Anatomic Variations of the Hepatic Artery in 5625 Patients

Abstract

Purpose: To analyze the origin and anatomic course of the hepatic arteries by using digital subtraction angiography (DSA) and multidetector CT in a large study sample.

Materials and methods: This retrospective study included 5625 patients who underwent liver CT and chemoembolization between January 2005 and December 2018 (mean age, 60 years ± 11 [range, 11-99 years]; 4464 males). The CT and DSA images were reviewed to evaluate the visceral arterial anatomy for variations in the celiac axis and hepatic arteries. Aberrant right hepatic arteries (aRHAs) and aberrant left hepatic arteries (aLHAs) were defined on the basis of their origin and anatomic course. Statistical analyses were performed to evaluate the association between aRHAs and aLHAs and the association between variations in the hepatic artery and celiac axis.

Results: Right hepatic arteries were categorized as being aRHAs (if originating from the proximal to middle common hepatic artery, gastroduodenal artery, superior mesenteric artery [SMA], celiac axis, aorta, splenic artery, or left gastric artery [LGA]) or as being aLHAs (if arising from the LGA, celiac axis, aorta, or SMA). The prevalence of aRHAs (15.63%; 879 of 5625) and the prevalence aLHAs (16.32%; 918 of 5625) were similar. Patients with an aRHA were more likely to have an aLHA than those without an aRHA (29.01% vs 13.97%; P < .001), and patients with an aLHA were more likely to have an aRHA than those without an aLHA (27.78% vs 13.26%; P < .001). There was no association between the hepatic arterial variations and celiac axis variations. A hypothetical anatomic model summarizing the observed variations was created.

Conclusion: A comprehensive list of hepatic arterial variations and a three-dimensional hypothetical model for the observed variations were described.Keywords: CT, Angiography, Liver, Anatomy, Arteries© RSNA, 2021 Supplemental material is available for this article. See also commentary by Sutphin and Kalva in this issue.

Keywords: Anatomy; Angiography; Arteries; CT; Liver.

Graphical abstract

Figure 1:

Aberrant right hepatic artery (aRHA) originating from the gastroduodenal artery (GDA) in a 59-year-old man. (A) The digital subtraction angiographic image obtained at the common hepatic artery shows the aRHA (arrow) originating from the GDA. (B) On an axial arterial phase CT image, the aRHA (arrowhead) is coursed anteriorly to the common bile duct (arrow).

Figure 2:

Aberrant right hepatic artery (aRHA) originating from the proximal common hepatic artery (CHA) in a 71-year-old man. (A) The digital subtraction angiographic image obtained at the celiac axis demonstrates the aRHA (arrow) arising from the proximal CHA. (B) On a curved multiplanar reconstruction image, the aRHA (arrow) arising from the CHA (arrowhead) is crossing the main portal vein (asterisk) posteriorly.

Figure 3:

Schematic diagrams of the normal hepatic artery and representative cases of minor hepatic arterial variations. (A) Normal hepatic arterial anatomy. (B) Trifurcation of the common hepatic artery (CHA) into the right and left hepatic arteries and gastroduodenal artery. (C) The right and left hepatic arteries are separately and sequentially originating from the distal CHA. Red = hepatic artery, blue = portal vein, green = bile duct.

Figure 4:

Schematic diagrams of aberrant right hepatic arteries (aRHAs) of various origins: (A) from the superior mesenteric artery (SMA), (B) from the gastroduodenal artery (GDA), (C) from the celiac axis, (D) from the proximal to middle common hepatic artery (CHA), and (E) from the aorta. Red = hepatic artery, blue = portal vein, green = bile duct.

Figure 5:

Schematic diagrams of aberrant left hepatic arteries (aLHAs) from (A) the left gastric artery (LGA) and from (B) the celiac axis. Red = hepatic artery, blue = portal vein, green = bile duct.

Figure 6:

Hypothetical anatomic model summarizing the observed hepatic arterial variations. Vessels colored in red indicate normal arterial anatomy, whereas arteries colored in gray represent possible anatomic courses. Blue = portal vein, green = bile duct.