Characterization of the middle hepatic artery and its relevance to living donor liver transplantation

Abstract

In comparison with the left and right hepatic arteries, there is a relative lack of information on the middle hepatic artery (MHA). In this study, data obtained by multidetector computed tomography from 145 patients were studied to evaluate anatomical variations of the MHA, a hilar artery that primarily supplies hepatic segment 4. An MHA was present in 103 (71%) of the subjects. In livers that had a replaced left hepatic artery, the MHA originated from the right hepatic artery; in livers that had a replaced right hepatic artery, it originated from the left hepatic artery. It always arose directly or indirectly from the common hepatic artery, from which the gastroduodenal artery also arose. We classified MHAs into 5 types according to the anatomical variations of the origin. This classification may have major relevance to modern surgical practice related to living donor liver transplantation (LDLT). The new classification of hepatic arterial anatomy may enhance the acquisition of further knowledge on arterial development, and its application may favorably influence the outcome of LDLT. Liver Transpl 16:736-741,

Hepatic Arterial Configuration in Relation to the Segmental Anatomy of the Liver; Observations on MDCT and DSA Relevant to Radioembolization Treatment

“…Previous studies showed contradictory results, which may be attributable to these differences in definition. Two recent studies indicated that the artery vascularizing S4 predominantly originated from the RHA and less frequently from the LHA, from both hepatic arteries or directly from the PHA in a trifurcation [8,12]. Our results are more in agreement with earlier studies [1,9,18], suggesting that the artery vascularizing S4 predominantly originates from the LHA and less frequently from the RHA, both hepatic arteries or the PHA.…”

“…Studies that previously investigated the origin of this arterial branch, often used different definitions, and terms, such as A4 and MHA were interchangeably used [8,12,18]. From an anatomical point of view, the term MHA refers to a hilar artery that originates from the CHA or PHA, between the origins of the LHA and RHA, whereas A4 also can refer to a small intrahepatic branch that originates from the distal LHA or RHA [12]. Previous studies showed contradictory results, which may be attributable to these differences in definition.…”

“…The artery vascularizing S4 was named a middle hepatic artery (MHA) when originating from the CHA/PHA as a hilar artery, and a S4 artery (A4) when originating as an intrahepatic branch from the LHA and/or RHA [12]. Aberrant hepatic arteries were defined as hepatic arterial branches that did not originate from the celiac axis directly, or indirectly through the CHA or PHA [1].…”

“…The definitions for aberrant hepatic arteries, replaced, and accessory hepatic arteries are in accordance with the work by Michels [1]. The distinction between A4 and MHA is based on the definition used by Wang et al [12]. The definitions for hepatic arterial configuration, arterial segmental vascularization pattern, early branching pattern, and specification of segments that can be vascularized by replaced and accessory left hepatic arteries were created as part of the extended anatomical classification of variant hepatic arterial anatomy described in this manuscript Table 4 and schematically illustrated in Figs.…”

Study of Aberrant Hepatic Arteries and Its Relevance in Trans-Arterial Embolization Therapy in Hepatictumours

“…These rare types of variations are not seen in the present study. In a study of 145 subjects, Shaofa Wang et al [17] found middle hepatic artery ( MHA) in 103 (71%) of the subjects. [18] stated that middle hepatic artery (MHA) to the quadrate lobe came from RHA in 50% of cases, and in 44% of cases from LHA, and in 6% from the coeliac, hepatic artery, gastroduodenal artery and right gastric artery.…”