open access

Ahead of Print
Original article
Submitted: 2020-08-21
Accepted: 2021-02-01
Published online: 2021-03-01
Get Citation

Anatomical variations of the hepatic artery: a closer view of rare unclassified variants

A. Imam1, C. Karatas1, N. Mecit1, A. Durur Karakaya2, T. Yildirimoglu1, M. Kalayoglu1, T. Kanmaz1
DOI: 10.5603/FM.a2021.0024
·
Pubmed: 33749803
Affiliations
  1. Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey
  2. Radiology Department, Koc University Hospital, Istanbul, Turkey

open access

Ahead of Print
ORIGINAL ARTICLES
Submitted: 2020-08-21
Accepted: 2021-02-01
Published online: 2021-03-01

Abstract

Background: Defining the hepatic artery anatomy is of great importance for both surgeons and radiologists. Michel classification was designed to classify hepatic artery variations. Nevertheless, there are variations that do not fit into this classification. In this study, we aim to define the incidence of all variations in a healthy liver donor by reviewing their CT scan with special emphasis on variations that do not fit in any of the Michel classes. Materials and methods: A retrospective analysis of CT scan of donors and potential liver donors who were evaluated by triphasic CT scan. The CT scans were reviewed independently by a radiologist and two transplant surgeons. Cases that did not fit in any of the Michel classes were classified as class 0. Results: Out of 241 donors, 210 were classified within the Michel classification, of which 60.9 % were class I and 9.1% class II. Thirty-one donors (12.9%) classified as class 0. Of which, nine, three, two and three had replaced right hepatic artery from pancreaticoduodenal artery, gastroduodenal artery, aorta and celiac artery, respectively. Two and 6 donors had accessory right hepatic artery from pancreaticoduodenal artery and gastroduodenal artery respectively.  Segment 4 artery originated from left and right hepatic artery in 56.8% and 31.9%, respectively. Conclusions: A great caution should be taken when evaluating the hepatic artery anatomy, clinicians should anticipate and be familiar with the rare unclassified variations of the hepatic artery.

Abstract

Background: Defining the hepatic artery anatomy is of great importance for both surgeons and radiologists. Michel classification was designed to classify hepatic artery variations. Nevertheless, there are variations that do not fit into this classification. In this study, we aim to define the incidence of all variations in a healthy liver donor by reviewing their CT scan with special emphasis on variations that do not fit in any of the Michel classes. Materials and methods: A retrospective analysis of CT scan of donors and potential liver donors who were evaluated by triphasic CT scan. The CT scans were reviewed independently by a radiologist and two transplant surgeons. Cases that did not fit in any of the Michel classes were classified as class 0. Results: Out of 241 donors, 210 were classified within the Michel classification, of which 60.9 % were class I and 9.1% class II. Thirty-one donors (12.9%) classified as class 0. Of which, nine, three, two and three had replaced right hepatic artery from pancreaticoduodenal artery, gastroduodenal artery, aorta and celiac artery, respectively. Two and 6 donors had accessory right hepatic artery from pancreaticoduodenal artery and gastroduodenal artery respectively.  Segment 4 artery originated from left and right hepatic artery in 56.8% and 31.9%, respectively. Conclusions: A great caution should be taken when evaluating the hepatic artery anatomy, clinicians should anticipate and be familiar with the rare unclassified variations of the hepatic artery.

Get Citation

Keywords

anatomical variations, computed tomography, hepatic artery, replaced right hepatic artery, gastroduodenal artery, pancreaticoduodenal artery

About this article
Title

Anatomical variations of the hepatic artery: a closer view of rare unclassified variants

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Original article

Published online

2021-03-01

Page views

596

Article views/downloads

473

DOI

10.5603/FM.a2021.0024

Pubmed

33749803

Keywords

anatomical variations
computed tomography
hepatic artery
replaced right hepatic artery
gastroduodenal artery
pancreaticoduodenal artery

Authors

A. Imam
C. Karatas
N. Mecit
A. Durur Karakaya
T. Yildirimoglu
M. Kalayoglu
T. Kanmaz

References (18)
  1. Balachandran A, Darden DL, Tamm EP, et al. Arterial variants in pancreatic adenocarcinoma. Abdom Imaging. 2008; 33(2): 214–221.
  2. Cazejust J, Bessoud B, Colignon N, et al. Hepatocellular carcinoma vascularization: from the most common to the lesser known arteries. Diagn Interv Imaging. 2014; 95(1): 27–36.
  3. Ciyiltepe H, Cetin D, Aday U, et al. Rare hepatic artery anomaly (Michel type unclassified) in a patient who underwent radical gastrectomy for gastric cancer: a case report. Bezmialem Science. 2017; 5(3): 142–144.
  4. Favelier S, Germain T, Genson PY, et al. Anatomy of liver arteries for interventional radiology. Diagn Interv Imaging. 2015; 96(6): 537–546.
  5. Goss C. Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. By N. A. Michels. xiv + 581 pages, 172 figures. $24.00. J. B. Lippincott Company, Philadelphia, 1955. Anat Rec. 1960; 137(2): 153–154.
  6. Hlaing KP, Othman F. Complex pattern of a variant hepatic artery. Singapore Med J. 2012; 53(9): e186–e188.
  7. Imam R, Khalayleh H, Khoury D, et al. Rupture of an idiopathic aneurysm of the inferior pancreaticoduodenal artery leading to an intra-abdominal bleeding. J Acute Care Surg. 2020; 10(1): 33–35.
  8. Johnson PB, Cawich SO, Shah S, et al. Vascular supply to the liver: a report of a rare arterial variant. Case Rep Radiol. 2013; 2013: 969327.
  9. Liang Y, Li E, Min J, et al. Rare anatomic variation of the right hepatic artery and accessory right hepatic artery supplying hepatocellular carcinoma: A case report and literature review. Medicine (Baltimore). 2017; 96(39): e8144.
  10. Mehta V, Dave V, Suri RK, et al. Quadrifurcation of the hepatic artery proper in conjunction with double right gastric arteries. Singapore Med J. 2012; 53(10): e211–e213.
  11. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966; 112(3): 337–347.
  12. Morita M. Reports and conception of three anomalous cases on the area of the celiac and the superior mesenteric arteries. Igaku Kenkyu. 1936; 5: 159–172.
  13. Munshi IA, Fusco D, Tashjian D, et al. Occlusion of an aberrant right hepatic artery, originating from the superior mesenteric artery, secondary to blunt trauma. J Trauma. 2000; 48(2): 325–326.
  14. Padilla Valverde D, Villarejo Campos P, Villanueva Liñán J, et al. [Radiological-surgical methods to identify celiac-mesenteric anomalies of the hepatic artery before duodenopancreatectomy]. Cir Esp. 2013; 91(2): 103–110.
  15. Polguj M, Podgórski M, Hogendorf P, et al. Variations of the hepatobiliary vasculature including coexistence of accessory right hepatic artery with unusually arising double cystic arteries: case report and literature review. Anat Sci Int. 2014; 89(3): 195–198.
  16. Prakash , Rajini T, Mokhasi V, et al. Coeliac trunk and its branches: anatomical variations and clinical implications. Singapore Med J. 2012; 53(5): 329–331.
  17. Tandler J. über die Varietäten der Arteria coeliaca und deren Entwickelung. Beiträge und Referate zur Anatomie und Entwickelungsgeschichte. 1904; 25(2): 473–500.
  18. Ye Z, Ye S, Zhou D, et al. A rare variation of celiac trunk and hepatic artery complicating pancreaticoduodenectomy: A case report and literature review. Medicine (Baltimore). 2017; 96(48): e8969.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By  "Via Medica sp. z o.o." sp.k., Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl