Evaluation of hepatic arterial anatomy by multidetector computed tomographic angiography in living donor liver transplantation

Abstract

The aim of this study was to define the different courses and percentages of hepatic artery that were detected during preoperative evaluation of living liver donors by multidetector computed tomographic angiography (MDCTA). We evaluated 150 donors before hepatic transplantation. All of the donors were evaluated by multislice CT scan with 256 detectors. For each patient, arterial, portal and venous phase images were obtained. The hepatic arterial variations were evaluated by the same radiologist according to Michels' classification. Common hepatic arterial anatomy (type I) was observed in 95 donors (63.3%). Other arterial variations were determined in the remaining 55 donors (36.6%). The second common variation was type XI which did not match with the description of Michels' classification variation in 15 donors (10%). The remaining variations described in Michels' classification were seen at lower rates. Type VII or X variation was not seen. MDCTA is a useful method to identify the blood supply of the liver before the liver transplantations, and surgeons can make their plan on the basis of CT data.

Anatomic variation of celiac axis and hepatic artery as evidenced in multidetector computed tomography in patients at tertiary care center in Nepal

“…Other studies done by Keles, et al and Duran, et al, also showed rarity of these two variants, as they did not detect these variants in their study as well. 22,25 In our study type IV (LHA from LGA and RHA from SMA), VIII (Accessory LHA from LGA and RHA from SMA) and IX (CHA from SMA) were uncommon variants with 3 cases (1.7%) for each type being recorded. Prevalence of these variants were 1%, 2% and 4.5% in study by Michel et al; 2%, 2.6% and 1.3% in study by Keles,et al and 2%,1% and 4% in study by Duran et al, respectively.…”

“…Prevalence of these variants were 1%, 2% and 4.5% in study by Michel et al; 2%, 2.6% and 1.3% in study by Keles,et al and 2%,1% and 4% in study by Duran et al, respectively. 15,22,25 Apart from ten anatomical variations of celiac and hepatic artery as described by Michel our study showed 3.4% had different variant anatomy that is not included in Michel's classification, e.g. Common celiac and superior mesenteric trunk from aorta, common hepatic artery directly originating from aorta, replace RHA from superior pancreaticoduodenal artery and LHA from LGA.…”

“…Type II variation (replaced LHA from LGA) was seen in 6.6%. 22 This anatomy was seen in 10% in study by Mitchel 15 and 2.5% in study by Koops 21 . In our study population prevalence of this study was only 2.8%.…”

“…21 A study by Keles showed prevalence of such unclassified group of variants to be as high as 10%. 22 Though multiple literature can be found regarding prevalence of anatomic variation in celiac axis and hepatic artery in various study population, only limited studies have been carried out about the gender specific prevalence of these variation. One such study by Farghadani, et al based on MDCT of 607 kidney donor and traumatic patient showed prevalence of anatomic variation of celiac axis and hepatic arteries and gender based distribution of these variants.…”

Unusual anatomical variations of the hepatic arteries and bile ducts: What are the surgical implications

“…Meticulous dissection and proper identification of structures before any clamping and division are always warranted. Furthermore, pre-operative imaging studies such as computed tomography (CT) angiography and magnetic resonance (MR) cholangiopancreatography should be done as indicated to guide operative planning 20,21 . For instance, finding anomalous branching patterns, replaced or accessory hepatic arteries requires extra caution to prevent injury and ischemia during surgeries on the biliary tree, liver resections, and liver transplantation 21 .…”