A rare type of hepatobiliary arterial system in man – presence of accessory left and replaced right hepatic arteries and double cystic arteries

Abstract

In addition to the normal textbook description, the hepatobiliary arterial system in man shows many anatomical variations that have definite clinical importance. The presence of aberrant hepatic and cystic arteries may lead to a number of iatrogenic injuries during some open surgical or endoscopic procedures. In the course of routine students’ dissection of a 62-year-old Caucasian female cadaver, an interesting pattern of the arterial supply to the liver and gallbladder was described. In the case reported, an unusually small proper hepatic artery was identified supplying the left liver lobe. In addition, an accessory left hepatic artery was also observed arising from the left gastric artery. Another large variant artery to the liver was also dissected that started from the first portion of the superior mesenteric artery – known as replaced right hepatic artery. The gallbladder, in this case, had two supplying arteries of different origin arising from the small proper hepatic artery and replaced right hepatic artery. This rare and complicated arterial variation might be of considerable importance for liver and gallbladder resections, liver transplants and laparoscopic procedures in this area. Keywords: accessory left hepatic artery; double cystic artery; hepatobiliary arterial system; replaced right hepatic artery; variation

Keywords

• accessory left hepatic artery
• double cystic artery
• hepatobiliary arterial system
• replaced right hepatic artery
• variation

References

1. Clemente CD, editor. Anatomy of the human body. 30th ed.
2. Philadelphia: Lea and Febiger; 1985. p. 731–48.
3. Michels NA. Newer anatomy of the liver and its variant blood supply
4. and collateral circulation. Am J Surg 1966;112:337–47.
5. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic
6. arteries in 1000 cases. Ann Surg 1994;220:50–2.
7. Adachi B. Anatomie der Japaner I. Das Arteriensystem der Japaner.
8. Bd II: Aorta thoracalis bis Arcus plantaris profundus. Kyoto: Verlag

9. der Keiserlich-Japanischen Universität zu Kyoto; 1928. p. 18–66.
10. Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT.
11. Variant hepatic arterial anatomy revisited: digital subtraction angiography
12. performed in 600 patients. Radiology 2002;224:542–7.
13. Abdullah SS, Mabrut JY, Garbit V, De La Roche E, Olagne E, Rode
14. A, Morin A, Berthezene Y, Baulieux J, Ducerf C. Anatomical variations
15. of the hepatic artery: study of 932 cases in liver transplantation.
16. Surg Radiol Anat 2006;28:468–73.
17. Prabhasavat K, Homgade C. Variation of hepatic artery by 3-D
18. reconstruction MDCT scan of liver in Siriraj Hospital. J Med Assoc
19. Thai 2008;91:1748–53.
20. Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, Saglam
21. M, Karademir I. Anatomical variations of hepatic arterial system,
22. coeliac trunk and renal arteries: an analysis with multidetector CT
23. angiography. Br J Radiol 2010;83: 661–7.
24. Gielecki Gielecki J, Zurada A, Sonpal N, Jabloƒska B. The clinical
25. relevance of coeliac trunk variations. Folia Morphol (Warsz) 2005;
26. :123–9
27. Mugunthan N, Jansirani D, Felicia C, Anbalagan J. Anatomical variations
28. in the arterial supply of liver. International Journal of Anatomical
29. Variations 2012;5:107–9.
30. Nayak SB, Vasudeva SK. Vascular variations of liver and gallbladder:
31. a case report. Anat Cell Biol 2013;46:217–9.
32. Singh B, Anand M, Gupta S. A rare variant angioarchitecture of
33. upper abdomen. Anat Cell Biol 2014;47:73–6.
34. Anson BJ. Anatomical considerations in surgery of the gall bladder. J
35. Mich State Med Soc 1956;55:671–2.
36. Hugh TB, Kelly MD, Li B. Laparoscopic anatomy of the cystic
37. artery. Am J Surg 1992;163:593–5.
38. Sugita R, Yamazaki T, Fujita N, Naitoh T, Kobari M, Takahashi S.
39. Cystic artery and cystic duct assessment with 64-detector row CT
40. before laparoscopic cholecystectomy. Radiology 2008;248:124–31.
41. Loukas M, Fergurson A, Louis RG Jr, Colborn GL. Multiple variations
42. of the hepatobiliary vasculature including double cystic arteries,
43. accessory left hepatic artery and hepatosplenic trunk: a case report.
44. Surg Radiol Anat 2006;28:525–8.
45. Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification
46. of the anatomic variations of cystic artery during laparoscopic cholecystectomy.
47. World J Gastroenterol 2007;13:5629–34.
48. Nagral S. Anatomy relevant to cholecystectomy. J Minim Access
49. Surg 2005;1:53–8.
50. Fathy O, Zeid MA, Abdallah T, Fouad A, Eleinien AA, el-Hak
51. NG, Eleibiedy G, el-Wahab MA, Sultan A, Anwar N, Ezzat F.
52. Laparoscopic cholecystectomy: a report on 2000 cases. Hepatogastroenterology
53. ; 50:967–71.
54. Torres K, Chrościcki A, Golonka A, Torres A, Staśkiewicz G,
55. Palczak R, Ceja-Sanchez JM, Ceccaroni M, Drop A. The course of
56. the cystic artery during laparoscopic cholecystectomy. Folia Morphol
57. (Warsz) 2009;68:140–3.
58. Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D, Graur
59. F. Laparoscopic cholecystectomy: incidents and complications. A
60. retrospective analysis of 9542 consecutive laparoscopic operations.
61. HPB (Oxford) 2003;5: 152–8.
62. Chaib E, Ribeiro MA Jr, Saad WA, Gama-Rodrigues J. The main
63. hepatic anatomic variations for the purpose of split-liver transplantation.
64. Transplant Proc 2005;37:1063–6.