Angiographic Anatomy on the Course of Liver Intra-arterial Infusion

Abstract

There is a great variability in the anatomy of the mesenteric and the hepatic arterial bed. The celiac trunk trifurcates into the common hepatic, left gastric, and splenic artery, the former divided consequently into the gastro-duodenal and proper hepatic artery. The proper hepatic artery bifurcates into the right (RHA) and left hepatic artery (LHA) to supply the corresponding hepatic lobes. Vessels originating from branches appearing as anatomical variations are called “aberrants” meaning that an aberrant hepatic artery refers to a branch that does not arise from its usual source. Aberrants act as substitutes from absent arteries. Alternatively, they may appear as an additional artery to the normally present; the former is called also “aberrant,” i.e., accessory artery. For the history, in 1953, Michels published first his classical study on hepatic arterial anatomy, describing in detail the results following the dissection of 200 cadavers. According to that study, ten anatomical variations of the hepatic artery were identified. In 1966, Michels proposed an internationally recognized classification of these hepatic abnormalities, which was only very later, in 1994, modified by Hiatt. When performing radio-infusions, it is of high importance, to identify any vessel that might supply blood to organs other than the target organ, i.e., the liver.