Prevalence of Hepatic Arterial Variations With Implications in Pancreatoduodenectomy

Abstract

Background: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. Aim: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. Methods: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. Results: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. Conclusions: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.

Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy—own results and a systematic review of the literature

“…The CT findings were confirmed at surgery in all patients. The high diagnostic accuracy of CT was confirmed in the study of Balzan et al, and besides meticulous surgical technique, may partially explain the successful preservation of all aRHA in our cohort (29). Considering this background, we do not have any explanation for some very low rates of aRHA recognition using CT as low as 50-70%, recently reported (19,22,24).…”

Coeliac trunk and its anatomic variations: a cadaveric study

“…These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning [40]. In transarterial chemoembolisation (TACE) or radioembolisation of hepatic cancers and metastases it is essential to analyze hepatic and extrahepatic perfusion in order to prevent iatrogenic postprocedural complications such as radiation induced ulcers in the stomach and duodenum or severe pancreatitis [41,42,43].…”

Precision anatomy for safe approach to pancreatoduodenectomy for both open and minimally invasive procedure: A systematic review

“…There are several terms that describe the variation of hepatic arteries: "aberrant," "accessory," "replacement," "substitute," and "anomalous." [11][12][13][14][15][16][17][18] However, the definitions of these terms were different in each report and were not explained or defined in several reports. Crocetti et al 18 described right hepatic artery (RHA) variations to be divided into "accessory" and "aberrant."…”