Aberrant right hepatic arterial anatomy and pancreaticoduodenectomy: recognition, prevalence and management

Abstract

Recognition of aberrant vasculature to the liver before PD is important. Preoperative imaging studies will often be adequate to identify these anomalies, but interpreting radiologists may not be aware of its clinical significance. Surgeons performing PD must be adept at managing ARHAA safely.

Does Aberrant Hepatic Arterial Anatomy Affect Resection Margin Status In Pancreaticoduodenectomy For Pancreatic Adenocarcinoma?

“…Primary end-to-end or end-to-side anastomosis with the GDA stump or splenic artery are commonly techniques described in the literature [4,5,10,13,17]. Whereas Stauffer et al describes using a PTFE jump graft to the GDA in one case, and an interposition gonadal vein graft to the GDA in another [16]. None of the patients in our study required vascular reconstruction.…”

“…Finally, attempts to preserve the vessel while ensuring oncological clearance may damage the adventitia increasing the risk of pseudoaneurysm formation and postoperative haemorrhage especially in the setting of a pancreatic fistula or intra-abdominal collections [10,16].…”

Diagnosis and management of duodenal adenocarcinomas: a comprehensive review for the radiologist

“…The superior pancreaticoduodenal artery typically arises from the GDA, runs along the pancreatoduodenal groove, and is an anatomic landmark between second part of the duodenum and the pancreatic head. A not infrequent variant is the presence of an accessory/ replaced right hepatic artery arising from the superior mesenteric artery, which may be seen in upto 16% cases and should be carefully noted [12]. The hepatic artery is the predominant supply of the bile ducts.…”

Variant anatomy of the celiac trunk –review of literature with a case report

“…Out of 180 dissections, Jones and Hardy noted the origin of replaced RHA from SMA in 18%, from gastroduodenal artery in 6% and from right gastric artery or aorta in 1.6% 17 . John Stauffer et al retrospectively reviewed 43 191 patients who underwent pancreaticoduodenectomy with the help of preoperative imaging and identified replaced RHA from SMA in 12%.…”