Welcome to International Journal of Anatomy and Research

Type of Article: Original Research

Year: 2016 | Volume 4 | Issue 3 | Page No. 2795-2803

Date of Publication: 30-09-2016

DOI: http://dx.doi.org/10.16965/ijar.2016.334

EXTRA-HEPATIC BRANCHING PATTERN OF COMMON HEPATIC ARTERY AND ITS VARIATIONS: A HUMAN CADAVERIC STUDY

Snigdha Das ¹, Ashwini C Appaji *².

¹ Assistant Professor, Department of Anatomy, Tripura Medical College and B R Ambedkar Memorial Teaching Hospital, Tripura, India.

^*2 Associate Professor, Department of Anatomy, M. S. Ramaiah Medical College, Bangalore, Karnataka, India.

Address: : Dr Ashwini C Appaji, Associate Professor, Department of Anatomy, M. S. Ramaiah Medical College, MSRIT Post, Bangalore. 560054, Karnataka, India. Mobile: 9845994708
E-Mail: ashwinishivaprasad@gmail.com

ABSTRACT

Background and objective: The hepatic arterial anatomy is variable. Pre-operative evaluation of extra-hepatic arterial pattern is relevant for the surgeons during hepatic surgery as well as for the radiologists while doing different procedures. The main purpose of the study was to identify the normal & variable branching pattern of common hepatic artery.
Materials and Methods: Extra-hepatic arterial pattern was observed in 45 adult cadavers (male & female) by in situ dissection. The point of origin & branching pattern of common hepatic artery (CHA) till the porta hepatis were observed and also looked for presence of aberrant/accessory hepatic arteries. The branching pattern of hepatic artery before entering the liver was photographed.
Result: Normal extra-hepatic arterial pattern was found in 46.67% livers. The variable branching patterns was seen in the remaining livers (53.3%). The common variations were: presence of accessory left hepatic artery (LHA) from left gastric artery (LGA) (20%), trifurcation of common hepatic artery (CHA) into gastro-duodenal artery (GDA), right hepatic artery (RHA) & left hepatic artery (LHA) (13.33%), origin of right gastric artery (RGA) from left hepatic artery (LHA) (13.33%). Some rare variations were also observed.
Conclusion: The knowledge of extra-hepatic arterial anatomy is important in the field of hepatic surgery especially during split & living donor liver transplantations. It will help to reduce the post-operative complications such as hepatic necrosis and bleeding during surgery.
Key words: Common Hepatic artery, aberrant hepatic artery, liver transplantation.

REFERENCES

1. Braun MA, Collins MB, Wright P. An aberrant right hepatic artery from the right renal artery: anatomical vignette. Cardiovasc Intervent Radiol. 1991; 14: 349-351.
2. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral        circulation. Am J Surg. 1966; 112: 337-347. 
3. Jonathan R.Hiatt,  Joubin Gabbay, Ronald W.Busuttil. Surgical anatomy of the hepatic arteries in 1000 cases. Annals of Surgery.1994; 220(1):50-52.
4. Bannister L. H, Berus. M. M, Collins. P, Dyson. M, Dusek. J. E, Ferguson. M. W. J. Gray’s Anatomy, 40th edition. ELBS, 2009; Chapter- liver: 1163-1173.
5. Keith L. Moore and T.V.N.Persaud. The Developing Human Clinically Oriented Embryology.8th edition, 2009; Chapter No 15-The digestive system: 218-220.Elsevier.
6. Guang Yu Jin, Hee Chul Yu, Hyung-sun Lim, Jang ll Moon,Jeong Hun Lee, Jin Wook  Chung, et.al. Anatomical Variation of the Origin of the Segment 4 Hepatic artery & their clinical Implication. Liver transplantation.2008; 14: 1180-1184.
7. Rafael Lopez-Andujar, Angel Moya, Eva Montalva, Marina Berenguer, Manuel De Juan,  Fernando San Juan, et.al. Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers. Liver transplantation. 2007; 13: 1401-1404.    
8. Michael T. Lavelle, Vivian S. Lee, Nell M. Rofsky, Glenn A. Krinsky, Jeffrey     C.Weinreb. Dynamic Contrast-enhanced Three-dimensional MR Imaging of Liver Parenchyma: Source Images & Angiographic Reconstructions to define Hepatic Arterial Anatomy.Radiology.2001; 218: 389-394.
9. Soon-Young Song, Jin Wook Chung, Yong Hu Yin, Hwan Jun Jae, Hyo-Cheol Kim, Ung Bae Jeon et.al. Celiac axis and common hepatic artery variations in 5002 patients: Systemic analysis with spiral CT and DSA. Vascular and Interventional Radiology. 2010; 255(1): 278-288.
10. Siraj Saadaldin Abdullah ,Jean-Yves Mabrut,Vincent Garbit, Eric De La Roche , Eric    Olagne, Agne`s Rode et al.Anatomical variations of the hepatic artery: study of 932cases in liver transplantation. Surg Radiol Anat. 2006; 28: 468–473.
11. Sharmila Saran Rajendran, Senthil Kumar Anbumani, Aruna Subramaniam, M.S.Thotakura Balaji,Hannah Sugirthabai Rajila Rajendran.Variable branching patterns of the common hepatic artery and the coeliac artery. Journal of Clinical & Diagnostic Research.2011; November (suppl-2); 5(7):1433-1436.
12. Debasis Bandopadhyay, Surajit Ghatak, Nivenjit Tiwari, Lalit Garg. Hepatic artery variation: a case report. International Journal of Anatomical Variations. 2012; 5: 79-80.
13. Baker RJ, Josef E. Fischer, Mastery of Surgery, LIPPINCOTT WILLIAM & WILKINS. 4th edition, 2001; chapter- The Liver & Biliary Tract: 1047-1050.
14. C.D.Gupta, S.C.Gupta. Evaluation of intrahepatic arterial branching patterns in corrosion casts.J.anat.1976;122(1):31-41.
15. Guang Yu Jin, Hee Chul Yu, Hyung-sun Lim, Jang ll Moon,Jeong Hun Lee, Jin Wook  Chung, et.al. Anatomical Variation of the Origin of the Segment 4 Hepatic artery & their clinical Implication. Liver transplantation.2008;14:1180-1184.
16. Dushyant Sahani, Aparna Mehta, Michel Blake, Srinivasa Prasad, Gordan Harris, Sanjay Saini. Preoperative hepatic vascular evaluation with CT and MR Angiography : implications for surgery. Radiographics. 2004; 24(5): 1367-1380.
17. Couinaud C. Surgical anatomy of the liver revisited: Embryology. Paris, Couinaud, 1989,   pp. 11-24.
18. Sehgal G, Srivastava A.K, Sharma P.K, Kumar N, Singh R. Variations of extra-hepatic segments of hepatic arteries: a multislice computed angiography study. International Journal of Scientific and Research Publications. 2013; 3(2): 2250-3153.
19. Awaris Ahmed, Rashed Nazir, Rayyan Pervez, Umar Amin, Sadia Babar, Atif Rana. Hepatic arterial variations and its implications on hepatobiliary surgery. European Society of Radiology. 2013; 10: 1-29.
20. John E. Skandalakis, Lee J. Skandalakis, Panajiotis N. Skandalakis, Petros Mirilas.Hepatic surgical anatomy. Surg Clin Am. 2004; 84: 413-435.
21. Binit Sureka, Mahesh Kumar Mittal, Aliza Mittal, Mukul Sinha, Narendra Kumar Bhambri, Brij Bhushan Thukral. Variations of celiac axis, common hepatic artery and its branches in 600 patients. Indian Journal of Radiology and Imaging. 2013; 23(3): 223-233.
22. Daseler, E.H. Anson, B.J., Hambley, W.C., A.F.Reimamm. The cystic artery & constituents of the hepatic pedicle-a study of 500 specimens. Surg, Gynaecol & Obstet. 1947; 85: 47-63.
23. Song SY, Chung JW, Lim HG,Park JH. Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients. J Vasc Interv Radiol. 2006 March; 17(3):461-9.
24. H.Nakamura, H. Uchida, C.Kuroda, H. Yoshioka, K. Tokunaga, T. Kitatani et.al. Accessory left gastric artery arising from left hepatic artery: angiographic study. American Journal of Roentgenology.1980; 134(3): 529-532.

Snigdha Das, Ashwini C Appaji. EXTRA-HEPATIC BRANCHING PATTERN OF COMMON HEPATIC ARTERY AND ITS VARIATIONS: A HUMAN CADAVERIC STUDY. Int J Anat Res 2016;4(3):2795-2803. DOI: 10.16965/ijar.2016.334