Rare anastomosis between a replaced right hepatic artery and left branch of the proper hepatic artery

Importance of Anatomical Variation of the Hepatic Artery for Complicated Liver and Pancreatic Surgeries: A Review Emphasizing Origin and Branching

Knowledge of anatomical variations of the hepatic artery from its origin to intrahepatic segmentation is of utmost importance for planning upper abdominal surgeries including liver transplantation, pancreatoduodenectomy, and biliary reconstruction. The origin and branching pattern of the hepatic artery was thoroughly described by the classification of Michels and Hiatt. Some rare variations of the hepatic artery were classified by Kobayashi and Koops. By the use of the multidetector computed tomography (MDCT) technique, the branching pattern of the hepatic artery can be visualized quite accurately. Unawareness of these arterial variations may lead to intraoperative injuries such as necrosis, abscess, and failure of the liver and pancreas. The origin and course of the aberrant hepatic arteries are crucial in the surgical planning of carcinoma of the head of the pancreas and hepatobiliary surgeries. In liver transplant surgeries, to minimize intraoperative bleeding complications and postoperative thrombosis, exact anatomy of the branching of the hepatic artery, its variations and intrahepatic course is of utmost importance. This review discusses variations in the anatomy of the hepatic artery from its origin to branching by the use of advanced imaging techniques and its effect on the liver, pancreatic, biliary and gastric surgeries.

Replaced right hepatic artery arising from the distal renal artery, a new variation

PURPOSE

Arterial irrigation of the liver is highly variable and widely studied due to its importance in the correct planification of the surgical or endovascular treatment of the hepatobilary area. Various classifications have been published of the common and uncommon anatomic variations of the hepatic arterial distribution. While the classic anatomic pattern of the proper hepatic artery-when it originates from the celiac trunk dividing into left and right branches-represents 50-83% of the described patterns, there are numerous uncommon distributions based on the presence of replaced or accessory hepatic arteries. In this article, we present a case of a replaced right hepatic artery originating from the right distal renal artery.

METHODS

Contrast enhanced computed tomography (CECT) examination was performed on a 67 years-old male patient with compensated alcoholic cirrhosis as part of the disease monitoring.

RESULTS

The replaced right hepatic artery of the patient arises from the right distal renal artery and-after its cranial course-enters the porta hepatis posterior to the main portal vein. After giving off the cystic artery, it irrigates the right hepatic lobe. The left hepatic artery does not show any variation.

CONCLUSION

We present CT angiography images of an extremely rare anatomic variation of the hepatic arterial irrigation in a cirrhotic patient.