Prepancreatic common hepatic artery arising from superior mesenteric artery: an exceptional but important finding during pancreaticoduodenectomy

Cinelli, Lorenzo; Felli, Eric; Muttillo, Edoardo Maria; Fiorentini, Guido; Diana, Michèle; Pessaux, Patrick; Felli, Emanuele

doi:10.1007/s00276-021-02786-7

Cited by 3 publications

(5 citation statements)

References 28 publications

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“…They found that the prevalence of the tp-CHA was ~ 0.38%; [12] however, one more recent case series assessed nine patients undergoing PD with a RCHA and found that the intrahepatic course occurred more often at a rate of 3 out of the 9 patients (33%). [13] Four of the patients had a posterior positioned artery, while in three cases, it was anteriorly located. In three of these patients, preoperative planning was performed with knowledge of the variation while in four cases, the CHA variation was not described in the preoperative radiology reports.…”

Section: Discussionmentioning

confidence: 86%

Replaced Common Hepatic Artery Variations: Anatomical Considerations and Implications for Surgery: A Review and Case Report

2022

J Surg

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Cadaver organ donors have been an excellent resource for studying vascular systems since precise anatomical details can be identified and assessed. From these studies over the past several decades, anatomical variations have been categorized into classification and modeling systems. These systems have been used as procedural guides and planning by anatomists, surgeons and interventional radiologists. This has helped to predict and strive for optimal surgical and clinical outcomes, as well as help reduce procedural complications associated with anatomical knowledge deficiencies. Aberrations of the celiac trunk have been studied quite extensively because it is generally prone to variations and because of its juxtaposition and contribution to the pancreas, liver, duodenum and hepatic biliary tree. Six of the common classification systems currently used by surgeons and interventional radiologists include those created by Lipshutz, Adachi, Morita, Uflacker, Hiatt and Michels. All six classification systems acknowledge the rare variant characterized by a common hepatic artery arising from the superior mesenteric artery, which is referred to as the replaced common hepatic artery or the celiacomesenteric trunk. This variant can have significant clinical implications owing to its proximity to the pancreatic head. As imaging modality advancements continue to evolve, it is expected that anatomical modeling will also likely enhance. We are entering a time when more centralized and cohesive arterial classification systems are needed to help further our understanding of vascular variant patterns.

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Section: Discussionmentioning

confidence: 86%

Replaced Common Hepatic Artery Variations: Anatomical Considerations and Implications for Surgery: A Review and Case Report

2022

J Surg

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“…In three of eight cases 8 , 11 , 12 , the surgical team was able to accurately detect vascular abnormalities through precise preoperative imaging examination. The first case was a 79-year-old man who experienced a painless progressive jaundice for two weeks and underwent a subsequent PD as a result of the ampullary tumour diagnosis.…”

Section: Discussionmentioning

confidence: 98%

“…Classifications like Michel’s and Hiatt’s are commonly used to categorize these variations. Among the rarest types, occurring in less than 2% of cases, is where the CHA arises entirely from the SMA, noted as type IX in Michel’s classification, (Table 1 ) and type V in Hiatt’s classification (Table 2 ) 8 .…”

Section: Discussionmentioning

confidence: 99%

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A rare variation of common hepatic artery identified during pancreaticoduodenectomy: a case report and literature review from Syria

Saiouf,

Nayouf,

Aldairi

et al. 2024

Annals of Medicine &Amp; Surgery

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Introduction: It is common for the liver to be supplied blood by a hepatic artery branching off the coeliac trunk. Occasionally, a replaced common hepatic artery (RCHA), emerges from the superior mesenteric artery (SMA), can supply the liver in 1.5–4.0% of cases. Computed tomography (CT) angiography is a highly accurate method for identifying arterial anomalies, which may remain undetected until the time of surgery, leading to unexpected complications. Case presentation: A 53-year-old male exhibiting symptoms of decreased appetite, weight loss, vomiting, and altered sclera, urine, and stool colour, underwent a contrast-enhanced CT scan revealing biliary tract dilatation and pancreatic abnormalities, leading to a pancreaticoduodenectomy. During the surgery, an uncommon arterial finding—CHA from SMA—was noted. Pancreatic cancer was confirmed. The patient was discharged a week post-surgery without issues, emphasizing perioperative care progress. Discussion: The authors’ study focused on the detection conditions of the same hepatic artery anomaly in eight cases reported between 2017 and 2023. In two of them the anomaly was discovered in cadaver by routine autopsy. In three cases, this variation was identified before the surgery, but in three other cases it wasn’t detected until the surgical procedure. In the authors’ case, due to multiple reasons, the anomaly remained undetectable until the surgery. Conclusion: This study underscores the importance of thorough preoperative evaluation to grasp vascular variations for better patient care. Also, a noteworthy observation in our case is that the surgeon identified an expanded hepatic vessel, prompting further investigation into this anomaly.

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“…They observed tp-CHA variation in 0.38% of cases. However, one recent case series assessed nine patients undergoing pancreaticoduodenectomy with an RCHA and found that the intrahepatic course occurred more often than it appears in the literature, with a prevalence of 33% [30].…”

Section: Discussionmentioning

confidence: 99%

Clinical Consideration of Anatomical Variations in the Common Hepatic Arteries: An Analysis Using MDCT Angiography

Ghenciu

Bolintineanu

Iacob³

et al. 2023

Diagnostics

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Purpose: The purpose of this study was to determine the prevalence of normal hepatic vascularization and variations in the common hepatic arteries using multidetector computer tomography angiography. These variants should be acknowledged before any surgery of the upper abdomen. The aim of our work was to analyze the variations in the hepatic arteries and their possible clinical and surgical implications. Materials and methods: This study was carried out on 4192 patients who underwent 64-slice MDCT angiography, from August 2015 to December 2021. We used surface and volume-rendering techniques in order to post-process images of the vascular components in the desired area. Results: We highlighted 76 cases with replaced common hepatic arteries, which are characterized by the origin of the common hepatic artery trunk located outside the classical composition of the celiac trunk. We identified three levels of origin: the abdominal aorta, the superior mesenteric artery and the left gastric artery. We observed six different aspects of the morphological variability of the celiac trunk and the superior mesenteric artery. The trajectory of the artery trunk, between the aortic origin and the hepatic pedicle portion of the hepatic portal vein, is variable and we analyzed the pancreatic trajectory accordingly. Conclusions: The prevalence of hepatic arterial variants found during this study was similar to that in other specialized studies. We came across variants that have not been described in the well-known classification of Michels and even described extremely rare variations. The study of abnormal hepatic vascularization plays an important role in the surgical planning of hepatic transplantation, liver and pancreatic resection and extrahepatic upper abdominal surgeries.

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Prepancreatic common hepatic artery arising from superior mesenteric artery: an exceptional but important finding during pancreaticoduodenectomy

Cited by 3 publications

References 28 publications

Replaced Common Hepatic Artery Variations: Anatomical Considerations and Implications for Surgery: A Review and Case Report

Replaced Common Hepatic Artery Variations: Anatomical Considerations and Implications for Surgery: A Review and Case Report

A rare variation of common hepatic artery identified during pancreaticoduodenectomy: a case report and literature review from Syria

Clinical Consideration of Anatomical Variations in the Common Hepatic Arteries: An Analysis Using MDCT Angiography

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