Anatomic variations of the hepatic artery : A study of 33 cases and review

##plugins.themes.academic_pro.article.main##

Amine Daghfous
Oussama Baraket
Heykal Bedioui
Sofiene Ayadi
Mongi Mighri
Hassen Touinsi
Mohamed Jouini
Montacer Kacem
Zoubeir Ben Safta
Sassi Sadok

Abstract

Background: The hepatic artery is prone to numerous anatomic variations dictated by certain variables of the organogenesis.
Aim : To research study the anatomic variations of the hepatic artery as well as their implications within surgical practice.
Methods: Study of a post-mortem series of 33 cases of dissection of the hepatic pedicle with fresh corpses (deaths amounting no longer than 24 hours), carried out in conditions that are quite close to those met with the living ones.
Results: The common hepatic artery was divided at the foot of the hepatic pedicle into a gastro duodenal artery and into a proper hepatic artery in 94% of the cases. In 6% of the cases, we noticed a threelevel change, a branching of the average hepatic artery into a gastro duodenal artery, a right hepatic artery and a left hepatic artery. The proper hepatic artery represented the pedicle segment of the hepatic artery in 94% of the cases. In 36% of the cases, the liver was irrigated
by two hepatic arteries. In 12% of the cases, there was the matter of the right hepatic artery, branch of the mesenteric artery. In 24% of the cases, there was the matter of the left hepatic artery branch of the left gastric artery.
Conclusion: The perfect knowledge in preoperative and preoperative stages of the anatomic variations of the hepatic pedicle is quite essential. Actually, the lack of knowledge of these variations exposes to the risk of certain complications which are sometimes deadly during hepatic transplants, pancreatic surgery, cholecystectomies, through laroscopic way as well as in the treatment of gastro-esophagus surging.

Keywords:

Anatomy, Surgery, Liver, Transplant, Coelioscopy

##plugins.themes.academic_pro.article.details##

References

  1. Caty L, Denère E, Fontaine C, Guillem P. Concurent aberrant right gastric vein directly draining into the live rand variations of the hepatic artery. Surg Radiol Anat 2004; 26: 70- 3.
  2. Duval JM, Prevot J, Loescher JP. Un cas de tronc coeliomésentérique donnant deux artères hépatiques. CRAA 1959; 237- 42.
  3. Saeed M, Murshid K, Rufai A, Elsayed SEO, Sadiq MS. Coexistence of multiples anomalies in the celiac-mesenteric arterial system. Clin Anat 2003; 16: 30-6.
  4. Valette PJ, De Baere T. Anatomie biliaire et vasculaire du foie. J Radiol 2002; 83: 221- 32.
  5. Bouchet A, Cuilleret J. Le foie et les voies biliaires. Dans : Bouchet A, Cuilleret J, eds. Anatomie topographique, descriptive et fonctionnelle. L'abdomen, la région rétro péritonéale le petit bassin, le périnée. Paris. SIMEP : 1945- 88.
  6. Couinaud C. Le foie. Etude anatomique et chirurgicale. Chapitre VI: Le pédicule sous hépatique. Edition Masson et Cie (1975): 70- 186.
  7. Kamina P, Di Mario V. Abdomen : Parois et appareil digestive Tome 1 P Kamina volume 8 ; Paris : Maloine 1998: 88- 93.
  8. Rouvière H, Delmas A. Foie. Anatomie humaine. Descriptive, topographique et fonctionnelle. Edition Masson, 13ème édition 1992: 459- 8.
  9. Denys A, Sauvanet A, Wicky S, Schnyder P, Belghiti J. Anatomie chirurgicale du foie: ce qu'il faut savoir. J Radiol 2000; 83: 205- 18.
  10. Jonathan R, Hiatt J, Joubin G, Ronald W, Busuttil MD. Surgical anatomy of hepatic arteries in 1000 cases. Ann Surg 1994; 220: 50- 2.
  11. Vandamme JPJ, Bonte J, Van Der Schueren G. A revaluation of hepatic and cystic arteries the importance of the aberrant hepatic branches. Acta Anat 1969; 73: 192- 209.
  12. Couinaud C. Distribution de l'artère hépatique dans le foie. Acta Anat 1954 ; 22 : 49- 51.
  13. Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial revisited: digital subtraction angiography performed in 600 patients. Radiology 2002; 224: 542- 47.
  14. Koops A, Wojciechowski B, Broering DC, Adam G, Krupski- Berdien G. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 2004; 26: 239- 44.
  15. Lafortune M, Lepanto L. Anatomie du foie : échographie et doppler. J Radiol 2002; 83: 235- 44.
  16. Jones RM, Hardy KJ. The hepatic artery: a reminder of surgical anatomy. J. R. Coll Surg Edinb 2001; 46: 168- 70.
  17. Konstam MA, Novelline RA, Athanasoulis CA. Aberrant hepatic artery: a potential cause for error in the angiographic diagnosis of traumatic liver hematoma. Gastrointest Radiol 1979; 30: 43- 5.
  18. Weiglein AH. Variations and topography of the arteries in the lesser omentum in humans. Clin Anat 1996; 9: 143- 50.
  19. McNulty JG. Total anomalous arterial supply to the liver and gallbladder from the gastroduodenal artery: a case report. Surg Radiol Anat 2000; 22: 123- 4.
  20. Blumgart LH, Hann LE. Surgical and radiologic anatomy of the liver and biliary tract. Dans: Blumgart LH, Fong Y. Surgery of the liver and biliary tract, Third edition, volume I: 3- 33.
  21. Brems JJ, Millis JM, Hiatt JR et al. Hepatic artery reconstruction during liver transplantation. Transplantation 1989; 47: 403- 6.
  22. Chun Zhao J, Chun Lu S, Nan Yan L et al. Incidence and treatment of hepatic artery complications after liver transplantation. World J Gastroenterol 2003; 9: 2853- 55.
  23. Merion RM, Burtch GD, Ham JM, Turcotte JG, Campbell DA. The hepatic artery in liver transplantation. Transplantation 1989; 48: 438- 43.
  24. Lerut J, Laterre PF, Roggen F et al. Adult hepatic retransplantation. UCL experience. Acta Gastro Enterologica Belgica 1999; 12: 261- 6.
  25. Chevalier JM. Foie, voies biliaires intra-hépatiques et système porte dans: Anatomie, Tronc, Paris : Médecine science Flammarion, 1998 : 212- 33.
  26. Robert D, Byers W, Shunzaburo I, Santuro T, Thomas E. Simplified technique for revascularization of homografts of liver with a variant right hepatic artery from the superior mesenteric artery. Surg Gynecol Obstet 1985; 160: 475- 6.
  27. Thomas E, Starzl, Charles M et al. An improved technique for multiple organ havesting. Surg Gynecol Obstet 1987; 165: 345-8.
  28. Jeon H, Ortiz JA, Manzarbeitia CY, Alvarez SC, Sutherland DER, Reich DJ. Combined liver and pancreas procurement from a controlled non-heart-beating donor with aberrant hepatic arterial anatomy. Transplantation 2002; 74: 1636- 9.
  29. Chaib E, Ribeiro M, Saad W, Gama-Rodrigues J. The main hepatic anatomic variations for the purpose of Split-Liver transplantation. Transplatation Proc 2005; 37: 1063- 6.
  30. Balija M, Huis M, Nicholic V, Stulhofer M. Laparoscopic viscualization of the cystic artery anatomy. World J Surg 1999; 7: 703- 7.
  31. Halasz NA. Cholecystectomy and hepatic artery injuries. Arch Surg 1991; 126: 137- 138.
  32. Launois B, Bohmer, Maddern G. Pathologie de l'artère hépatique. EMC Techniques chirurgicales- Appareil digestive 2004 ; 7-042-A-11.
  33. Wachberg RH, Cho KC, Raïna S. Liver infraction folowing unrecognized right hepatic artery ligation at laparoscopic cholecystectomy. Abdom Imaging 1994; 19: 53- 4.
  34. Richelme H, Birtwisle Y, Bourgeon A. Les attaches postérieures du pancréas. Chirurgie 1984; 110: 150- 7.
  35. Richelme H, Michetti CI, Birtwisle Y, Bourgeon A. La section de la lame rétro pancréatique droite au cours de la duodénopancréatectomie. Ann Chir 1986; 40: 401- 4.
  36. Spay G. Problèmes et modalités techniques de l'exérèse pancréatique totale pour adénocarcinome. J Chir 1981; 118: 161- 8.
  37. Volpe CM, Peterson S, Hoover EL, Doerr RJ. Justification For visceral angiography prior to pancreaticoduodenectomy. Am Surg 1998; 64: 758-61.
  38. Klingler PJ, Seelig MH, Floch NR et al. Aberrant left hepatic artery in laparoscopic antireflux procedures. Surgical Endoscopy 2004; 18: 807- 11.