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

Abstract

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.

Keywords: anatomical variations; hepatic artery; multidetector computed tomography angiography.

Figure 1

Three distinct types of level of origin of the replaced common hepatic arteries. Replaced CHA origins at the level of: (A) the abdominal portion of the aorta; (B,C) the superior mesenteric artery; (D) the left gastric artery (personal casuistry). (A) Male patient, 75 years old, with a diagnosis of peripheral arterial disease (PAD); (B) male patient, 66 years old, with a diagnosis of critical limb ischemia; 3D reconstruction, for a better view of the described arteries we used gantry tilt/spin (degrees -124/42) (C) male patient, 70 years old, with a diagnosis of chronic kidney disease; (D) male patient, 73 years old, with a diagnosis of PAD. Abbreviations: ALHA—accessory left hepatic artery, CHA—common hepatic artery, CT—celiac trunk, GS TR—gastrosplenic trunk GDA—gastroduodenal artery, HM TR—hepatomesenteric trunk LGA—left gastric artery, LHA—left hepatic artery, PHA—proper hepatic artery, SMA—superior mesenteric artery, and SA—splenic artery.

Figure 1

Three distinct types of level of origin of the replaced common hepatic arteries. Replaced CHA origins at the level of: (A) the abdominal portion of the aorta; (B,C) the superior mesenteric artery; (D) the left gastric artery (personal casuistry). (A) Male patient, 75 years old, with a diagnosis of peripheral arterial disease (PAD); (B) male patient, 66 years old, with a diagnosis of critical limb ischemia; 3D reconstruction, for a better view of the described arteries we used gantry tilt/spin (degrees -124/42) (C) male patient, 70 years old, with a diagnosis of chronic kidney disease; (D) male patient, 73 years old, with a diagnosis of PAD. Abbreviations: ALHA—accessory left hepatic artery, CHA—common hepatic artery, CT—celiac trunk, GS TR—gastrosplenic trunk GDA—gastroduodenal artery, HM TR—hepatomesenteric trunk LGA—left gastric artery, LHA—left hepatic artery, PHA—proper hepatic artery, SMA—superior mesenteric artery, and SA—splenic artery.

Figure 2

MDCT angiography, coronal view. 3D reconstruction, for a better view of the described arteries we used gantry tilt/spin (degrees -6/3). Replaced common hepatic artery originating from the left gastric artery. Female patient, 66 years old, with a diagnosis of PAD.

Figure 3

MDCT angiography of the AA and liver. Female patient, 83 years old, with a diagnosis of PAD. (A) Anterior aspect; (B) transversal aspect. Abbreviations: HPV—hepatic portal vein, PHA—proper hepatic artery, SMV—superior mesenteric vein, and L—liver.