Replaced gastroduodenal artery with continuation as accessory left hepatic artery: a rare anatomical variant

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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Greater Saphenous Vein Graft Revascularization of the Left Hepatic Artery after Resection of Intrahepatic Cholangiocarcinoma with Common Hepatic Artery Resection

Archives of Hand and Microsurgery ◽

10.12790/ahm.19.0064 ◽

2020 ◽

Vol 25 (2) ◽

pp. 161-165

Author(s):

Jong Yun Choi ◽

Ee Room Jung ◽

Jangyoun Choi ◽

Ki Hwan Kim ◽

Sung-No Jung ◽

...

Keyword(s):

Hepatic Artery ◽

Saphenous Vein ◽

Saphenous Vein Graft ◽

Tumor Resection ◽

Gastroduodenal Artery ◽

Common Hepatic Artery ◽

Left Hepatic Artery ◽

Hepatic Artery Resection ◽

The Common ◽

Artery Resection

Resection of biliary tract malignancies may require resection of the hepatic vasculature. While immediate revascularization of the liver is necessary, reconstruction is difficult when the original vessels are unavailable. We document a case in which a segment of the common hepatic artery was excised during tumor resection and the remaining proximal vessel displayed intima dissection. A greater saphenous vein was placed as a bridge between the remaining left hepatic artery and gastroduodenal artery for successful revascularization.

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Abnormal Persistence of Embryonic Blood Supply of Liver: Anatomist’s Delight, Surgeon’s Nightmare

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2019.106 ◽

2019 ◽

Vol 62 (2) ◽

pp. 72-76

Author(s):

Sabah Yaseen ◽

Surbhi Wadhwa ◽

Kahkashan Jeelani ◽

Anita Mahajan ◽

Sabita Mishra

Keyword(s):

Hepatic Artery ◽

Vascular Anatomy ◽

Left Gastric Artery ◽

Gastroduodenal Artery ◽

Unique Case ◽

Left Hepatic Artery ◽

Hepatic Arteries ◽

Patient Morbidity ◽

High Incidence ◽

The Common

The high incidence of hepato-biliary vascular anatomy variations necessitates its evaluation prior to performing liver transplantation, hepatobiliary, pancreatic, gastric and oesophageal surgeries. We report a unique case of persistence of embryonic arteries of the liver, wherein, the liver was supplied by five vessels. In addition to the usual right and left hepatic arteries from the hepatic artery proper, the liver received two accessory right hepatic arteries, one from the gastroduodenal artery, while another arising from superior mesenteric artery and an accessory left hepatic artery, from the left gastric artery. The origin of gastroduodenal artery was found to be unusually high and its abnormal anterior course over the common bile duct further added complexity to the hepatobiliary anatomy. The presence of these aberrant and accessory arteries predisposes to inadvertent injury leading to patient morbidity and sometimes mortality.

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Clinical Significance of Anatomical Variant of the Left Hepatic Artery for Perihilar Cholangiocarcinoma Applied to Right-Sided Hepatectomy

World Journal of Surgery ◽

10.1007/s00268-014-2715-8 ◽

2014 ◽

Vol 38 (12) ◽

pp. 3210-3214 ◽

Cited By ~ 6

Author(s):

Hiroaki Shimizu ◽

Isamu Hosokawa ◽

Masayuki Ohtsuka ◽

Atsushi Kato ◽

Hideyuki Yoshitomi ◽

...

Keyword(s):

Hepatic Artery ◽

Clinical Significance ◽

Perihilar Cholangiocarcinoma ◽

Left Hepatic Artery ◽

Anatomical Variant

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Complications in hepatic arterial infusion chemotherapy: retrospective comparison of catheter tip placement in the right/left hepatic artery vs. the gastroduodenal artery

Surgery Today ◽

10.1007/s00595-016-1465-7 ◽

2017 ◽

Vol 47 (7) ◽

pp. 851-858 ◽

Cited By ~ 1

Author(s):

Rinpei Imamine ◽

Toshiya Shibata ◽

Ken Shinozuka ◽

Kaori Togashi

Keyword(s):

Hepatic Artery ◽

Hepatic Arterial Infusion ◽

Gastroduodenal Artery ◽

Left Hepatic Artery ◽

Arterial Infusion ◽

Arterial Infusion Chemotherapy ◽

Infusion Chemotherapy ◽

Retrospective Comparison ◽

Catheter Tip ◽

The Right

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Multidisciplinary treatment of left hepatic artery pseudoaneurysm after hepatobiliary resection for gallbladder cancer: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0757-8 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Ryusei Yamamoto ◽

Teiichi Sugiura ◽

Yukiyasu Okamura ◽

Takaaki Ito ◽

Yusuke Yamamoto ◽

...

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Liver Failure ◽

Hepatic Artery ◽

Remnant Liver ◽

Left Hepatic Artery ◽

Artery Pseudoaneurysm ◽

Hepatobiliary Resection ◽

Portal Vein Arterialization ◽

Arterial Inflow

Abstract Background When a postoperative hepatic artery pseudoaneurysm develops after massive hepatectomy, both an intervention for the pseudoaneurysm and patency of hepatic artery should be considered because occlusion of the residual hepatic artery results in critical liver failure. However, the treatment strategy for a pseudoaneurysm of the hepatic artery after hepatobiliary resection is not well established. Case presentation A 65-year-old woman underwent right hepatectomy, extrahepatic duct resection, and portal vein resection, for gallbladder cancer. Although the patient had an uneventful postoperative course, computed tomography on postoperative day 6 showed a 6-mm pseudoaneurysm of the hepatic artery. Angiography revealed the pseudoaneurysm located on the bifurcation of the left hepatic artery to the segment 2 artery plus the segment 3 artery and 4 artery. Stent placement in the left hepatic artery was not feasible because the artery was too narrow, and coiling of the pseudoaneurysm was associated with a risk of occluding the left hepatic artery and inducing critical liver failure. Therefore, portal vein arterialization constructed by anastomosing the ileocecal artery and vein was performed prior to embolization of the pseudoaneurysm to maintain the oxygen level of the remnant liver, even if the left hepatic artery was accidentally occluded. The pseudoaneurysm was selectively embolized without occlusion of the left hepatic artery, and the postoperative laboratory data were within normal limits. Although uncontrollable ascites due to portal hypertension occurred, embolization of the ileocolic shunt rapidly resolved it. The patient was discharged on postoperative day 45. Conclusion Portal vein arterialization prior to embolization of the aneurysm may be a feasible therapeutic strategy for a pseudoaneurysm that develops after hepatectomy for hepatobiliary malignancy to guarantee arterial inflow to the remnant liver. Early embolization of arterioportal shunting after confirmation of arterial inflow to the liver should be performed to prevent morbidity induced by portal hypertension.

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Liver necrosis shortly after pancreaticoduodenectomy with resection of the replaced left hepatic artery

World Journal of Surgical Oncology ◽

10.1186/s12957-017-1151-2 ◽

2017 ◽

Vol 15 (1) ◽

Cited By ~ 8

Author(s):

Michihiro Yamamoto ◽

Masazumi Zaima ◽

Hidekazu Yamamoto ◽

Hideki Harada ◽

Junichiro Kawamura ◽

...

Keyword(s):

Hepatic Artery ◽

Liver Necrosis ◽

Left Hepatic Artery

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Reconstruction of Aberrant Left Hepatic Artery in Orthotopic Liver Transplantation – Single Center Experience

10.21926/obm.transplant.2101138 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Plamen Mihaylov ◽

◽

Burcin Ekser ◽

Daiki Soma ◽

Andrew Lutz ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatic Artery ◽

Graft Survival ◽

Arterial System ◽

Single Center ◽

Left Hepatic Artery ◽

Entire Cohort ◽

Single Center Experience ◽

Aberrant Left Hepatic Artery ◽

Low Incidence

One of the most feared complications in liver transplantation is hepatic arterial thrombosis (HAT). The incidence of HAT in liver transplantation varies from 1.2% and 8%. One of the risk factors for this complication is anatomical complexity of hepatic arterial system. The focus of this short communication is to show our approach in dealing with aberrant left hepatic artery in settings of liver transplantation. This is a single center experience. Between January 2016 and June 2019, we procured and transplanted 357 adult liver allografts. Of these, there were 34 (9.5%) livers with aberrant left hepatic artery. All of them have been reconstructed on bench table. There was no incidence of HAT in the entire cohort with ALHA. The one-year graft survival for this patient cohort was 93.1%. Our surgical approach resulted in a low incidence of HAT of 1% with excellent graft survival.

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