Replaced right hepatic artery arising from the gastroduodenal artery: a rare and challenging anatomical variant of the Whipple procedure

Abstract Accurate assessment of the vascular anatomy is a prerequisite of any pancreatic resection, since an unnoticed arterial injury in the context of a complex resection such as Whipple procedure, can seriously jeopardize patient’s safety. This article aims to describe an infrequent anatomic variant of a replaced right hepatic artery originating directly from the gastroduodenal artery and its potential implications for duodenopancreatectomy, as the gastroduodenal artery is routinely divided. We present here two different cases of this arterial abnormality identified during a Whipple procedure and its implications in each different setting. Preoperative identification of anatomical variations is essential for proficient surgical planning. Nevertheless, when detected during surgery, an meticulous dissection of the hepatoduodenal ligament is required to identify all the vascular relations in order to avoid irreversible damage.

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Revascularization of the Gastroduodenal Artery in a Pancreas Allograft from a Donor with a Replaced Right Hepatic Artery

Transplantation Journal ◽

10.1097/01.tp.0000145056.82764.53 ◽

2005 ◽

Vol 79 (4) ◽

pp. 503 ◽

Cited By ~ 9

Author(s):

Ngoc Thai ◽

Akhtar Khan ◽

Kusum Tom ◽

Amit Basu ◽

Ron Shapiro ◽

...

Keyword(s):

Hepatic Artery ◽

Gastroduodenal Artery ◽

Right Hepatic Artery ◽

Replaced Right Hepatic Artery ◽

Pancreas Allograft

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Implications of the replaced right hepatic artery originating from the gastroduodenal artery in the setting of a pancreatic head mass

Clinical Imaging ◽

10.1016/j.clinimag.2018.07.024 ◽

2018 ◽

Vol 52 ◽

pp. 189-192

Author(s):

Akhil Chawla ◽

Michael H. Rosenthal ◽

Thomas E. Clancy

Keyword(s):

Hepatic Artery ◽

Pancreatic Head ◽

Gastroduodenal Artery ◽

Right Hepatic Artery ◽

Replaced Right Hepatic Artery

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VARIATIONS OF HEPATIC ARTERY ENCOUNTERED IN HEPATOPANCREATICO BILIARY SURGERIES: A STUDY ABOUT REPLACED HEPATIC ARTERY -AN ORIGINAL RESEARCH ARTICLE

10.36106/paripex/6800546 ◽

2019 ◽

pp. 1-3

Author(s):

Anitha. V

Keyword(s):

Hepatic Artery ◽

Anatomical Variations ◽

Original Research ◽

Original Research Article ◽

Biliary Surgery ◽

Medical College ◽

Right Hepatic Artery ◽

Replaced Right Hepatic Artery ◽

Research Article ◽

Multiple Variants

Background: It is very essential to have a good knowledge about hepatic arterial anatomical variations while performing hepatopancreaticobiliary surgical procedures.The frequency of inadvertent or iatrogenic hepatic vascular injury rises in the event of aberrant anatomy and variations. Our study emphasizes the variations of hepatic artery especially the replaced right hepatic artery while doing pancreatico duodenectomy. Methods: During routine 50 hepatopancreatico biliary surgeries done from the period of 2013 to 2018 at department of surgical gastro enterology i n kanyakumari government medical college, asaripallam,tamil nadu.We came across 2 cases of variations of right hepatic artery which was picked up and studied. Results: Out of 50 hepatopancreatico biliary surgeries, only 2 cases(4%) showed the presence of replacing right hepatic artery originating from superior mesenteric artery. Conclusions:An intact hepatic artery is the gateway to successful hepato biliary surgery.Surgeons undertaking hepato biliary surgery must know the hepatic artery anatomy to recognise multiple variants for safe surgery and low morbidity.

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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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ARTERY FIRST TECHNIQUE FOR MANAGEMENT OF ABERRANT HEPATIC ARTERIAL ANATOMY DURING PANCREATICODUODENECTOMY-EXPERIENCE FROM A SPECIALIZED HEPATO-PANCREATO-BILIARY UNIT

Journal of Cancer & Allied Specialties ◽

10.37029/jcas.v2i2.72 ◽

2016 ◽

Vol 2 (2) ◽

Author(s):

Muhammad Taqi Pirzada ◽

Raza Sayyed ◽

Aamir Ali Syed ◽

Fasial Hanif

Keyword(s):

Hepatic Artery ◽

Vascular Anatomy ◽

Liver Parenchyma ◽

Replaced Right Hepatic Artery ◽

Classi Cation ◽

Hepatic Vessels ◽

Artery First ◽

Operative Recovery ◽

Arterial Anatomy ◽

Liver Ischaemia

Purpose: Aberrant hepatic arterial anatomy poses a challenge for surgeon during pancreaticoduodenectomy (PD). These anomalies are best picked up on pre-operative imaging to avoid inadvertent injury to the aberrant vasculature resulting in liver ischaemia or biliary-enteric anastomotic failure. We present our experience of dealing with aberrant hepatic vessels during PD. Methods: Patients with aberrant hepatic vasculature who underwent PD between September 2014 and August 2015 were included in the study. We used artery rst technique for dissection in cases identified on pre operative imaging. Aberrations were classed according to Hiatt classi cation. Results: A total of 23 PD were performed with aberrant arterial anatomy in 10 (43%) cases. These vessels were recognised and preserved in nine cases. In one patient, the replaced right hepatic artery (RRHA) arising from superior mesenteric artery (SMA) was coursing through pancreatic parenchyma needing resection and reconstruction with uneventful post-operative recovery. We also identified one RRHA arising from SMA coursing lateral to common bile duct and entering liver parenchyma in gallbladder fossa. Conclusion: Aberrant hepatic arterial anomalies are common and should ideally be picked up by pre-operative imaging. It is possible to preserve these vessels in most cases with careful surgical dissection using artery first technique. Surgeons performing PD should be well versed with the aberrant vascular anatomy to minimise any inadvertent damage. Key words: Aberrant hepatic artery, artery first technique, pancreaticoduodenectomy

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