PREVALENCE OF HEPATIC ARTERIAL VARIATIONS WITH IMPLICATIONS IN PANCREATODUODENECTOMY

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.

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

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.328 ◽

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.

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

Visceral Medicine ◽

10.1159/000510484 ◽

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.

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

10.32512/jmr/2.2.2019/ ◽

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.

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

10.32512/jmr/2.2.2019.13.16 ◽

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

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Hepatic Artery Embolization prior to En Bloc Resection of an Encased Common Hepatic Artery in Adenocarcinoma of the Head of the Pancreas

Case Reports in Medicine ◽

10.1155/2013/205475 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Gregory Sergeant ◽

Erik Schadde ◽

Geert Maleux ◽

Raymond Aerts

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Balloon Dilation ◽

En Bloc Resection ◽

Common Hepatic Artery ◽

Pathological Examination ◽

Periampullary Cancer ◽

En Bloc ◽

Head Of The Pancreas ◽

The Common

A 64-year-old female patient with adenocarcinoma of the head of the pancreas with encasement of the common hepatic artery and portal vein stenosis was reexplored after six cycles of gemcitabine (1000 mg/m2). Prior to surgery, the patient underwent balloon dilation and stenting of the portal vein in addition to successful coil embolisation of the common hepatic artery, proper hepatic artery, and proximal gastroduodenal artery. After embolisation, a pylorus-preserving pancreaticoduodenectomy was performed with resection of the common hepatic artery and portal vein confluens. Pathological examination showed a moderately differentiated pT3N0 (Stage IIa, TNM 7th edition) tumor with negative section margins. We show with this case that in selected cases of periampullary cancer with encasement of the common hepatic artery, it is technically feasible to perform pancreaticoduodenectomy with hepatic artery resection and negative surgical margins. Nevertheless, the oncological benefit of extended arterial resections remains controversial.

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Effects of norepinephrine on blood flow in the common hepatic artery and portal vein following surgical denervation of the celiac trunk in dogs

Journal of the Autonomic Nervous System ◽

10.1016/0165-1838(92)90192-j ◽

1992 ◽

Vol 37 (1) ◽

pp. 72

Author(s):

Shuuji Akasaka

Keyword(s):

Blood Flow ◽

Portal Vein ◽

Hepatic Artery ◽

Celiac Trunk ◽

Common Hepatic Artery ◽

The Common

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Portal vein arterialization using an accessory right hepatic artery in liver transplantation

Liver Transplantation ◽

10.1002/lt.23653 ◽

2013 ◽

Vol 19 (7) ◽

pp. 773-775 ◽

Cited By ~ 10

Author(s):

Siegfredo Paloyo ◽

Seigo Nishida ◽

Ji Fan ◽

Akin Tekin ◽

Gennaro Selvaggi ◽

...

Keyword(s):

Liver Transplantation ◽

Portal Vein ◽

Hepatic Artery ◽

Right Hepatic Artery ◽

Portal Vein Arterialization

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Novel surgical technique and efficacy analysis of donor pancreas preparation without vascular reconstruction in pancreas transplantation

Journal of International Medical Research ◽

10.1177/0300060519870894 ◽

2019 ◽

Vol 47 (12) ◽

pp. 6182-6191

Author(s):

Wen-wei Liao ◽

Xiang-chao Ling ◽

Cheng Zhang ◽

Fu-rong Liu ◽

Xiao-feng Zhu ◽

...

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Pancreas Transplantation ◽

Vascular Complications ◽

Celiac Trunk ◽

Vascular Reconstruction ◽

Gastroduodenal Artery ◽

Common Hepatic Artery ◽

Efficacy Analysis ◽

Outflow Channel

Objective Because of the complicated blood supply and vascular structure of the pancreas, blood vessel reconstruction and reshaping are generally required during pancreas transplantation. We modified the vascular preparation procedure for the donor pancreas (i.e., no vascular reconstruction was performed) based on experiences in our department and in other domestic and international transplantation centers. Methods Twelve donor pancreas preparations without vascular reconstruction were performed. The patch (Carrel patch), celiac trunk, and superior mesenteric artery were preserved as arterial inflow channels for the donor pancreas. The common hepatic artery and the gastroduodenal artery were transected at a site 0.5 cm away from the bifurcation. The bifurcated portion was preserved for the donor liver. The stumps of the gastroduodenal artery and common hepatic artery were then ligated. The portal vein was transected in the middle of the hepatoduodenal ligament during separation of the liver and pancreas. The partial portal vein preserved with the pancreas was used as the outflow channel of the donor pancreas. Results The transplanted pancreas functioned well in the recipients, and no vascular complications were reported. Conclusion The overall efficacy of pancreas transplantation without vascular reconstruction has been improved.

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