Surgical Anatomy of the Hepatic Arteries in 1000 Cases

Hiatt, Jonathan R.; Gabbay, Joubin S.; Busuttil, Ronald W.

doi:10.1097/00000658-199407000-00008

Cited by 775 publications

(656 citation statements)

References 5 publications

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“…After Michels 3 initial classification, several authors described their own observations. [4][5][6] From a surgical point of view, we believe that Michels 3 initial classification is more complete since it establishes the differences between "an accessory" and "a replaced" artery, concepts not explained in more recent classifications. That is the main reason we choose it in the present study.…”

Section: Discussionmentioning

confidence: 91%

“…[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%

“…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 extrahepatic arteries need to be carefully identified during this step of the liver transplantation procedure to avoid injuries that jeopardize the viability of the graft once implanted.…”

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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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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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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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“…Identifying this artery and its pattern is important when planning and performing hepatic resection. Accidental damage to this artery can cause a number of complications such as hepatic artery thrombosis, ischemic cholangiopathy, or a decrease in the size of the left hepatic lobe 8.…”

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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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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“…An intact hepatic artery is the gateway to successful hepatobiliary surgery. Introduction of laparoscopic cholecystectomy has stimulated a renewed interest in the anatomy of the hepatic artery [1]. Division or damage with subsequent thrombosis produces ischemia of the liver or bile duct which can have devastating consequences for the patient.…”

Section: Measurement Of the Celiac Trunk Diametermentioning

confidence: 99%

Morphometric Study of Coeliac Trunk Specific Reference to Hepatic Artery Pattern in the West-Indian Population

Singh¹,

Bhatt²,

Patel

et al. 2012

Indian J Surg

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The aim of this study was to analyze anatomy of the celiac trunk through its diameter, length, and variation of its branches. We studied 40 cadavers (25 males and 15 females) in the various colleges in the west India for the variation in the celiac trunk. Dissection of the celiac trunk was performed after opening of the peritoneal cavity. The length of the celiac trunk up to the common hepatic artery was observed. Diameter of the celiac trunk and distance between the celiac trunk and the superior mesenteric artery were observed. We found cases of rare vascular variation in the branching pattern and the common hepatic artery, which arises from the superior mesenteric artery and there is abnormal relation between the common hepatic artery portal vein and the bile duct. In a case we have observed that the superior mesenteric artery gives acute angulations downward on the right side. This type of study of celiac trunk and presence of variation in hepatic arteries will allow the surgeon to practice safe laparoscopic cholecystectomy, liver resections, or vascular recombination in transplantation and, thereby, avoid errors and patient morbidity.

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Surgical Anatomy of the Hepatic Arteries in 1000 Cases

Cited by 775 publications

References 5 publications

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

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

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

Morphometric Study of Coeliac Trunk Specific Reference to Hepatic Artery Pattern in the West-Indian Population

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