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

Abstract

Knowledge of anatomical variations of the hepatic artery from its origin to intrahepatic segmentation is of utmost importance for planning upper abdominal surgeries including liver transplantation, pancreatoduodenectomy, and biliary reconstruction. The origin and branching pattern of the hepatic artery was thoroughly described by the classification of Michels and Hiatt. Some rare variations of the hepatic artery were classified by Kobayashi and Koops. By the use of the multidetector computed tomography (MDCT) technique, the branching pattern of the hepatic artery can be visualized quite accurately. Unawareness of these arterial variations may lead to intraoperative injuries such as necrosis, abscess, and failure of the liver and pancreas. The origin and course of the aberrant hepatic arteries are crucial in the surgical planning of carcinoma of the head of the pancreas and hepatobiliary surgeries. In liver transplant surgeries, to minimize intraoperative bleeding complications and postoperative thrombosis, exact anatomy of the branching of the hepatic artery, its variations and intrahepatic course is of utmost importance. This review discusses variations in the anatomy of the hepatic artery from its origin to branching by the use of advanced imaging techniques and its effect on the liver, pancreatic, biliary and gastric surgeries.

Keywords: MDCT; aberrant artery; hepatic artery; liver transplantation; pancreatoduodenectomy.

Figure 1

(A) Schematic representation of regular branching of the hepatic artery. (B) Coronal maximum intensity projection (MIP) (64-row scanner CT angiography) image of the abdominal region showing the regular anatomical branching pattern of the hepatic artery. Slice thickness: 1.2 mm. AA: Abdominal aorta; CT: Celiac trunk; SA: Splenic artery; LGA: Left gastric artery; CHA: Common hepatic artery; PHA: Proper hepatic artery; RHA: Right hepatic artery; LHA: Left hepatic artery; GDA: Gastroduodenal artery; SMA: Superior mesenteric artery.

Figure 2

(A) Schematic representation of the origin of CHA from the aorta. (B) Three-dimensional (3D) volume render (3D-VR) image (64-row scanner CT angiography) of the abdominal region showing the aberrant (replaced) CHA originating from the aorta. AA: Abdominal aorta; CT: Celiac trunk; SA: Splenic artery; LGA: Left gastric artery; CHA: Common hepatic artery; PHA: Proper hepatic artery; RHA: Right hepatic artery; LHA: Left hepatic artery; GDA: Gastroduodenal artery; SMA: Superior mesenteric artery.

Figure 3

(A) Schematic representation of aberrant (replaced) CHA originating from SMA. (B) Three-dimensional (3D) volume render (3D-VR) image (64-row scanner CT angiography) of the abdominal region showing the aberrant (replaced) CHA originating from SMA. AA: Abdominal aorta; CT: Celiac trunk; SA: Splenic artery; LGA: Left gastric artery; CHA: Common hepatic artery; RHA: Right hepatic artery; LHA: Left hepatic artery; GDA: Gastroduodenal artery; SMA: Superior mesenteric artery.

Figure 4

(A) Schematic representation of aberrant (replace) RHA originated from SMA. (B) Three-dimensional (3D)-VR image (64 row CT-angiography) of the abdominal region showing aberrant (replaced) RHA originated from SMA. AA: Abdominal aorta; CT: Celiac trunk; SA: Splenic artery; LGA: Left gastric artery; CHA: Common hepatic artery; RHA: Right hepatic artery; LHA: Left hepatic artery; GDA: Gastroduodenal artery; SMA: Superior mesenteric artery.

Figure 5

(A) Schematic representation of aberrant (replaced) LHA originated from LGA. (B) Three-dimensional (3D)-VR image (64 row CT-angiography) of the abdominal region showing aberrant (replaced) LHA originated from LGA. AA: Abdominal aorta; CT: Celiac trunk; SA: Splenic artery; LGA: Left gastric artery; CHA: Common hepatic artery; RHA: Right hepatic artery; LHA: Left hepatic artery; GDA: Gastroduodenal artery; SMA: Superior mesenteric artery.

Figure 6

(A) Schematic representation of accessory LHA (aLHA) originated from LGA. (B) Three-dimensional (3D) volume render (3D-VR) image (64-row scanner CT angiography) of the abdominal region showing the accessory LHA (aLHA) originated from LGA. AA: Abdominal aorta; CT: Celiac trunk; SA: Splenic artery; LGA: Left gastric artery; CHA: Common hepatic artery; PHA: Proper hepatic artery; RHA: Right hepatic artery; LHA: Left hepatic artery; GDA: Gastroduodenal artery; SMA: Superior mesenteric artery.

Figure 7

(A) Axial phase maximum intensity projection (MIP) (64-row scanner CT angiography) image of the abdominal region showing tumor infiltrating pancreatic head indicated by the arrow. (B) Axial phase maximum intensity projection (MIP) (64-row scanner CT angiography) image of the abdominal region showing tumor invading the artery indicated by the arrow.