The Unusual Localization of Right Hepatic Artery Multiple Anatomic Variants in Celiac Axis

Yıl 2013, Cilt: 10 Sayı: 12, - , 21.03.2016

Kemal Arslan Hande Koksal Osman Dogru Suleyman Bakdık

Öz

The extrahepatic vascular and biliary anatomy of Calot\'s triangle is well known to be highly variable and this provides a surgical challenge. The liver has a dual blood supply consisting of the portal vein and the hepatic artery. The hepatic artery which delivers 25% of the blood supply, arises from the celiac trunk. The celiac trunk gives off the left gastric, splenic and common hepatic arteries. The common hepatic artery then divides into gastroduodenal artery and hepatic artery proper which diverts in right and left hepatic arteries. The systic artery usually originates from the right hepatic artery. The “classic” arterial anatomy is present in approximately 75% of cases. The remaining 25% of the cases have many anatomical variants. Here in we present a patient with multiple anatomic variants in celiac trunk which were determined incidentally during laparoscopic cholecystectomy. Being aware of the arterial variations in the liver is really important in surgical procedures in order to avoid bleeding and ischemia.

Anahtar Kelimeler

Variation, right hepatic arter, celiac trunk

The Unusual Localization of Right Hepatic Artery Multiple Anatomic Variants in Celiac Axis

Öz

Ekstrahepatik vasküler ve Calot’s üçgeninin biliyer anatomisi oldukça değişken olduğu bilinmektedir ve bu cerrahi bir endişe oluşturur. Karaciğer portal ven ve hepatik arterin oluşturduğu ikili bir kan kaynağına sahiptir. Çölyak trunkusdan kaynak alan hepatik arter kan akımının % 25’ini sağlar. Çölyak trunkus, sol gastrik arter, splenik arter ve ortak hepatik arter dallarını verir. Daha sonra ortak hepatik arter; gastroduodenal arter ve hepatik arteri verir, hepatik arter de sağ ve sol hepatik dallara ayrılır. Sistik arter genellikle sağ hepatik arterden kaynaklanmaktadır. "Klasik" arteriyel anatomi vakaların yaklaşık% 75'inde mevcuttur. Olguların% 25'inde pek çok anatomik varyantlar vardır. Biz laparoskopik kolesistektomi sırasında tesadüfen tespit edilen Çölyak trunkusunda birden anatomik varyantları olan bir hastayı sunduk. Cerrahi işlemler sırasında kanama ve iskemiyi önlemek için karaciğer içinde arteriyel varyasyonları bilmek çok önemlidir

Anahtar Kelimeler

Varyasyon, sağ hepatik arter, çölyak gövde

Kaynakça

• Hiatt JB, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 1994;220:50-2.
• Jones R, Hardy K. Surgical technique- the hepatic artery: a reminder of surgical anatomy. J Royal Coll Surg 2001; 46:168-70.
• Moore K. Clinically Oriented Anatomy. Philadelphia, PA: Lippincott Williams and Wilkins; 1992; 199.
• Scott-Conner C, Hall T. Variant arterial anatomy in lapaıroscopic cholecystectomy. Am J Surg 1992;163:590-2.
• Molmenti EP, Pinto PA, Klein J, et al. Normal and variıant arterial supply of the livar and gallbladder. Pediatr Transplant 2003;7:80.
• Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1966; 112: 337-47.
• Koops A, Wojciechowski B, Broering DC, Adam G, Krupski- Berdien G. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiograıphies. Surg Radiol Anat 2004;26:239-44.
• Abdullah SS, Mabrut JY, Garbit V, et al. Anatomical variıations of the hepatic artery: study of 932 casesin liver transplantation. Surg Radiol Anat 2006;28:468-73.
• Miyaki T. Patterns of arterial supply of the human fetal liver. The significance of the accessory hepatic artery. Acta Anat 1989;136:107-11.
• Osawa T, Feng XY, Sasaki N, et al. Rare case of the inferior mesenteric artery and the common hepatic artery arising from the superior mesenteric artery. Clin Anat 2004;17: 518-21.
• Zahoi DE, Matusz PL, Brinzaniuc KC, et al. The analysis of the accessory arterial sources of the liver. Study on corırosion casts. FASEB J 2007;21: A968.
• Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial anatomy revisited: digital substraction angiography performed in 600 patients. Radiology 2002;224:542-7.