Skip to main content
Top
Published in: Surgical and Radiologic Anatomy 10/2015

Open Access 01-12-2015 | Original Article

Clinically relevant anatomical parameters of the replaced right hepatic artery (RRHA)

Authors: Grzegorz Staśkiewicz, Kamil Torres, Marta Denisow, Anna Torres, Elżbieta Czekajska-Chehab, Andrzej Drop

Published in: Surgical and Radiologic Anatomy | Issue 10/2015

Login to get access

Abstract

Purpose

Vascular anatomy of the liver is subjected to many variations. The most common hepatic artery (HA) replacement is the right hepatic artery (RRHA). Variations of the HA are particularly important consideration when choosing the best surgical procedure or if radiological abdominal intervention is required. In this study, we evaluated the anatomical details of the RRHA origin.

Methods

Retrospective investigation of clinical data from 1569 patients who underwent an abdominal MDCT was performed. The anatomy of RRHA origin was described based on four parameters measured: D—the distance between SMA origin and the RRHA origin, L—the lumen at the place of origin, AH—the origin angle from the SMA in horizontal plane, and AV—the origin angle from the SMA in vertical plane.

Results

RRHA arising from SMA was detected in 10.13 % of cases (159/1569) and its anatomy was subjected to variations. Mean (±SD) of parameters D, L, AH and AV was 27.34 mm ± 6.83, 3.29 mm ± 1.17, 97.27º ± 26.69 and 89.73º ± 20.81, respectively. Values of parameters D and L were significantly higher in males compared to females.

Conclusion

Although radiologists are not always aware of the clinical significance of the RRHA origin, the evaluation of its anatomy is thought to help reduce the risk of inadvertent vascular injury, especially in pancreatoduodenectomy. Detection and evaluation of the RRHA does not necessarily require angio-CT examination. Our study demonstrated that the MDCT, the standard imaging modality for diagnosing the abdominal symptoms, is sufficient to provide the knowledge of the HA abnormalities.
Literature
1.
go back to reference Adamthwaite JA, Pennington N, Menon KV (2007) Anomalous hepatic arterial anatomy discovered during pancreaticoduodenectomy. Surg Radiol Anat 29:269–271CrossRefPubMed Adamthwaite JA, Pennington N, Menon KV (2007) Anomalous hepatic arterial anatomy discovered during pancreaticoduodenectomy. Surg Radiol Anat 29:269–271CrossRefPubMed
2.
go back to reference Biehl TR, Traverso LW, Hauptmann E, Ryan JA Jr (1993) Preoperative visceral angiography alters intraoperative strategy during the Whipple procedure. Am J Surg 165:607–612CrossRefPubMed Biehl TR, Traverso LW, Hauptmann E, Ryan JA Jr (1993) Preoperative visceral angiography alters intraoperative strategy during the Whipple procedure. Am J Surg 165:607–612CrossRefPubMed
3.
go back to reference Braun MA, Collins MB, Wright P (1991) An aberrant right hepatic artery from the right renal artery: anatomical vignette. Cardiovasc Intervent Radiol 14:349–351CrossRefPubMed Braun MA, Collins MB, Wright P (1991) An aberrant right hepatic artery from the right renal artery: anatomical vignette. Cardiovasc Intervent Radiol 14:349–351CrossRefPubMed
4.
go back to reference Co Kun M, Kayahan E-M, Ozbek O, Cakir B, Dalgic A, Haberal M (2005) Imaging of hepatic arterial anatomy for depicting vascular variations in living related liver transplant donor candidates with multidetector computed tomography: comparison with conventional angiography. Transplant Proc 37:1070–1073CrossRef Co Kun M, Kayahan E-M, Ozbek O, Cakir B, Dalgic A, Haberal M (2005) Imaging of hepatic arterial anatomy for depicting vascular variations in living related liver transplant donor candidates with multidetector computed tomography: comparison with conventional angiography. Transplant Proc 37:1070–1073CrossRef
5.
go back to reference Duran C, Uraz S, Kantarci M, Ozturk E, Doganay S, Dayangac M, Bozkurt M, Yuzer Y, Tokat Y (2009) Hepatic arterial mapping by multidetector computed tomographic angiography in living donor liver transplantation. J Comput Assist Tomogr 33:618–625CrossRefPubMed Duran C, Uraz S, Kantarci M, Ozturk E, Doganay S, Dayangac M, Bozkurt M, Yuzer Y, Tokat Y (2009) Hepatic arterial mapping by multidetector computed tomographic angiography in living donor liver transplantation. J Comput Assist Tomogr 33:618–625CrossRefPubMed
6.
go back to reference Eshuis WJ, Olde Loohuis KM, Busch ORC, van Gulik TM, Gouma DJ (2011) Influence of aberrant right hepatic artery on perioperative course and longterm survival after pancreatoduodenectomy. Oxford HPB 13:161–167PubMed Eshuis WJ, Olde Loohuis KM, Busch ORC, van Gulik TM, Gouma DJ (2011) Influence of aberrant right hepatic artery on perioperative course and longterm survival after pancreatoduodenectomy. Oxford HPB 13:161–167PubMed
8.
go back to reference Gümüs H, Bükte Y, Ozdemir E, Sentürk S, Tekbas G, Onder H, Ekici F, Bilici A (2013) Variations of the celiac trunk and hepatic arteries: a study with 64-detector computed tomographic angiography. Eur Rev Med Pharmacol Sci 17:1636–1641 Gümüs H, Bükte Y, Ozdemir E, Sentürk S, Tekbas G, Onder H, Ekici F, Bilici A (2013) Variations of the celiac trunk and hepatic arteries: a study with 64-detector computed tomographic angiography. Eur Rev Med Pharmacol Sci 17:1636–1641
10.
go back to reference Jah A, Jamieson N, Huguet E, Praseedom R (2009) The implications of the presence of an aberrant right hepatic artery in patients undergoing a pancreaticoduodenectomy. Surg Today 39:669–674CrossRefPubMed Jah A, Jamieson N, Huguet E, Praseedom R (2009) The implications of the presence of an aberrant right hepatic artery in patients undergoing a pancreaticoduodenectomy. Surg Today 39:669–674CrossRefPubMed
11.
go back to reference Kadir S, Lundell C, Saeed M (1991) Coeliac, superior and inferior mesenteric arteries. In: Kadir S (ed) Atlas of normal and variant anatomy. Saunders, Philadelphia, pp 365–385 Kadir S, Lundell C, Saeed M (1991) Coeliac, superior and inferior mesenteric arteries. In: Kadir S (ed) Atlas of normal and variant anatomy. Saunders, Philadelphia, pp 365–385
12.
go back to reference Kim AW, McCarthy WJ, Maxhimer JB, Quiros RM, Hollinger EF, Doolas A, Millikan KW, Deziel DJ, Godellas CV, Prinz RA (2002) Vascular complications associated with pancreaticoduodenectomy adversely affect clinical outcome. Surgery 132:738–744CrossRefPubMed Kim AW, McCarthy WJ, Maxhimer JB, Quiros RM, Hollinger EF, Doolas A, Millikan KW, Deziel DJ, Godellas CV, Prinz RA (2002) Vascular complications associated with pancreaticoduodenectomy adversely affect clinical outcome. Surgery 132:738–744CrossRefPubMed
13.
go back to reference Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G (2004) Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 26:239–244CrossRefPubMed Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G (2004) Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 26:239–244CrossRefPubMed
14.
go back to reference Lee JM, Lee YJ, Kim CW, Moon KM, Kim MW (2009) Clinical implications of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy. World J Surg 33:1727–1732CrossRefPubMed Lee JM, Lee YJ, Kim CW, Moon KM, Kim MW (2009) Clinical implications of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy. World J Surg 33:1727–1732CrossRefPubMed
15.
go back to reference Menon KV, Hakeem AR, Heaton ND (2014) Review article: liver transplantation for hepatocellular carcinoma—a critical appraisal of the current worldwide listing criteria. Aliment Pharmacol Ther. doi:10.1111/apt.12922 [Epub ahead of print] (Aug 26) Menon KV, Hakeem AR, Heaton ND (2014) Review article: liver transplantation for hepatocellular carcinoma—a critical appraisal of the current worldwide listing criteria. Aliment Pharmacol Ther. doi:10.​1111/​apt.​12922 [Epub ahead of print] (Aug 26)
16.
go back to reference Michels NA (1955) Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. JB Lippincott, Philadelphia Michels NA (1955) Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. JB Lippincott, Philadelphia
17.
go back to reference Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347CrossRefPubMed Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347CrossRefPubMed
18.
go back to reference Munshi IA, Fusco D, Tashjian D, Kirkwood JR, Polga J, Wait RB (2000) Occlusion of an aberrant right hepatic artery, originating from the superior mesenteric artery, secondary to blunt trauma. J Trauma 48:325–326CrossRefPubMed Munshi IA, Fusco D, Tashjian D, Kirkwood JR, Polga J, Wait RB (2000) Occlusion of an aberrant right hepatic artery, originating from the superior mesenteric artery, secondary to blunt trauma. J Trauma 48:325–326CrossRefPubMed
19.
go back to reference Rong GH, Sindelar WF (1987) Aberrant peripancreatic arterial anatomy. Considerations in performing pancreatectomy for malignant neoplasms. Am Surg 53:726–729PubMed Rong GH, Sindelar WF (1987) Aberrant peripancreatic arterial anatomy. Considerations in performing pancreatectomy for malignant neoplasms. Am Surg 53:726–729PubMed
20.
go back to reference Rougier P, Mitry E, Barbare JC, Taieb J (2007) Hepatocellular carcinoma (HCC): an update. Semin Oncol 34(2 Suppl 1):S12–S20CrossRefPubMed Rougier P, Mitry E, Barbare JC, Taieb J (2007) Hepatocellular carcinoma (HCC): an update. Semin Oncol 34(2 Suppl 1):S12–S20CrossRefPubMed
22.
go back to reference Stefling MK, Lawrence JA, Weintraub JL, Raptopoulos V (1994) CT angiography: expanded clinical applications. AJR Am J Roentgenol 163:947–955CrossRef Stefling MK, Lawrence JA, Weintraub JL, Raptopoulos V (1994) CT angiography: expanded clinical applications. AJR Am J Roentgenol 163:947–955CrossRef
23.
go back to reference Torres K, Staśkiewicz G, Denisow M, Pietrzyk Ł, Torres A, Szukała M, Czekajska-Chehab E, Drop A (2014) Anatomical variations of the celiac trunk in the homogenous Polish population. Folia Morphol (Warsz). doi:10.5603/FM.2014.0059 Torres K, Staśkiewicz G, Denisow M, Pietrzyk Ł, Torres A, Szukała M, Czekajska-Chehab E, Drop A (2014) Anatomical variations of the celiac trunk in the homogenous Polish population. Folia Morphol (Warsz). doi:10.​5603/​FM.​2014.​0059
24.
go back to reference Traverso LW, Freeny PC (1989) Pancreaticoduodenectomy. The importance of preserving hepatic blood flow to prevent biliary fistula. Am Surg 55:421–426PubMed Traverso LW, Freeny PC (1989) Pancreaticoduodenectomy. The importance of preserving hepatic blood flow to prevent biliary fistula. Am Surg 55:421–426PubMed
25.
go back to reference Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, Saglam M, Karademir I (2010) Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol 83:661–667PubMedCentralCrossRefPubMed Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, Saglam M, Karademir I (2010) Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol 83:661–667PubMedCentralCrossRefPubMed
26.
go back to reference Wang D, Jin B, Lewandowski RJ, Ryu RK, Sato KT, Mulcahy MF, Kulik LM, Miller FH, Salem R, Li D, Omary RA, Larson AC (2010) Quantitative 4D transcatheter intraarterial perfusion MRI for monitoring chemoembolization of hepatocellular carcinoma. J Magn Reson Imaging 31(5):1106–1116. doi:10.1002/jmri.22155 PubMedCentralCrossRefPubMed Wang D, Jin B, Lewandowski RJ, Ryu RK, Sato KT, Mulcahy MF, Kulik LM, Miller FH, Salem R, Li D, Omary RA, Larson AC (2010) Quantitative 4D transcatheter intraarterial perfusion MRI for monitoring chemoembolization of hepatocellular carcinoma. J Magn Reson Imaging 31(5):1106–1116. doi:10.​1002/​jmri.​22155 PubMedCentralCrossRefPubMed
27.
go back to reference Wang S, He X, Li Z, Peng Z, Tam NL, Sun C, Hu A, Huang J (2010) Characterization of the middle hepatic artery and its relevance to living donor liver transplantation. Liver Transpl 16(6):736–741. doi:10.1002/lt.22082 PubMed Wang S, He X, Li Z, Peng Z, Tam NL, Sun C, Hu A, Huang J (2010) Characterization of the middle hepatic artery and its relevance to living donor liver transplantation. Liver Transpl 16(6):736–741. doi:10.​1002/​lt.​22082 PubMed
28.
go back to reference Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH):an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25CrossRefPubMed Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH):an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25CrossRefPubMed
29.
go back to reference Woods MS, Traverso LW (1993) Sparing a replaced common hepatic artery during pancreaticoduodenectomy. Am Surg 59:719–721PubMed Woods MS, Traverso LW (1993) Sparing a replaced common hepatic artery during pancreaticoduodenectomy. Am Surg 59:719–721PubMed
30.
go back to reference Yamamoto S, Kubota K, Rokkaku K, NemotoT Sakuma A (2005) Disposal of replaced common hepatic artery coursing within the pancreas during pancreatoduodenectomy: report of a case. Surg Today 35:984–987CrossRefPubMed Yamamoto S, Kubota K, Rokkaku K, NemotoT Sakuma A (2005) Disposal of replaced common hepatic artery coursing within the pancreas during pancreatoduodenectomy: report of a case. Surg Today 35:984–987CrossRefPubMed
31.
go back to reference Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, Pitt HA, Lillemon KD (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma. Ann Surg 229:613–624PubMedCentralCrossRefPubMed Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, Pitt HA, Lillemon KD (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma. Ann Surg 229:613–624PubMedCentralCrossRefPubMed
Metadata
Title
Clinically relevant anatomical parameters of the replaced right hepatic artery (RRHA)
Authors
Grzegorz Staśkiewicz
Kamil Torres
Marta Denisow
Anna Torres
Elżbieta Czekajska-Chehab
Andrzej Drop
Publication date
01-12-2015
Publisher
Springer Paris
Published in
Surgical and Radiologic Anatomy / Issue 10/2015
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-015-1491-y

Other articles of this Issue 10/2015

Surgical and Radiologic Anatomy 10/2015 Go to the issue