Skip to main content
SpringerLink
Log in

The coexistence of both replaced proper hepatic and gastroduodenal arteries due to the common hepatic artery absence

  • Anatomic Variations
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Anatomical variants of the celiac trunk (CT) branches and especially these of hepatic arteries (HAs) are among the most common variants of the arterial tree. The knowledge of the wide variability in hepatic arterial supply is of paramount importance in hepatobiliary, pancreatic, gastric, and esophageal surgery, as well as in liver transplantations. The purpose of this case report is to describe a rare variant discovered during abdominal dissection of a 74-year-old male cadaver of Greek origin, in which the common hepatic artery was absent and its branches, the proper hepatic artery (PHA) and the gastroduodenal artery (GDA) had an aberrant and separate origin. The entire arterial supply to the liver derived from the aberrant PHA, that originating from the superior mesenteric artery and was named as PHA (RPHA). The RPHA, after a course posterior to the portal vein, terminated into the right and left HAs, at the hilum. The GDA originated from the CT, as well as the left gastric and splenic artery. The right gastric artery originated from the PHA, as usual. The current case emphasizes the necessity of preoperative imaging when evaluating the resectability of a tumor in hepatobiliary and pancreatic area taking into account the possible vascular variations. Abdominal surgeon should be aware of any aberrancy to avoid potential iatrogenic injury and lethal complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CT:

Celiac trunk

SMA:

Mesenteric artery

LGA:

Left gastric artery

SA:

Splenic artery

CHA:

Common hepatic artery

PHA:

Proper hepatic artery

RPHA:

Replaced proper hepatic artery

HAs:

Hepatic arteries

RHA:

Right hepatic artery

LHA:

Left hepatic artery

GDA:

Gastroduodenal artery

RGA:

Right gastric artery

References

  1. Alakkam A, Hill Robert V, Saggio G (2015) Superior mesenteric origin of the proper hepatic artery: embryological and clinical implications. Surg Radiol Anat. doi:10.1007/s00276-015-1599-0

    PubMed  Google Scholar 

  2. Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT (2002) Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology 224:542–547

    Article  PubMed  Google Scholar 

  3. Daseler EH, Anson BJ, Hambley WC, Reimann AF (1947) The cystic artery and constituents of the hepatic pedicle: a study of 500 specimens. Surg Gynecol Obstet 85:47–63

    CAS  PubMed  Google Scholar 

  4. Hiatt JR, Gabbay J, Busuttil RW (1994) Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 220(1):50–52

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Huang CM, Chen RF, Chen QY, Wei J, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Lu J, Cao LL, Lin M (2015) Application value of a 6-type classification system for common hepatic artery absence during laparoscopic radical resections for gastric cancer a large-scale single-center study. Medicine (Baltimore) 94(32):e1280

    Article  Google Scholar 

  6. Iyori K, Horigome M, Yumoto S, Yamadera Y, Saigusa Y, Iida F, Matsubara H, Ariizumi K, Hashimoto R (2004) Aneurysm of the gastroduodenal artery associated with absence of the celiac axis: report of a case. Surg Today 34(4):360–362

    Article  PubMed  Google Scholar 

  7. Koops A, Wojciechowski B, Broering D et al (2004) Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 26:239–244

    Article  CAS  PubMed  Google Scholar 

  8. Marco-Clement I, Martinez-Barco A, Ahumada N, Simon C, Valderrama JM, Sanudo J, Arrazola J (2016) Anatomical variations of the celiac trunk: cadaveric and radiological study. Surg Radiol Anat 38(4):501–510

    Article  CAS  PubMed  Google Scholar 

  9. Mburu KS, Alexander OJ, Hassan S, Bernard N (2010) Variations in the branching pattern of the celiac trunk in a Kenyan population. Int J Morphol 28(1):199–204

    Article  Google Scholar 

  10. Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347

    Article  CAS  PubMed  Google Scholar 

  11. Natsis K, Piagkou M, Stamatopoulos T, Spyridakis I, Apostolidis S (2017) Anastomotic loop between common hepatic artery and gastroduodenal artery in coexistence with an aberrant right hepatic artery. Folia Morphol (Warsz). doi:10.5603/FM.a2017.0023

    Google Scholar 

  12. Onashvili N, Kutateladze M, Tugushi N, Avazashvili I, Mizandari M (2016) Hepatic arterial anatomy variations in patients with hepatocellular carcinoma evaluated by computed tomography angiography. Georgian Med News 261:31–36

    Google Scholar 

  13. Powerski MJ, Erxleben C, Scheurig-Münkler C, Geisel D, Hamm B, Gebauer B (2015) Anatomic variants of arteries often coil-occluded prior to hepatic radioembolization. Acta Radiol 56(2):159–165

    Article  PubMed  Google Scholar 

  14. Schwarz L, Huet E, Yzet T, Fuks D, Regimbeau JM, Scotte M (2014) An extremely uncommon variant of left hepatic artery arising from the superior mesenteric artery. Surg Radiol Anat 36(1):91–94

    Article  CAS  PubMed  Google Scholar 

  15. Skórzewska A, Stajgis P, Grzymisławska M, Rojewska M, Krajecki M, Bruska M, Juszkat R (2014) Rare variations of hepatic arteries in association with variable origin of gastroduodenal artery found in multidetector computed tomography angiography. Folia Morphol 73(4):531–535. doi:10.5603/FM.2014.0082

    Article  Google Scholar 

  16. Song S-Y, Chung JW, Yin YH, Jae HJ, Kim HC, Jeon UB, Cho BH, So YH, Park JH (2010) Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiol 255(1):278–288

    Article  Google Scholar 

  17. Standring S (2008) Gray’s anatomy: anatomical basis of clinical practice, 40th edn. Elsevier Churchill Livingstone, New York, p 207

    Google Scholar 

  18. Staśkiewicz G, Torres K, Denisow M, Torres A, Czekajska-Chehab E, Drop A (2015) Clinically relevant anatomical parameters of the replaced right hepatic artery (RRHA). Surg Radiol Anat 37(10):1225–1231

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tandler J (1904) Uber die varietaten der Arteria coeliaca und deren Entwicklung. Anat Hft. 25:473–500

    Article  Google Scholar 

  20. Traverso LW, Freeny PC (1989) Pancreaticoduodenectomy. The importance of preserving hepatic blood flow to prevent biliary fistula. Am Surg 55(7):421–426

    CAS  PubMed  Google Scholar 

  21. Wang L, Xu J, Sun D, Zhang Z (2016) Aberrant hepatic arteries running through pancreatic parenchyma encountered during pancreatoduodenectomy, two rare case reports and strategies for surgical treatment. Medicine (Baltimore) 95(49):e3867

    Article  Google Scholar 

  22. Yang SH, Yin YH, Jang JY, Lee SE, Chung JW, Suh KS, Lee KU, Kim SW (2007) Assessment of hepatic arterial anatomy in keeping with preservation of the vasculature while performing pancreatoduodenectomy: an opinion. World J Surg 31(12):2384–2391

    Article  PubMed  Google Scholar 

  23. Zarzavadjian Le Bian A, Costi R, Blangy S, Sbai-Idrissi MS, Smadja C (2015) Pancreaticoduodenectomy in the presence of a common hepatic artery originating from the superior mesenteric artery. Technical implications. Int J Surg 17:1–4. doi:10.1016/j.ijsu.2015.03.010

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to take the opportunity to thank the Assistant Professor Evaggelia Piperaki for her valuable contribution in the schematic drawing of the dissection (Fig. 1c).

Author information

Authors and Affiliations

  1. Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P.O. Box: 300, 54124, Thessaloniki, Greece

    Konstantinos Natsis, Nikolaos Lazaridis, Georgios Koimtzis & Stylianos Apostolidis

  2. Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece

    Maria Piagkou

Authors
  1. Konstantinos Natsis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Piagkou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikolaos Lazaridis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georgios Koimtzis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stylianos Apostolidis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Konstantinos Natsis.

Ethics declarations

Conflict of interest

None of the authors have any conflict and any financial interest.

Informed consent

Written informed consent was obtained from the subject who was a body donator, before his death.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Natsis, K., Piagkou, M., Lazaridis, N. et al. The coexistence of both replaced proper hepatic and gastroduodenal arteries due to the common hepatic artery absence. Surg Radiol Anat 39, 1293–1296 (2017). https://doi.org/10.1007/s00276-017-1866-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-017-1866-3

Keywords

Search

Navigation