Congenital biliary dilatation in the era of laparoscopic surgery, focusing on the high incidence of anatomical variations of the right hepatic artery

The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver . It also supplies the gall bladder, cystic duct, common hepatic duct and upper and middle part of common bile duct. Normal hepatic arterial anatomy occurs in approximately in 80% of cases, for the remaining 20% multiple variations have been described. Misinterpretation of anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. Materials and Methods: This descriptive study conducted on 50 cadavers in Department of Anatomy,Govt Medical College, Kozhikode to document the normal anatomy and different variations of right hepatic artery regarding its origin and relation with the common hepatic duct. Results : Right hepatic artery had its origin from proper hepatic artery in 47 (94%) cases, in one case the artery came from common hepatic artery, aberrant origin of right hepatic artery was seen in 4% cases, one case from celiac trunk directly and the other from superior mesenteric artery. Relation with common hepatic duct : In 46 cases (92%) the artery (normal and aberrant) passes posterior to common hepatic duct. In 6%, the artery was related anterior to common hepatic duct. In one case the artery was medial to the common hepatic duct. Conclusions : This study highlights the importance of knowledge of such anomalies since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

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Anomalous Celiac Trunk Variation Encountered in Y-90 Radioembolization

Proceedings of IMPRS ◽

10.18060/24637 ◽

2020 ◽

Vol 3 ◽

Author(s):

Alexander Huang ◽

Ramana Yedavalli

Keyword(s):

Hepatic Artery ◽

Celiac Trunk ◽

Anatomical Variations ◽

Left Gastric Artery ◽

Arterial Supply ◽

Right Hepatic Artery ◽

Replaced Right Hepatic Artery ◽

Ct Angiogram ◽

The Right ◽

Selection Of

Background: Yttrium-90 microsphere embolization is a selective internal radiation therapy (SIRT) used in the treatment of hepatocellular carcinoma and liver metastases. Current literature recommends lobar, or more selective, infusion of SIRT to allow for precise radiation administration and to mitigate risk of non-target embolization. Lobar infusion requires knowledge of anatomical variations of hepatic arterial supply. The trifurcation of the celiac trunk into the left gastric artery, splenic artery, and common hepatic artery is the most common presentation representing 51% to 89% of patient anatomy. A replaced right hepatic artery (RHA) arising from the superior mesenteric artery (SMA) is one of the most common variants of hepatic arterial supply with a prevalence of 10.6% to 15%. Common variations such as these are well described and easily mapped using catheter angiography, but rarer variations are not as well described and more challenging to map. Project Methods: Mapping catheter angiogram of the celiac trunk and SMA was obtained. Additional aortogram and CT angiogram were obtained to further elucidate patient’s anatomy. Results: Initial mapping angiogram was only partially successful because the RHA could not be selected. Abdominal aortogram and CT angiogram of the abdomen and pelvis revealed a replaced RHA arising directly from the distal celiac trunk. Additionally, the patient had a replaced cystic artery arising from the left hepatic artery and an arc of Buhler connecting the proximal SMA to the proximal aspect of the right hepatic artery. Conclusion: Radiologists need to be aware of rare variations in hepatic arterial supply for the safe and effective treatment of hepatic neoplasms, whether primary or metastatic. Description of arterial variation and informed selection of arterial branches will remain a critical aspect of improving efficiency and reducing risks of hepatic embolization procedures.

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Percutaneous Trans-Hepatic Embolization of an Iatrogenic Extra-Hepatic Pseudoaneurysm of the Right Hepatic Artery in a Patient With Previous Occlusion of the Proper Hepatic Artery: An Endovascular Procedure to Avoid a Difficult Surgical Repair

Vascular and Endovascular Surgery ◽

10.1177/15385744211022591 ◽

2021 ◽

pp. 153857442110225

Author(s):

Giuseppe S. Gallo ◽

Roberto Miraglia ◽

Luigi Maruzzelli ◽

Francesca Crinò ◽

Christine Cannataci ◽

...

Keyword(s):

Computed Tomography ◽

Hepatic Artery ◽

Surgical Repair ◽

Endovascular Embolization ◽

Proper Hepatic Artery ◽

Ultrasound Guided ◽

Complete Occlusion ◽

Right Hepatic Artery ◽

Ultrasonographic Guidance ◽

The Right

We report a case of successful percutaneous transhepatic, embolization of an iatrogenic extra-hepatic pseudoaneurysm (PsA) of the right hepatic artery (RHA) under combined fluoroscopic and ultrasonographic guidance. A 73-year-old man underwent percutaneous transhepatic biliary drainage placement in another hospital, complicated by haemobilia and development of a RHA PsA. Endovascular embolization was attempted, resulting in coil embolization of the proper hepatic artery, and persistence of the PsA. At this point, the patient was referred to our hospital. Computed tomography and direct angiography confirmed the iatrogenic extra-hepatic PsA of the RHA, refilled by small collaterals from the accessory left hepatic artery (LHA) and coil occlusion of the proper hepatic artery. Attempted selective catheterization of these vessels was unsuccessful due to the tortuosity and very small caliber of the intra-hepatic collaterals, the latter precluding endovascular treatment of the PsA. Percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA was performed with Lipiodol® and cyanoacrylate-based glue (Glubran®2). Real time fluoroscopic images and computed tomography confirmed complete occlusion of the pseudoaneurysm. Surgical repair, although feasible, was considered at high risk. In our patient, we decided to perform a percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA using a mix of Lipiodol® and Glubran®2 because of the fast polymerization time of the glue allowing the complete occlusion of the PsA in few seconds, thus eliminating the risk of coil migration, reducing the risk of PsA rupture and avoid a difficult surgical repair.

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Anomalous arterial supply to the gallbladder from the superior mesenteric artery: angiography and computed tomography findings in two cases

Acta Radiologica ◽

10.1080/02841850802282829 ◽

2008 ◽

Vol 49 (9) ◽

pp. 987-990 ◽

Cited By ~ 1

Author(s):

Y. Katada ◽

M. Kishino ◽

K. Ishihara ◽

T. Takeguchi ◽

H. Shibuya

Keyword(s):

Computed Tomography ◽

Superior Mesenteric Artery ◽

Hepatic Artery ◽

Mesenteric Artery ◽

Cystic Artery ◽

Arterial Supply ◽

Hepatic Arteries ◽

Right Hepatic Artery ◽

Pancreatic Artery ◽

The Right

The arterial supply of the gallbladder usually arises from the right hepatic artery. Other origins include the left, proper, and common hepatic arteries. We report cases of the cystic artery arising from the superior mesenteric artery and arising from the dorsal pancreatic artery originating in turn from the superior mesenteric artery, as demonstrated by angiography and computed tomography.

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An Unusual Cause of an Intraperitoneal Bleed: Bleeding Hepatic Artery Pseudoaneurysm Due to an Eroding Cholecystitis

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620982431 ◽

2020 ◽

Vol 8 ◽

pp. 232470962098243

Author(s):

Khalid Sawalha ◽

Anthony Kunnumpurath ◽

Ronald McCann

Keyword(s):

Hepatic Artery ◽

Open Cholecystectomy ◽

Artery Aneurysm ◽

Hemodynamic Instability ◽

Central Line ◽

Hepatic Artery Aneurysm ◽

Artery Pseudoaneurysm ◽

Right Hepatic Artery ◽

Abdominal Ct Scan ◽

The Right

An 80-year-old male patient presented with sepsis secondary to infected central line which was placed for native aortic valve endocarditis. He also had melena and abdominal pain prior to his presentation. Abdominal computed tomography (CT) was done, which showed cholelithiasis. Esophagogastroduodenoscopy was also done with no source of bleeding identified. Later, he developed hemodynamic instability requiring aggressive fluid resuscitation and multiple packed blood cell transfusions. In view of his hemodynamic instability, a repeat abdominal CT scan showed air droplets within the gallbladder pneumobilia, ascites, diverticulosis, and a bleeding infrahepatic hematoma measuring 6 × 10 cm, which was not on his prior scan 2 days prior. A mesenteric arteriogram was performed that identified an aneurysm of the right hepatic artery with no active bleeding; therefore, it was coiled. Due to his continued clinical decompensation, he underwent an urgent open cholecystectomy, in which serosanguineous fluid, cholecystocolic fistula, and old clot related to his previous bleed were encountered. However, control of bleeding was difficult, and the patient expired. We report this case of right hepatic artery aneurysm that we believe its etiology was related to eroding cholecystitis.

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