Triple arterial blood supply to the liver and double cystic arteries

Abstract

A rare combination of variations in the arterial supply of the liver and gallbladder was encountered in a male cadaver. The simultaneous occurrence of an accessory left hepatic artery and an accessory right hepatic artery from which double cystic arteries arose (one of which was low-lying). This combination has not yet been reported. The accessory left hepatic artery originated from the left gastric artery. The accessory right hepatic artery originated from the superior mesenteric artery. Such arterial variations are caused by differences in embryological development. This, however, may lead to complications related to diagnostic and therapeutic procedures in the upper abdomen.

Accessory right hepatic artery and aberrant bile duct in the hepatocystic triangle: a rare case with clinical implications

“…Accordingly, there may have been compression of the splenic vein by the enlarged ARHA and the pancreas, resulting in splenic vein thrombosis and left-sided portal hypertension [19]. In addition, the entry of the ARHA into the HCT has great surgical relevance, as injury may occur during laparoscopic cholecystectomy with catastrophic complications such as bleeding and liver ischemia [6,16,17,22]. The ARHA may also be damaged in various procedures associated with tumor-related pancreaticoduodenectomy [8].…”

“…Thus, the liver may be supplied by aberrant branches of the left gastric artery, the superior mesenteric artery (SMA), the aorta or other gut arteries. These aberrant arteries may be accessory or replaced [5,6,9,22]. Recognition of variations in hepatic arterial anatomy is of major importance in the planning and conducting of surgical and radiological procedures on the upperabdomen area, such as transplantation, cholecystectomy and pancreaticoduodenectomy [6,8,9,22].…”

“…These aberrant arteries may be accessory or replaced [5,6,9,22]. Recognition of variations in hepatic arterial anatomy is of major importance in the planning and conducting of surgical and radiological procedures on the upperabdomen area, such as transplantation, cholecystectomy and pancreaticoduodenectomy [6,8,9,22]. Based on records of 1000 patients who underwent liver harvesting for orthotopic transplantation, Hiatt et al [9] investigated the surgical anatomy of hepatic arteries.…”

“…The presence of an aberrant right hepatic artery is the most frequently encountered variation, and this may be either a replacement or an accessory (Hiatt Type III, 10.6% incidence) [5,9]. This aberrant artery may be accidentally injured during upper-abdomen operations resulting in fatal complications such as severe hemorrhage and hepatic necrosis [5,6,9,22]. Importantly, biliary tract variations -specifically, the presence of aberrant or accessory bile ducts -may complicate laparoscopic cholecystectomy.…”

Rare combined variations of the coeliac trunk, accessory hepatic and gastric arteries with co-occurrence of double cystic arteries

“…No other anomalies of coeliac trunk and hepatobiliary vasculature were observed in this case. Dolenšek [10] described occurrence of doubled CAs (larger sCA and small dCA) both of which arose from aRHA. Similarly to our case both accessory hepatic arteries were present but the aRHA emerged from the SMA and the PHA was trifurcated into left, middle and right hepatic arteries with coexistence of classical trifurcation of the coeliac trunk.…”