Anatomic Variations of Hepatic Artery: A Study in 479 Liver Transplantations

Abstract

Background:The incidence of anatomic variations of hepatic artery ranges from 20-50% in different series. Variations are especially important in the context of liver orthotopic transplantation, since, besides being an ideal opportunity for surgical anatomical study, their precise identification is crucial to the success of the procedure. Aim:To identify the anatomical variations in the hepatic arterial system in hepatic transplantation. Methods: 479 medical records of transplanted adult patients in the 13-year period were retrospectively analyzed, and collected data on hepatic arterial anatomy of the deceased donor. Results:It was identified normal hepatic arterial anatomy in 416 donors (86.84%). The other 63 patients (13.15%) showed some variation. According to the Michels classification, the most frequently observed abnormalities were: right hepatic artery branch of superior mesenteric artery (Type III, n=27, 5.63%); left hepatic artery branch of the left gastric artery (Type II, n=13, 2.71%); right hepatic artery arising from the superior mesenteric artery associated with the left hepatic artery arising from the left gastric artery (Type IV, n=4, 0.83%). Similarly, in relation to Hiatt classification, the most prevalent changes were: right hepatic accessory artery or substitute of the superior mesenteric artery (Type III, n=28, 6.05%)), followed by liver ancillary left artery or replacement of gastric artery left (Type II, n=16, 3.34. Fourteen donors (2.92%) showed no anatomical abnormalities defined in classifications, the highest frequency being hepatomesenteric trunk identified in five (01.04%). Conclusion:Detailed knowledge of the variations of hepatic arterial anatomy is of utmost importance to surgeons who perform approaches in this area, particularly in liver transplantation, since their identification and proper management are critical to the success of the procedure.

Anatomical Variations of the Superior Mesenteric Artery and Its Clinical and Surgical Implications in Humans

“…It was also verified in the studies of Fonseca Neto et al 3 , that SMA originated the right hepatic artery. Of the 479 patients who underwent liver transplantations, 63 (13.15%) had some type of SMA variation.…”

Coeliac trunk and its anatomic variations: a cadaveric study

“…In our study we referred to Adachi and Michels who have classified the celiac trunk into six different types [2,12]. However, these classifications do not include all observed variants of the celiac trunk as well as accessory or replaced hepatic arteries, both of them are still being mentioned and compared with newly described ones [5,20,22,23,24,25,26]. Furthermore, Adachi's and Michel's classifications described in textbooks were recently considered to create a scheme of the most frequent variants of the celiac trunk and anatomy of the hepatic circulation [19,24].…”

Abnormal Origin and Course of Hepatic Arteries: A Case Report

“…Given the wide range of variations present, knowledge of the possibilities to be found is even more relevant, especially for hepatic transplant surgery (14) , in which each branch can have a direct impact on the success of the surgery. In addition, there were no reports in the literature of the combination of variations of origin and division of hepatic arteries and variation of the right hepatic artery pathway reported here, showing the importance of the current report.…”