scholarly journals Preserving a Rare Type of Variant Right Hepatic Artery Combines Surgical Radicality and Intact Liver Perfusion during Pancreatectomy

2020 ◽  
pp. 1-3
Author(s):  
Ilgar Aghalarov ◽  
Theodor Lutz ◽  
Waldemar Uhl ◽  
Orlin Belyaev
Keyword(s):  
Hepatic Artery ◽  
Preoperative Evaluation ◽  
Liver Perfusion ◽  
Pancreatic Head ◽  
Celiac Trunk ◽  
Left Gastric Artery ◽  
Resection Margins ◽  
R0 Resection ◽  
Rare Type ◽  
Right Hepatic Artery

An anomalous anatomy of the celiac trunk, and particularly of the right hepatic artery, may have a significant impact on major hepatobiliary and pancreatic surgery. According to some authors, every third patient has an aberrant right hepatic artery. We present a very rare case of replaced right hepatic artery (RRHA) arising from the gastroduodenal artery associated with an accessory left hepatic artery originating from the left gastric artery in a 54-year-old woman with a pancreatic head carcinoma. The patient underwent total pancreatectomy on account of a soft lipomatous pancreas with heterogeneous changes of the pancreatic body and tail. We preserved the RRHA and achieved R0 resection margins. Preoperative evaluation of CT angiograms, an awareness of any anomalous arterial anatomy of the upper abdomen, and a meticulous surgical technique are the key to performing oncologically radical surgery without threatening the arterial liver supply.

scholarly journals PREVALENCE OF HEPATIC ARTERIAL VARIATIONS WITH IMPLICATIONS IN PANCREATODUODENECTOMY

2019 ◽  
Vol 32 (3) ◽  
Author(s):  
Silvio Marcio Pegoraro BALZAN ◽  
Vinicius Grando GAVA ◽  
Sabrina PEDROTTI ◽  
Marcelo Arbo MAGALHÃES ◽  
Alex SCHWENGBER ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Pancreatic Head ◽  
Celiac Trunk ◽  
Arterial System ◽  
Preoperative Imaging ◽  
Periampullary Cancer ◽  
Right Hepatic Artery ◽  
Arterial Variations ◽  
Enhanced Computed Tomography

ABSTRACT Background: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. Aim: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. Methods: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. Results: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. Conclusions: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.

scholarly journals One more anatomic variant of the celiac trunk(in French)

2019 ◽  
pp. 13-16
Keyword(s):  
Hepatic Artery ◽  
Pancreatic Head ◽  
Celiac Trunk ◽  
Anatomical Variations ◽  
Right Hepatic Artery ◽  
Anatomic Variant ◽  
Left And Right ◽  
Rare Anatomic Variant ◽  
Pancreatic Head Tumor ◽  
Arterial Anatomy

Anatomical variations of the celiac trunk are numerous. Variants of the hepatic artery are important to consider especially in the bilio-pancreatic procedures. Unusual arterial anatomy increases the risk of postoperative specific complications. We report a case of a rare anatomic variant of the celiac trunk that gives rise to a left and right hepatic artery separately. It is an exceptional variant found in a patient with a pancreatic head tumor and candidate for duodenopancreatectomy. Key words: celiac trunk, right hepatic artery, anatomic variant.

Rare Anatomic Variation of Left Gastric Artery and Right Hepatic Artery in a Female Cadaver

2008 ◽  
Vol 74 (5) ◽  
pp. 430-432
Author(s):  
Theodore Troupis ◽  
Stamatis Chatzikokolis ◽  
Michael Zachariadis ◽  
George Troupis ◽  
Sofia Anagnostopoulou ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Present Report ◽  
Anatomic Variation ◽  
Celiac Trunk ◽  
Left Gastric Artery ◽  
Proper Hepatic Artery ◽  
Gastric Artery ◽  
Right Hepatic Artery ◽  
Female Cadaver ◽  
The Right

The present report describes a rare case in which the left gastric artery arises directly from the abdominal aorta and the right hepatic artery from the superior mesenteric artery, as observed during the dissection of a female cadaver. The left gastric artery usually rises as one of the three branches of the celiac trunk, which was originally described by Haller in 1756, whereas the right hepatic artery usually originates from the proper hepatic artery. The knowledge of the typical anatomy of the abdominal arteries, and their variations, is especially important due to the numerous interventions performed in the abdominal area.

One more anatomic variant of the celiac trunk(in French)

2019 ◽  
pp. 13-16
Keyword(s):  
Hepatic Artery ◽  
Pancreatic Head ◽  
Celiac Trunk ◽  
Anatomical Variations ◽  
Right Hepatic Artery ◽  
Anatomic Variant ◽  
Left And Right ◽  
Rare Anatomic Variant ◽  
Pancreatic Head Tumor ◽  
Arterial Anatomy

Anatomical variations of the celiac trunk are numerous. Variants of the hepatic artery are important to consider especially in the bilio-pancreatic procedures. Unusual arterial anatomy increases the risk of postoperative specific complications. We report a case of a rare anatomic variant of the celiac trunk that gives rise to a left and right hepatic artery separately. It is an exceptional variant found in a patient with a pancreatic head tumor and candidate for duodenopancreatectomy. Key words: celiac trunk, right hepatic artery, anatomic variant.

scholarly journals Anomalous Celiac Trunk Variation Encountered in Y-90 Radioembolization

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. 

scholarly journals Arterial diameter of the celiac trunk and its branches: anatomical study

2009 ◽  
Vol 24 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Luís Augusto da Silveira ◽  
Fernando Braga Cassiano Silveira ◽  
Valéria Paula Sassoli Fazan
Keyword(s):  
Hepatic Artery ◽  
Celiac Trunk ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Left Gastric Artery ◽  
Gastric Artery ◽  
Arterial Diameter ◽  
Significant Difference ◽  
Diameter Reduction ◽  
Formalin Fixed

PURPOSE: Despite the fact that anatomical variations of the celiac trunk are well explored in the literature, information on these vessels diameters is scanty. The aims of the present study were to describe the arterial diameters of the celiac trunk and its main branches, and to investigate if these diameters are altered in those cases presenting anatomical variations of these vessels. METHODS: Twenty-one formalin fixed adult male cadavers were appropriately dissected for the celiac trunk identification and arterial diameter measurements. Arteries measured included the celiac trunk and its main branches (splenic artery, left gastric artery and common hepatic artery), as the proper hepatic artery, right gastric artery, the left and right hepatic arteries and the gastroduodenal artery. RESULTS: From the 21 cadavers, 6 presented anatomical variations of, at least, one of the above mentioned branches. The average arterial diameter comparisons between groups (normal and variable) clearly showed smaller diameters for variable vessels, but with no significant difference. CONCLUSION: Our data indicates the possibility of a diameter reduction of the celiac trunk main branches in the presence of anatomical variations. This should be taken into account on the selection for the liver transplantation donors.

scholarly journals Celiac Trunk and Hepatic Artery Variants in Pancreatic and Liver Resection Anatomy and Implications in Surgical Practice

2019 ◽  
Vol 7 (15) ◽  
pp. 2563-2568
Author(s):  
Danilo Coco ◽  
Silvana Leanza
Keyword(s):  
Liver Resection ◽  
Hepatic Artery ◽  
Pancreatic Resection ◽  
Celiac Trunk ◽  
Arterial System ◽  
R0 Resection ◽  
Surgical Practice ◽  
Arterial Variations ◽  
Arterial Anomaly ◽  
Hepatic Artery Variants

The presence of celiac trunk or hepatic arterial anomaly influences preservation of vascular arterial system and achievement of an R0 resection in the liver and pancreatic resection. The objective of this study is to review the literature, to describe the anomalous arterial variations of the celiac trunk and hepatic artery reiterating the importance of identification of the anomaly.

scholarly journals Anatomy of the vasculature supplying hepatobiliary structures and celiac trunk branching patterns in the Thai population

2019 ◽  
Vol 12 (4) ◽  
pp. 161-167
Author(s):  
Natcha Nateniyom ◽  
Thanasil Huanmanop ◽  
Sithiporn Agthong ◽  
Vilai Chentanez
Keyword(s):  
Hepatic Artery ◽  
Hepatic Duct ◽  
Celiac Trunk ◽  
Left Gastric Artery ◽  
Vascular Supply ◽  
Common Hepatic Duct ◽  
Branching Pattern ◽  
Thai Population ◽  
Branching Patterns ◽  
Upper Abdominal

AbstractBackgroundKnowledge of the anatomy of the celiac trunk (CT) and arterial supply of the hepatobiliary system is essential for surgical and interventional radiological treatment of upper abdominal diseases.ObjectivesTo determine the branching patterns of the CT and variation in origin and type of the right hepatic artery (RHA), left hepatic artery (LHA), and cystic artery (CA).MethodsThe anatomy of the CT in 100 cadavers from Thai adult donors was observed in 3 aspects: its branching pattern, the origin of the RHA and LHA, and the origin of the CA and its relation to the common bile duct (CBD) and common hepatic duct (CHD).ResultsThe majority of the CT branching pattern was categorized as the type II classical pattern, which has 3 branches: the left gastric artery (LGA), splenic artery (SA), and common hepatic artery (CHA). The RHA branched from proper hepatic artery in 67 cadavers. The origin of the accessory RHA was either from the abdominal aorta or superior mesenteric artery (SMA), whereas the replaced RHA originated from the CHA, SMA, or CT. The accessory LHA ramified from CHA (2 cases) and LGA (1 case). The replaced LHA was found in 30 cadavers and 29 arose from the CHA. The single and double types of CA were found in 94 and 4 cadavers, respectively. In all, 57% of single CA passed posteriorly and 39% passed anteriorly to the CBD and CHD.ConclusionsTo lower posttreatment complications, variations in the anatomy and the vascular supply of hepatobiliary structures should be considered.

scholarly journals Variation in the branching pattern of celiac trunk: a case report

2015 ◽  
Vol 32 (03) ◽  
pp. 200-202
Author(s):  
S. Nayak ◽  
A. Aithal ◽  
S. Shetty ◽  
N. Kumar ◽  
S. Ravindra ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Celiac Trunk ◽  
Anatomical Variations ◽  
Left Gastric Artery ◽  
Branching Pattern ◽  
Gastric Artery ◽  
Current Case ◽  
Hepatic Arteries ◽  
The People ◽  
The Right

AbstractArterial supply for the derivatives of foregut in the abdomen is provided by the branches of the celiac trunk. Celiac trunk is the first ventral branch of abdominal aorta and usually branches into splenic, common hepatic and left gastric arteries. Variations in the branching pattern of celiac trunk are common but in most of the people, they remain asymptomatic and go unnoticed. A good knowledge of these anatomical variations is important for surgeons undertaking various surgeries in the abdominal region and will help to minimise the complications related to abdominal surgery. Clinicians and radiologists should also be aware of any variations in the vascular pattern of the celiac trunk before performing angiographic examinations. In the current case, the celiac trunk divided into two branches; left gastric artery and hepato-splenic trunk. The hepato-splenic trunk further divided into splenic and common hepatic arteries. The common hepatic artery trifitrcated into proper hepatic, gastroduodenal and accessory hepatic arteries. Hepatic artery proper divided into right and left hepatic arteries. The accessory hepatic artery was tortuous and was as large as the left hepatic artery. It gave origin to the right gastric artery and entered the liver through left end of porta hepatis.

RIGHT HEPATIC ARTEY: CLINICAL SIGNIFICANCE OF VARIATIONS IN THE ORIGIN AND ITS RELATIONS WITH THE COMMON HEPATIC DUCT

2021 ◽  
pp. 45-47
Author(s):  
Sabeersha. S ◽  
K.S. Krishnakumari
Keyword(s):  
Hepatic Artery ◽  
Hepatic Duct ◽  
Celiac Trunk ◽  
Anatomical Variations ◽  
Middle Part ◽  
Common Hepatic Duct ◽  
Medical College ◽  
Right Hepatic Artery ◽  
The Common ◽  
The Right

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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