The Branching Pattern of the Inferior Pancreaticoduodenal Artery in Patients with a Replaced Right Hepatic Artery

Abstract

Understanding the anatomy of the inferior pancreaticoduodenal artery (IPDA) is important in patients undergoing pancreaticoduodenectomy, especially in an artery-first approach, resulting in some studies focusing on IPDA anatomy. However, the studies have covered only cases without variation in hepatic arterial anatomy, a common arterial variant, suggesting the necessity of the investigation of IPDA anatomy in cases with the variant. Using images of multidetector row computed tomography, cases with replaced right hepatic artery (rRHA) were picked out among 714 patients undergoing multidetector row computed tomography for determining arteries of the pancreatic head at our institution. IPDA branching pattern was investigated in the rRHA cases. Three-dimensional reconstruction was performed to visually understand the branching pattern in representative cases. rRHA was identified in 139 cases (19.5%); rRHA originating from the superior mesenteric artery (SMA) (type 1; 74.1%), celiac axis (type 2; 18.0%), and others (type 3; 7.9%). IPDA branching pattern was categorized; IPDA originated from SMA (type A), posterior and anterior IPDA originated from rRHA and SMA, respectively (type B), or IPDA originated from rRHA (type C). Of type 1 cases, 69, 23, and 11 cases showed type A, B, and C pattern, respectively. Of type 2 cases, 16 and 9 cases showed type A and B, respectively. All 11 type 3 cases showed type C. IPDA branching pattern was determined in the rRHA cases. This would help identification of rRHA cases where the artery-first approach is technically less feasible at pancreaticoduodenectomy (type 1-B, 1-C, and 2-B).

Precision anatomy for safe approach to pancreatoduodenectomy for both open and minimally invasive procedure: A systematic review

“…The main origin of aberrant RHA was SMA, celiac artery, and aorta, and the frequency was reported to be 74.1%‐80.7%, 18.0%‐19.2%, and 7.9%, respectively 11,42 . The most frequent running pattern of aberrant RHA was the route behind the head of the pancreas and then posteriorly and laterally to the main portal vein before reaching the liver (Figure 2b) (85.7%‐100%) 11,35 .…”

Aberrant Inferior Pancreaticoduodenal Artery During Upper Gastrointestinal Bleed Embolization

“…However, only one study looked at multiple branching patterns of IPDA in the setting of multiple patterns of replaced RHA. Tomimaru et al found the incidence of replaced RHA to be 19.5% (that includes every variation of RHA – not only originating from SMA) [ 8 ]. Most commonly they found IPDA to arise directly from SMA (designated as A).…”

“…The least common variation was the IPDA arising from replaced RHA (designated as C). In the third type, Tomimaru et al describe posterior IPDA arising from replaced RHA while the anterior IPDA arises from SMA (designated as B) [ 8 ]. At this point, we would like to propose the addition of a fourth branching pattern of IPDA (can be designated as D) in which the posterior IPDA arises from replaced RHA and anterior IPDA branches off the middle colic artery instead of directly from SMA [ 8 ].…”

“…The most common anatomical branching pattern seen in the general population is the anterior and posterior IPDA sharing a common origin directly from superior mesenteric artery (SMA) [ 6 ]. However, multiple branching patterns of IPDA are present in the setting of replaced/accessory right hepatic artery (RHA) [ 7 , 8 ].…”

Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment

“…The inferior pancreaticoduodenal artery (IPDA) becomes a good anatomical landmark during the dissection around the SMA [ 60 , 61 , 62 , 63 ]. The IPDA forms a common trunk with the first jejunal artery in most cases (J1A) [ 61 , 64 ]. The dissection range can be determined during surgery based on the path of this artery.…”