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      The Main Anatomic Variations of the Hepatic Artery and Their Importance in Surgical Practice: Review of the Literature

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          Abstract

          Anatomical variations of the hepatic artery are important in the planning and performance of abdominal surgical procedures. Normal hepatic anatomy occurs in approximately 80% of cases, for the remaining 20% multiple variations have been described. The purpose of this study was to review the existing literature on the hepatic anatomy and to stress out its importance in surgical practice. Two main databases were searched for eligible articles during the period 2000 - 2015, and results concerning more than 19,000 patients were included in the study. The most common variation was the replaced right hepatic artery (type III according to Michels classification) which is the chief source of blood supply to the bile duct.

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          Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients.

          George Getrajdman, Arthur Brody, Paul A. Covey … (2002)
          To evaluate and describe the prevalence of hepatic arterial variants seen at digital subtraction angiography in a large series of patients. Data were collected prospectively by using an arterial anatomy database questionnaire that was completed at the time each visceral angiographic examination was performed from May 1996 to October 2000. Six hundred patients underwent at least one visceral angiographic examination at one institution during the study period. Three hundred sixty-eight (61.3%) patients had the standard hepatic arterial anatomy. One hundred nineteen (19.8%) patients had variant left hepatic arteries (LHAs), and 89 (14.8%) had variant right hepatic arteries (RHAs). Twenty-eight (4.7%) patients had a variant anatomy involving both the LHA and the RHA. Twenty-four (4.0%) patients had a variant origin of the common hepatic artery (CHA) arising from either the superior mesenteric artery (SMA) or the aorta. In two patients, the proper hepatic artery (PHA) was the first branch of the SMA and the gastroduodenal artery (GDA) was a branch of the celiac axis. Double hepatic arteries were seen in 22 (3.7%) patients. Trifurcation or quadrifurcation of the GDA was seen in 50 (8.3%) patients, and the GDA originated distal to one hepatic artery in 25 (4.2%) patients in whom both hepatic arteries originated from the CHA. A replaced LHA was less common than has been previously reported, and in two cases, the PHA arose from the SMA. Digital subtraction visceral angiographic results are comparable to results of seminal angiographic studies in which the cut-film technique was used. Copyright RSNA, 2002
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            A COMPOSITE STUDY OF THE COELIAC AXIS ARTERY.

            B Lipshutz (1917)
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              Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies.

              B W Wojciechowski, G Krupski, D. Broering … (2004)
              In modern surgical and transplantation procedures the recognition of anatomic vascular abnormalities of the hepatic arteries is of greater importance than ever. The purpose of this study was to evaluate and classify these variations with respect to their impact on visceral surgery. A total of 604 selective celiac and superior mesenteric angiographies performed on patients with known or suspected liver cirrhosis or hepatic or pancreatic malignancies and on donors of partial liver grafts were analyzed retrospectively. The vascular anatomy of the liver was classified according to different established systems and with particular attention to rare variations. Hepatic arterial anatomy as considered normal in textbook descriptions was found in 79.1%, an aberrant or accessory left hepatic artery (LHA) arising from the left gastric artery in 3.0% and an aberrant or accessory right hepatic artery (RHA) branching off the superior mesenteric artery in 11.9% of the cases. In 1.4% of the cases there was a combination of anomalies of both the LHA and RHA. Variants of the celiac trunk, double hepatic arteries branching at the celiac trunk or hepatic arteries arising directly from the aorta, occurred in 4.1% of the cases. Further atypical branches of the LHA and RHA were found in 0.5% of the cases. Since the incidence and pattern of different types of hepatic arterial anatomy can require specialized preoperative diagnostic as well as intraoperative strategies, knowledge of these abnormalities and their frequency is of major importance for the surgeon as well as the radiologist.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Med Res
                Journal ID (iso-abbrev): J Clin Med Res
                Journal ID (publisher-id): Elmer Press
                Title: Journal of Clinical Medicine Research
                Publisher: Elmer Press
                ISSN (Print): 1918-3003
                ISSN (Electronic): 1918-3011
                Publication date (Print): April 2017
                Publication date (Electronic): 21 February 2017
                Volume: 9
                Issue: 4
                Pages: 248-252
                Affiliations
                [a ]Department of Anatomy of Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
                [b ]Department of Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece
                Author notes
                [c ]Corresponding Author: Anastasios Katsourakis, Department of Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece. Email: tasoskatsourakis@ 123456hotmail.com
                Article
                DOI: 10.14740/jocmr2902w
                PMC ID: 5330766
                PubMed ID: 28270883
                SO-VID: 295ef0fa-ae39-4000-910c-935120fde844
                Copyright © Copyright 2017, Noussios et al.
                License:

                This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date accepted : 23 January 2017
                Categories
                Subject: Review

                ScienceOpen disciplines: Medicine
                Keywords: celiac trunk,hepatic artery,review,anatomic variation,surgical practice
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: celiac trunk, hepatic artery, review, anatomic variation, surgical practice

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