region. These anomalies are usually asymptomatic but the presence of hepatic arterial variations may lead to injuries of the liver during surgery. The present study was conducted on 35 adult embalmed cadavers, 31 males, 4 females from August 2015 to December 2021 in the Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi. In this study of 35 cadavers, we present 3 variants: an accessory right hepatic artery, replaced common hepatic artery, replaced common hepatic artery anastomosis with accessory left hepatic artery and an arc of Buhler. One of our variants has not yielded a precedent in literature search. We have compared these variants with Michels and Hiatt classification. It is known that different variants arise at distinct stages of embryonic development. As specialists in anatomy, we have tried to correlate the variants in our study with their embryological origins.

Keyword

Hepatic artery; Accessory right hepatic artery; Replaced common hepatic artery; Accessory left hepatic artery; Arc of Buhler

Figure

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  Fig. 1 Accessory right hepatic artery (aRHA) arising from superior mesenteric artery (SMA). Liver lifted superiorly, stomach ligated and removed, pancreas reflected to the right, mobilised portal vein (PV) by cutting splenic vein (SV). Porta hepatis visualised with aRHA, greatly enlarged PV and bile duct (BD). LHA, left hepatic artery; RHA, right hepatic artery; CHA, common hepatic artery; GDA, gastroduodenal artery; RGA, right gastric artery; RGeA, right gastroepiploic artery; PHA, proper hepatic artery; AA, abdominal aorta; LGA, left gastric artery; CT, coeliac trunk; L, liver.

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  Fig. 2 rCHA arising from SMA. (A) Stomach cut at the pylorus, rCHA visualized. (B) Pancreas reflected to the right, rCHA visualized in its entirety, including its continuation as RGA along the lesser curvature. (C) Stomach reflected to the left, CT and its branches visualised. (D) rCHA and its relation to BD displayed. rCHA, replaced common hepatic artery; PHA, proper hepatic artery; GDA, gastroduodenal artery; SMA, superior mesenteric artery; PV, portal vein; RGA, right gastric artery; SA, splenic artery; LGA, left gastric artery; AA, abdominal aorta; CT, coeliac trunk; BD, bile duct; S, stomach; L, liver.

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  Fig. 3 rCHA arising from SMA with aberrant arc of Buhler. (A) Liver manoeuvred superiorly, lesser omentum cleared piecemeal, anastomosis between rCHA and aLGA seen. (B) Stomach resected, CT and its branches visualised. (C) Dual origin of rCHA and their merger around SMV seen. (D) Pancreas reflected to the right, arc of Buhler noted. rCHA, replaced common hepatic artery; aLGA, accessory left hepatic artery; LGA, left gastric artery; PV, portal vein; P, pancreas; BD, bile duct; GDA, gastroduodenal artery; RGA, right gastric artery; lrCHA, left division of rCHA; rrCHA, right division of rCHA; SMA, superior mesenteric artery; SMV, superior mesenteric vein; RCA, right colic artery; MCA, middle colic artery; SA, splenic artery; AA, abdominal aorta; CT, coeliac trunk; S, stomach; L, liver.

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  Fig. 4 Schematic representation of variants and embryological basis of variations observed in our study. (A) Primitive vasculature. (B) Embryological basis of normal development of coeliac trunk and superior mesenteric artery. (C) Accessory right hepatic artery arising from superior mesenteric artery. (D) Replaced common hepatic artery arising from superior mesenteric artery. (E) Replaced common hepatic artery arising from superior mesenteric artery anastomosis with accessory left hepatic artery from left gastric artery, arc of Buhler. VitA, vitelline artery; VA, ventral anastomosis; A, abdominal aorta; 1, abdominal aorta; 2, coeliac trunk; 3, superior mesenteric artery; 4, inferior mesenteric artery; 5, left gastric artery; 6, splenic artery; 7, common hepatic artery; 8, gastroduodenal artery; 9, right gastric artery; 10, proper hepatic artery; 11, right hepatic artery; 12, left hepatic artery; 13, middle colic artery; 14, right colic artery; r7, replaced common hepatic artery; lr7, left division of replaced common hepatic artery with arc of Buhler; rr7, right division of replaced common hepatic artery; a11, accessory right hepatic artery; a12, accessory left hepatic artery.

Reference

References

1. Blumgart LH, Belghiti J. 2007. Surgery of the liver, biliary tract, and pancreas. 4th ed. Saunders Elsevier;Philadelphia: DOI: 10.1016/B978-1-4160-3256-4.50009-0.

2. Von Haller A. 1756. Icones anatomicae quibus praecipuae aliquae partes corporis humani delineatae proponuntur et arteriarum potissimum historia continetur. Vandenhoeck;Gottingae: p. 270. Latin.

3. Michels NA. 1966; Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 112:337–47. DOI: 10.1016/0002-9610(66)90201-7. PMID: 5917302.

4. Hiatt JR, Gabbay J, Busuttil RW. 1994; Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 220:50–2. DOI: 10.1097/00000658-199407000-00008. PMID: 8024358. PMCID: PMC1234286.

5. Koshariya M, Khare V, Songra MC, Shukla S, Gupta A. 2021; Anomalous anatomical variations of coeliac trunk: a cadaveric study. Cureus. 13:e19108. DOI: 10.7759/cureus.19108. PMID: 34868759. PMCID: PMC8627549.

6. Noussios G, Dimitriou I, Chatzis I, Katsourakis A. 2017; The main anatomic variations of the hepatic artery and their importance in surgical practice: review of the literature. J Clin Med Res. 9:248–52. DOI: 10.14740/jocmr2902w. PMID: 28270883. PMCID: PMC5330766.

7. Malki Y, Lazaar H, Bouhout T, Serji B, El Harroudi T. 2021; Replaced common hepatic artery arising from the superior mesenteric artery discovered over a pancreaticoduodenectomy: a case report. Clin Surg. 6:3247.

8. Tiedemann F. 1822. Tabularum arteriarum corporis humani. Muller;Carlsruhae: p. 1–250. Latin.

9. Flint ER. 1923; Abnormalities of the right hepatic, cystic, and gastroduodenal arteries, and of the bile-ducts. Br J Surg. 10:509–19. DOI: 10.1002/bjs.1800104011.

10. Adachi B. 1928. Das Arteriensystem der Japaner. Vol.2:Kaiserlich-Japanischen Universitat;Kyoto: German. DOI: 10.1002/bjs.1800104011.

11. Michels NA. 1955. Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. Lippincott;Philadelphia: DOI: 10.1002/bjs.1800104011.

12. Andraus W, Haddad LB, Ducatti L, Martino RB, Santos VR, D'Albuquerque LA. 2013; Artery reconstruction in liver transplantation: the best reconstruction of right hepatic artery variation. Arq Bras Cir Dig. 26:62–5. DOI: 10.1590/S0102-67202013000100014. PMID: 23702874.

13. Sebben GA, Rocha SL, Sebben MA, Parussolo Filho PR, Gonçalves BH. 2013; Variations of hepatic artery: anatomical study on cadavers. Rev Col Bras Cir. 40:221–6. DOI: 10.1590/S0100-69912013000300010. PMID: 23912370.

14. Standring S. 2008. Gray's Anatomy: the anatomical basis of clinical practice. 40th ed. Churchill Livingstone;Edinburgh: p. 1072–4. p. 1116–7. p. 1130p. 1169–70.

15. Ghosh SK. 2014; Variations in the origin of middle hepatic artery: a cadaveric study and implications for living donor liver transplantation. Anat Cell Biol. 47:188–95. DOI: 10.5115/acb.2014.47.3.188. PMID: 25276478. PMCID: PMC4178194.

16. Kumar N, Swamy RS, Shetty P, Nayak SB, Patil J, Shetty SD, Guru A. 2014; Accessory right hepatic artery compensating rudimentary right branch of hepatic artery proper - a case report. Int J Health Sci Res. 4:331–4.

17. Eid N, Allouh M, Ito Y, Taniguchi K, Adeghate E. 2021; Jul. 5. Accessory right hepatic artery and aberrant bile duct in the hepatocystic triangle: a rare case with clinical implications. Folia Morphol (Warsz). [Epub]. https://doi.org/10.5603/FM.a2021.0065. DOI: 10.5603/FM.a2021.0065. PMID: 34219214.

18. Li X, Zhang X, Lu Q, Li A, Lin J, Fan H, Tang R. 2019; An accessory right hepatic artery derived from the superior mesenteric artery for anterior right liver lobe supply: a case report. Surg Radiol Anat. 41:969–71. DOI: 10.1007/s00276-018-2173-3. PMID: 30580394. PMCID: PMC6620246.

19. Farghadani M, Momeni M, Hekmatnia A, Momeni F, Baradaran Mahdavi MM. 2016; Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: evaluation with multidetector computed tomography angiography. J Res Med Sci. 21:129. DOI: 10.4103/1735-1995.196611. PMID: 28331515. PMCID: PMC5348823.

20. Fonseca-Neto OCLD, Lima HCS, Rabelo P, Melo PSV, Amorim AG, Lacerda CM. 2017; Anatomic variations of hepatic artery: a study in 479 liver transplantations. Arq Bras Cir Dig. 30:35–7. DOI: 10.1590/0102-6720201700010010. PMID: 28489166. PMCID: PMC5424684.

21. Cherian PT, Hegab B, Oliff SP, Wigmore SJ. 2010; The management of an accessory or replaced right hepatic artery during multiorgan retrieval: results of an angiographic study. Liver Transpl. 16:742–7. DOI: 10.1002/lt.22075. PMID: 20517908.

22. Dandekar U, Dandekar K, Chavan S. 2015; Right hepatic artery: a cadaver investigation and its clinical significance. Anat Res Int. 2015:412595. DOI: 10.1155/2015/412595. PMID: 26788371. PMCID: PMC4695647.

23. Zhang W, Wang K, Liu S, Wang Y, Liu K, Meng L, Chen Q, Jia B, Liu Y. 2020; A single-center clinical study of hepatic artery variations in laparoscopic pancreaticoduodenectomy: a retrospective analysis of data from 218 cases. Medicine (Baltimore). 99:e20403. DOI: 10.1097/MD.0000000000020403. PMID: 32481341. PMCID: PMC7249910.

24. Zaki SM, Abdelmaksoud AHK, Khaled BEA, Abdel Kader IA. 2020; Anatomical variations of hepatic artery using the multidetector computed tomography angiography. Folia Morphol (Warsz). 79:247–54. DOI: 10.5603/FM.a2019.0090. PMID: 31436302.

25. Osawa T, Feng XY, Sasaki N, Nagato S, Matsumoto Y, Onodera M, Nara E, Fujimura A, Nozaka Y. 2004; Rare case of the inferior mesenteric artery and the common hepatic artery arising from the superior mesenteric artery. Clin Anat. 17:518–21. DOI: 10.1002/ca.10234. PMID: 15300873.

26. Kahraman G, Marur T, Tanyeli E, Yildirim M. 2001; Hepatomesenteric trunk. Surg Radiol Anat. 23:433–5. DOI: 10.1007/s00276-001-0433-z. PMID: 11963627.

27. Moszkowicz D, Peschaud F, El Hajjam M, Saiag P, Nordlinger B. 2011; Preservation of an intra-pancreatic hepatic artery during duodenopancreatectomy for melanoma metastasis. Surg Radiol Anat. 33:547–50. DOI: 10.1007/s00276-010-0770-x. PMID: 21221968.

28. Acebes-García F, Pinto-Fuentes P, Pacheco-Sánchez D, Choolani-Bhojwani E, Marcos-Santos P, Bueno-Cañones A, Veleda-Belanche S. 2021; Surgical significance of replaced common hepatic artery originating distally from the superior mesenteric artery during the whipple procedure. HPB. 23(Suppl 3):S910. DOI: 10.1016/j.hpb.2021.08.885.

29. Zagyapan R, Kürkçüoğlu A, Bayraktar A, Pelin C, Aytekin C. 2014; Anatomic variations of the celiac trunk and hepatic arterial system with digital subtraction angiography. Turk J Gastroenterol. 25(Suppl 1):104–9. DOI: 10.5152/tjg.2014.5406. PMID: 25910286.

30. Kadir S, Lundell C, Saeed M. Kadir S, Brothers MF, editors. 1991. Celiac, superior and inferior mesenteric arteries. Atlas of Normal and Variant Angiographic Anatomy. Saunders;Philadelphia: p. 297–308.

31. Woods MS, Traverso LW. 1993; Sparing a replaced common hepatic artery during pancreaticoduodenectomy. Am Surg. 59:719–21. PMID: 7902051.

32. Sethy S, Nayak GR, Agrawal D, Mohanty B, Biswal R. 2012; Anomalous origin of hepatic artery and its relevance in hepatobiliary surgeries. Int J Cur Res Rev. 4:143–8.

33. Ha HI, Kim MJ, Kim J, Park SY, Lee K, Jeon JY. 2016; Replaced common hepatic artery from the superior mesenteric artery: multidetector computed tomography (MDCT) classification focused on pancreatic penetration and the course of travel. Surg Radiol Anat. 38:655–62. DOI: 10.1007/s00276-016-1618-9. PMID: 26758052.

34. Tiwari S, Roopashree R, Padmavathi G, Varalakshmi KL, Sangeeta M. 2014; Study of aberrant left hepatic artery from left gastric artery and its clinical importance. Int J Cur Res Rev. 6:25–8.

35. Walker TG. 2009; Mesenteric vasculature and collateral pathways. Semin Intervent Radiol. 26:167–74. DOI: 10.1055/s-0029-1225663. PMID: 21326561. PMCID: PMC3036491.