Preferencje help
Widoczny [Schowaj] Abstrakt
Liczba wyników


2017 | 76 | 4 |

Tytuł artykułu

Anastomotic loop between common hepatic artery and gastroduodenal artery in coexistence with an aberrant right hepatic artery

Warianty tytułu

Języki publikacji



Anatomical variations of the hepatic arteries are not uncommon. The anomalous hepatic arterial supply is of paramount importance in hepatobiliary, pancreatic or liver transplantation and in laparoscopic surgery. We describe an unusual case of a 66-year-old Greek male cadaver, where a rare anastomosis (in the form of an enlarged arterial loop, 4.84 mm in diameter) between the common hepatic artery (6.42 mm) and the gastroduodenal artery (GDA) (4.82 mm) coexisted with an aberrant right hepatic artery (ARHA) (6.38 mm) originating from the superior mesenteric artery. The proper hepatic artery was absent. The ARHA followed a route posterior to the portal vein and the common hepatic duct, entering the liver and supplying the right hepatic segment. A hypoplastic right gastric artery emanated from the GDA. Our case report highlights the combined variations of hepatic arteries and possible anastomoses emphasizing that a thorough knowledge of the classic and variable hepatic arterial anatomy are mandatory for surgeons and radiologists performing hepatic surgery and arteriography to avoid potential iatrogenic injuries in hepatobiliary and pancreas area and further medico-legal implications. (Folia Morphol 2017; 76, 4: 752–756)

Słowa kluczowe









Opis fizyczny



  • Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
  • Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Greece
  • 2nd Department of Paediatric Surgery, Papageorgiou Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece
  • 2nd Department of Paediatric Surgery, Papageorgiou Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece
  • Department of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece


  • 1. Bhardwaj N. Anomalous origins of hepatic artery and its significance for hepatobiliary surgery. J Anat Soc India. 2010; 59(2): 173–176, doi: 10.1016/s0003-2778(10)80020-6.
  • 2. Chaib E, Ribeiro MAF, Saad WA, et al. The main hepatic anatomic variations for the purpose of split-liver transplantation. Transplant Proc. 2005; 37(2): 1063–1066, doi: 10.1016/j.transproceed.2004.11.054, indexed in Pubmed: 15848623.
  • 3. Couinaud C. Surgical anatomy of the liver revisited. C.Couinaud, Paris 1989.
  • 4. Covey AM, Brody LA, Maluccio MA, et al. Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology. 2002; 224(2): 542–547, doi: 10.1148/radiol.2242011283, indexed in Pubmed: 12147854.
  • 5. Daseler EH, Anson BJ. The cystic artery and constituents of the hepatic pedicle; a study of 500 specimens. Surg Gynecol Obstet. 1947; 85(1): 47–63, indexed in Pubmed: 20249245.
  • 6. De Cecco CN, Ferrari R, Rengo M, et al. Anatomic variations of the hepatic arteries in 250 patients studied with 64-row CT angiography. Eur Radiol. 2009; 19(11): 2765–2770, doi: 10.1007/s00330-009-1458-7, indexed in Pubmed: 19471940.
  • 7. De Martino RR. Normal and Variant Mesenteric Anatomy. Mesenteric Vascular Disease. 2015: 9–23, doi: 10.1007/978-1-4939-1847-82.
  • 8. Gruttadauria S, Foglieni CS, Doria C, et al. The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases. Clin Transplant. 2001; 15(5): 359–363, indexed in Pubmed: 11678964.
  • 9. Healey Jr, Schwartz SI. Surgical Anatomy. In: Schwartz SI (ed.) Surgical Diseases of the Liver. McGraw-Hill, New York 1964.
  • 10. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994; 220(1): 50–52, indexed in Pubmed: 8024358.
  • 11. Ishigami K, Zhang Y, Rayhill S, et al. Does variant hepatic artery anatomy in a liver transplant recipient increase the risk of hepatic artery complications after transplantation? AJR Am J Roentgenol. 2004; 183(6): 1577–1584, doi: 10.2214/ajr.183.6.01831577, indexed in Pubmed: 15547194.
  • 12. Jah A, Jamieson N, Huguet E, et al. The implications of the presence of an aberrant right hepatic artery in patients undergoing a pancreaticoduodenectomy. Surg Today. 2009; 39(8): 669–674, doi: 10.1007/s00595-009-3947-3, indexed in Pubmed: 19639433.
  • 13. Jones RM, Hardy KJ. The hepatic artery: a reminder of surgical anatomy. J R Coll Surg Edinb. 2001; 46(3): 168–170, indexed in Pubmed: 11478014.
  • 14. Kapoor V, Brancatelli G, Federle MP, et al. Multidetector CT arteriography with volumetric three-dimensional rendering to evaluate patients with metastatic colorectal disease for placement of a floxuridine infusion pump. AJR Am J Roentgenol. 2003; 181(2): 455–463, doi: 10.2214/ajr.181.2.1810455, indexed in Pubmed: 12876026.
  • 15. Marcos A, Killackey M, Orloff MS, et al. Hepatic arterial reconstruction in 95 adult right lobe living donor liver transplants: evolution of anastomotic technique. Liver Transpl. 2003; 9(6): 570–574, doi: 10.1053/jlts.2003.50093, indexed in Pubmed: 12783397.
  • 16. Michels NA. Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. Lippincott, Philadelphia, Pa 1955.
  • 17. Michels NA. The anatomic variations of the arterial pancreaticoduodenal arcades: their import in regional resection involving the gall bladder, bile ducts, liver, pancreas and parts of the small and large intestines. J Int Coll Surg. 1962; 37: 13–40, indexed in Pubmed: 14473442.
  • 18. Michels NA. The hepatic, cystic and retroduodenal arteries and their relations to the biliary ducts with samples of the entire celiacal blood supply. Ann Surg. 1951; 133(4): 503–524, indexed in Pubmed: 14819988.
  • 19. Mugunthan N, Jansirani D, Felicia C, et al. Anatomical variations in the arterial supply of liver. Int J Anat Variations. 2012; 5: 107–9.
  • 20. Nakamura T, Tanaka K, Kiuchi T, et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation. 2002; 73(12): 1896–1903, indexed in Pubmed: 12131684.
  • 21. Pérez-Saborido B, Pacheco-Sánchez D, Barrera Rebollo A, et al. Incidence of hepatic artery variations in liver transplantation: does it really influence short- and longterm results? Transplant Proc. 2012; 44(9): 2606–2608, doi: 10.1016/j.transproceed.2012.09.064, indexed in Pubmed: 23146470.
  • 22. Peschaud F, El-Hajjam M, Malafosse R, et al. A common hepatic artery passing in front of the portal vein. Surg Radiol Anat. 2008; 28(2): 202–205, doi:10.1007/s00276-005-0063-y, indexed in Pubmed: 16362228.
  • 23. Sultana ZR, Khalil M, Rahman H, et al. Study of anatomical variation of right and left hepatic arteries. Mymensingh Med J. 2009; 18(1 Suppl): S29–S33, indexed in Pubmed: 19377428.
  • 24. Suzuki T, Nakayasu A, Kawabe K, et al. Surgical significance of anatomic variations of the hepatic artery. Am J Surg. 1971; 122(4): 505–512, indexed in Pubmed: 5098656.
  • 25. Tandler JU. Ber die varietaten der arteria coeliaca und derenentwickelung. Anat Hefte. 1904; 25: 475–500.
  • 26. Thompson IM. On the arteries and ducts in the hepatic pedicle; A study in statistical human anatomy. Univ California Publ Anat. 1933; 1: 55.
  • 27. Traverso LW, Freeny PC. Pancreaticoduodenectomy. The importance of preserving hepatic blood flow to prevent biliary fistula. Am Surg. 1989; 55(7): 421–426, indexed in Pubmed: 2742226.
  • 28. Ugurel MS, Battal B, Bozlar U, et al. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol. 2010; 83(992): 661–667, doi: 10.1259/bjr/21236482, indexed in Pubmed: 20551256.
  • 29. Valentine RJ, Wind GG. Anatomic exposures in vascular surgery. 2nd ed. Lippincott Williams & Wilkins, Philadelphia 2003; xiii: 577.
  • 30. Vandamme JP, Bonte J. The branches of the celiac trunk. Acta Anat (Basel). 1985; 122(2): 110–114, indexed in Pubmed: 4013640.
  • 31. Verbeke CS, Leitch D, Menon KV, et al. Redefining the R1 resection in pancreatic cancer. Br J Surg. 2006; 93(10): 1232–1237, doi: 10.1002/bjs.5397, indexed in Pubmed: 16804874.
  • 32. Varotti G, Gondolesi GE, Goldman J, et al. Anatomic variations in right liver living donors. J Am Coll Surg. 2004; 198(4): 577–582, doi:10.1016/j.jamcollsurg.2003.11.014, indexed in Pubmed: 15051012.
  • 33. Woodburne, Russell T. Essentials of Human Anatomy, 1st ed. Oxford University Press, New York 1957: 417–422.

Typ dokumentu



Identyfikator YADDA

JavaScript jest wyłączony w Twojej przeglądarce internetowej. Włącz go, a następnie odśwież stronę, aby móc w pełni z niej korzystać.