Hepatic arterial variations and liver-related diseases of 100 consecutive donors

Mäkisalo, Heikki; Chaib, Eleazar; Krokos, N. V.; Calne, Sir Roy

doi:10.1111/j.1432-2277.1993.tb00675.x

Cited by 29 publications

(23 citation statements)

References 7 publications

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“…Our results were close to those documented for conventional angiographies, the actual gold standard for vascular diagnostics, and furthermore widely match the results concerning the distribution of accessory and replaced vessels. Depending on the study, variations other than the textbook type were between 12 % and 49 % [7,11,31,37,38]. In our study the proportion was 27 %.…”

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confidence: 70%

Hepatic Arterial Supply in 1297 CT-Angiographies

Löschner

Nagel

Kausche

et al. 2015

Fortschr Röntgenstr

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Purpose: Analysis, evaluation and classification of hepatic arterial supply variants and determination of their frequency distribution in CT-angiographies. Materials and Methods: CT-angiographies of 1,568 patients were evaluated retrospectively for the period between January 1, 2010 and August 30, 2012. The hepatic arterial anatomy was assessed and categorized according to Michels?s classification. So far unclassified variants were considered separately. Results: CT-angiographies of 1297 patients were included in the study. Type I according to Michels was seen in 937 cases (72.2?%), followed by type V in 114 patients (8.8?%) and type III in 83 patients (6.4?%). Type X could not be found in any of the patients. Not yet classified variants were discovered in 26 patients. The most frequent variant in this connection was a right hepatic artery originating from the superior mesenteric artery with the left hepatic artery originating from the left gastric artery (n?=?10). Conclusion: Michels?s classification could be largely confirmed on the basis of a radiologically examined patient population. Not yet classified variants were categorized into subgroups of the existing classification. Key points: ??Imaging of hepatic arterial supply variants using CT-angiography ??Distribution of variations of arterial liver supply in a general patient population ??Expansion of Michels?s classification to include new variations of the arterial liver supply Citation Format: ??L?schner C, Nagel SN, Kausche S et?al. Hepatic Arterial Supply in 1297 CT-Angiographies. Fortschr R?ntgenstr 2015; 187: 276???282

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confidence: 70%

Hepatic Arterial Supply in 1297 CT-Angiographies

Löschner

Nagel

Kausche

et al. 2015

Fortschr Röntgenstr

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“…These studies are based on angiographic data and autopsy dissections, and mainly derive from surgery and transplantation literature. [4][5][6][7][8][9][10][11][12][13][14] The large sample size of transplanted livers is one of the major interests of this study. Indeed, harvested livers offer an excellent opportunity to describe, in situ, the anatomic variants of the arteries since all extrahepatic arteries need to be carefully identified during this step of the liver transplantation procedure to avoid injuries that jeopardize the viability of the graft once implanted.…”

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confidence: 99%

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

et al. 2007

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The aim of this study is to contribute our experience to the knowledge of the anatomic variations of the hepatic arterial supply. The surgical anatomy of the extrahepatic arterial vascularization was investigated prospectively in 1,081 donor cadaveric livers, transplanted at La Fe University Hospital from January 1991 to August 2004. The vascular anatomy of the hepatic grafts was classified according to Michels description (Am J Surg 1966;112:337-347) plus 2 variations. Anatomical variants of the classical pattern were detected in 30% of the livers (n ϭ 320). The most common variant was a replaced left artery arising from the left gastric artery (9.7%) followed by a replaced right hepatic artery arising from the superior mesenteric artery (7.8%). In conclusion, the information about the different hepatic arterial patterns can help in reducing the risks of iatrogenic complications, which in turn may result in better outcomes not only following surgical interventions but also in the context of radiological treatments. Knowledge of hepatic arterial vascularization has a significant relevance for the daily practice of a wide range of practitioners including not only surgeons specialized in the hepato-biliary-pancreatic area, but also general surgeons and radiologists, mainly those who are dedicated to interventional radiologic treatments.In the last few years, substantial improvements have been achieved in the surgical and/or radiological treatment of benign and malignant liver, pancreatic, and biliary diseases. With laparoscopic surgery the need has arisen for exact descriptions of the hepatic vascularization to avoid iatrogenic vascular lesions.In the setting of liver transplantation, the most effective approach to reduce the dropout rate on the waiting lists is to expand the number of available livers. Several strategies including living donors and split livers have been developed for this purpose. These are extremely complex techniques in which the exact knowledge of the arterial anatomy is a required step to plan the best resection as well as to minimize the risks of morbidity.The patterns of hepatic arterial supply are not constant. The usual anatomy of the hepatic arterial vascularization is a common hepatic artery arising from the celiac axis, accounting for 25 to 75% of the cases. 1 In the variant patterns, the hepatic lobes receive arterial flow through branches coming from the superior mesenteric artery, left gastric artery, or, rarely, from other arterial trunks. 2 Since Michels 3 published his first report, several studies have reported not only common and rare hepatic artery variants, but also different classifications. These studies are based on angiographic data and autopsy dissections, and mainly derive from surgery and transplantation literature. [4][5][6][7][8][9][10][11][12][13][14] The large sample size of transplanted livers is one of the major interests of this study. Indeed, harvested livers offer an excellent opportunity to describe, in situ, the anatomic variants of the arteries since all e...

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“…Its prevalence ranges from 25-45% (1)(2)(3)(4). The most frequent arterial variant is the aberrant right hepatic artery arising from the superior mesenteric artery (SMA) followed by aberrant left hepatic artery originated from the left gastric artery (1).…”

Section: Introductionmentioning

confidence: 99%

Implication of the presence of a variant hepatic artery during the Whipple procedure

Rubio-Manzanares-Dorado¹,

Marín-Gómez²,

Aparicio-Sánchez³

et al. 2015

Rev Esp Enferm Dig

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Introduction:The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD) in patients with or without a variant hepatic artery arising from superior mesenteric artery. Material and methods:We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean ± standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05. Results:We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%). The most frequent variant was an aberrant right hepatic artery (n = 7), following by the accessory right hepatic artery (n = 2) and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2). In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications.Conclusion: Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.

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Hepatic arterial variations and liver-related diseases of 100 consecutive donors

Cited by 29 publications

References 7 publications

Hepatic Arterial Supply in 1297 CT-Angiographies

Hepatic Arterial Supply in 1297 CT-Angiographies

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

Implication of the presence of a variant hepatic artery during the Whipple procedure

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