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

Affiliations
  • 1Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

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

  • 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.

  • 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.

  • 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.

  • 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

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