Anat Cell Biol.  2023 Jun;56(2):276-279. 10.5115/acb.22.248.

A portal quadrad with triple hepatic arteries

• Stoudemire CE
• Sachsenmeier CN
• Link BL
• Klein FM
• Kulesza R

• KMID: 2544091
• DOI: http://doi.org/10.5115/acb.22.248

Abstract

The arterial support of the liver is most commonly from the celiac trunk via the proper hepatic artery (PHA). The PHA divides into left and right branches: the right hepatic artery (RHA) supplies the right and caudate lobes while the left hepatic artery (LHA) supplies the left and quadrate lobes. Aberrant hepatic arteries are relatively common, and the most frequent contributors are the superior mesenteric artery and left gastric artery. Herein we present findings from postmortem dissection of an abdominal cavity that revealed a rare combination of reported variations. Specifically, this subject had three extrahepatic arteries - a replaced LHA (rLHA), a PHA, and a replaced RHA (rRHA). The rLHA originated from the left gastric and the rRHA originated from the superior mesenteric artery. Knowledge of these variations is important for surgical and radiological procedures to avoid complications during treatment and improve patient outcomes.

Keyword

Dissection; Liver; Arteries

Figure

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  Fig. 1 (A) is the foregut from the subject, removed from the body cavity. The celiac trunk (asterisk) and SMA branch from the aorta (A) in typical fashion. The left gastric artery issued a branch directed towards the inferior aspect of the left lobe of the liver (red arrowhead c). The common hepatic artery (CH) split to form the proper hepatic artery, which continues as the middle hepatic artery (red arrowhead b), and the gastroduodenal artery (purple wire). The SMA formed a larger branch directed superiorly towards the porta hepatis (red arrowhead a). The common bile duct is indicated by the green arrowhead. The inferior vena cava is indicated by the blue asterisk and the portal vein is indicated by the magenta asterisk. (B) The liver has been dissected to provide a better view of the arteries entering the inferior aspect. The aorta and its branches are colored red. The branch from the SMA to the liver also provides the cystic artery (yellow wire). SMA, superior mesenteric artery; St, stomach; P, pancreas; Sp, splenic artery; LG, left gastric.

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  Fig. 2 (A) shows a schematic of the arterial pattern to the liver in this subject. The red arrowheads are the same as in Fig. 1. Red arrowheads indicate the three arteries supplying the liver- these vessels originate from the SMA (a), proper hepatic artery (b), and LG (c). The hepatic branch from the SMA provided the cystic artery (green arrowhead). The colored blocks above the hepatic arteries correspond to the liver regions shown in (B). (B) is a schematic representation of the liver from the subject of this case study. Based on the arrangement of arteries along the inferior aspect of the liver, we propose this arterial map: the right lobe of the liver was supplied by the replaced right hepatic artery from the SMA, while the remaining liver was supplied by the middle hepatic artery from the celiac trunk, with segment II and III supplied by the replaced left hepatic artery from the left gastric artery. SMA, superior mesenteric artery; CH, common hepatic artery; LG, left gastric artery; Sp, splenic artery; C, celiac trunk.

Reference

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