Newer anatomy of the liver and its variant blood supply and collateral circulation

Michels, Nicholas A.

doi:10.1016/0002-9610(66)90201-7

Cited by 808 publications

(642 citation statements)

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“…Healey and Schroy (1953) and Michels (1966) reported that the MHA originated in about equal proportions from the RHA and the LHA 7, 12. In our study, the MHA originated from the RHA and the LHA with the same frequency of 31%, while in one case (3.4%) it branched off from the PHA.…”

Section: Discussionmentioning

confidence: 99%

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Arterial Blood Supply of Liver Segment IV and Its Possible Surgical Consequences

Alghamdi

Viebahn

Justinger

et al. 2017

American Journal of Transplantation

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The risk of ischemia of segment IV after split liver resection is high. This anatomical study was done to identify the arterial blood supply and the intrahepatic distribution of liver segment IV. The anatomy of segment IV was studied in 29 livers from adult cadavers. To identify the arterial blood supply of segment IV, water and ink were injected into the various branches of the hepatic artery and the outflow through segment IV and discoloration of the liver parenchyma were observed. In 23 of the 29 livers (79.3%), the arterial perfusion of segment IV was separated by a line drawn from the left side of the inferior vena cava at the top of and lateral to the falciform ligament to the medial point of the gallbladder bed. The area lateral to this line was supplied mainly by the right hepatic artery, and the area medial to it was supplied mainly by the left hepatic artery. In addition to the classification system of Couinaud, we describe here a new division of liver segment IV based on arterial blood supply. These anatomical findings may be useful in defining the resection line for split liver to prevent necrosis of segment IV.

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Section: Discussionmentioning

confidence: 99%

“…The middle hepatic artery supplies segment IV 7. Identifying this artery and its pattern is important when planning and performing hepatic resection.…”

Section: Introductionmentioning

confidence: 99%

Arterial Blood Supply of Liver Segment IV and Its Possible Surgical Consequences

Alghamdi

Viebahn

Justinger

et al. 2017

American Journal of Transplantation

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“…[3][4][5]8,10,12 Michels 3 reported in 1966 a classification of 10 possible anatomical variants of the extrahepatic arterial distribution that was based on a study of 200 autopsy cases. After Michels 3 initial classification, several authors described their own observations.…”

Section: Discussionmentioning

confidence: 99%

“…That is the main reason we choose it in the present study. Although classically it was considered that the hepatic arterial vascularization is terminal and that there are no intrahepatic communications between the different branches, 3,16 more recent data, particularly that originating from the living donor experience, has challenged this concept. 17 We considered it important to identify all the hepatic arteries and to classify them as "accessory" or "replaced."…”

Section: Discussionmentioning

confidence: 99%

“…We have also adapted the concepts of "accessory" and "replaced" artery, described by Michels. 3 If 2 hepatic arteries supply the same hepatic lobe, 1 originating in the common hepatic trunk and the other arising from a different arterial trunk, the last one is called an "accessory." On the other hand, if there is only 1 hepatic artery for the hepatic lobe, that does not arise from the common hepatic artery, it is called a "replaced" artery.…”

Section: Methodsmentioning

confidence: 99%

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Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

et al. 2007

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The aim of this study is to contribute our experience to the knowledge of the anatomic variations of the hepatic arterial supply. The surgical anatomy of the extrahepatic arterial vascularization was investigated prospectively in 1,081 donor cadaveric livers, transplanted at La Fe University Hospital from January 1991 to August 2004. The vascular anatomy of the hepatic grafts was classified according to Michels description (Am J Surg 1966;112:337-347) plus 2 variations. Anatomical variants of the classical pattern were detected in 30% of the livers (n ϭ 320). The most common variant was a replaced left artery arising from the left gastric artery (9.7%) followed by a replaced right hepatic artery arising from the superior mesenteric artery (7.8%). In conclusion, the information about the different hepatic arterial patterns can help in reducing the risks of iatrogenic complications, which in turn may result in better outcomes not only following surgical interventions but also in the context of radiological treatments. Knowledge of hepatic arterial vascularization has a significant relevance for the daily practice of a wide range of practitioners including not only surgeons specialized in the hepato-biliary-pancreatic area, but also general surgeons and radiologists, mainly those who are dedicated to interventional radiologic treatments.In the last few years, substantial improvements have been achieved in the surgical and/or radiological treatment of benign and malignant liver, pancreatic, and biliary diseases. With laparoscopic surgery the need has arisen for exact descriptions of the hepatic vascularization to avoid iatrogenic vascular lesions.In the setting of liver transplantation, the most effective approach to reduce the dropout rate on the waiting lists is to expand the number of available livers. Several strategies including living donors and split livers have been developed for this purpose. These are extremely complex techniques in which the exact knowledge of the arterial anatomy is a required step to plan the best resection as well as to minimize the risks of morbidity.The patterns of hepatic arterial supply are not constant. The usual anatomy of the hepatic arterial vascularization is a common hepatic artery arising from the celiac axis, accounting for 25 to 75% of the cases. 1 In the variant patterns, the hepatic lobes receive arterial flow through branches coming from the superior mesenteric artery, left gastric artery, or, rarely, from other arterial trunks. 2 Since Michels 3 published his first report, several studies have reported not only common and rare hepatic artery variants, but also different classifications. These studies are based on angiographic data and autopsy dissections, and mainly derive from surgery and transplantation literature. [4][5][6][7][8][9][10][11][12][13][14] The large sample size of transplanted livers is one of the major interests of this study. Indeed, harvested livers offer an excellent opportunity to describe, in situ, the anatomic variants of the arteries since all e...

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History of Liver Surgery

Foster

1991

Arch Surg

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Although battle surgeons had débrided small bits of liver protruding through wounds since ancient times, formal entry into the peritoneal cavity to staunch hemorrhage due to trauma or to remove tumors or drain cysts had to await the advent of general anesthesia and antisepsis. After a burst of pioneering activity from 1880 to 1910, little progress was made until after World War II. In the last 40 years, remarkable advances have been made in the techniques of liver resection, our understanding of liver diseases requiring operation, and our ability to support patients through major resections. Liver transplantation epitomizes the challenges that can now be accepted, and its success augurs well for an increase in liver operations in the future.

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Newer anatomy of the liver and its variant blood supply and collateral circulation

Cited by 808 publications

References 1 publication

Arterial Blood Supply of Liver Segment IV and Its Possible Surgical Consequences

Arterial Blood Supply of Liver Segment IV and Its Possible Surgical Consequences

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

History of Liver Surgery

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