Hepatic Arterial Variations and Its Implication During Pancreatic Cancer Surgeries

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

“…Embryologically, vascular supply of the hepatobiliary system and gut comes from four interconnecting ventral roots known as ventral segmental arteries originating from the dorsal aorta. These four roots give rise to the left gastric, splenic, common hepatic and superior mesenteric arteries, respectively [ 2 , 13 ]. The development of the hepatic artery starts in the 8th week of intrauterine life [ 14 ].…”

“…The variations of CHA need great attention at the time of surgery, as injury to the hepatic artery not only causes liver ischemia but may also cause huge intraperitoneal life-threatening blood loss [ 2 ]. In the second variation, CHA originates from SMA as an aberrant artery and further follows two paths (intra- and extra-parenchymal paths) to reach the liver hilum and follow the conventional intrahepatic course to supply the segments of liver.…”

“…It is very difficult to save CHA in case of its intraparenchymal course during the surgical dissection of the pancreatic head. In the condition of damage to the CHA, reconstruction surgery is performed with end-to-end anastomosis [ 2 , 19 ]. In cases where hepatic arterial reconstruction cannot be performed, the integrity of the gastric arterial arcade between the right and left gastric arteries is detected to maintain the hepatic perfusion via collateral circulation.…”

“…It may originate from the SMA, proper hepatic artery, aorta, left gastric artery and splenic artery. According to the present literature, replaced RHA is present in 5 to 21% of cases and the accessory RHA is present in 1 to 8% of cases [ 2 , 4 , 5 , 18 , 19 , 30 , 32 ]. Replace RHA (Michel Type III) arises from the SMA, passes laterally and posterior to the portal vein and posterolateral to the bile duct, enters the hepatoduodenal ligament and can be palpated at the foramen of Winslow [ 2 , 4 , 18 ] ( Figure 4 ).…”

“…According to the literature, hepatic artery variations are common, and knowledge of these variations has great clinical significance in complicated liver and pancreatic surgeries. Lack of knowledge of these anatomical variations may result in intraoperative injuries in open and laparoscopic surgical procedures [ 2 ]. Hepatic artery variations were studied in detail by various researchers and given the internationally accepted classification.…”