Anatomical variants of the hepatic artery: evaluation with MDCT. Frequency in our environment and repercussion in patients undergoing CDP

Abstract

Knowledge and identification of the origin and variations of the hepatic artery are important in upper abdominal surgeries, especially in cephalic duodenopancreatectomy (CPD), due to its high complexity and postoperative morbidity and mortality. The vascularization of the organs involved arises from the celiac trunk that is divided into 3 branches, one is the common hepatic artery that gives two terminal branches: own hepatic artery and gastroduodenal artery. From the first will arise the right, middle and left hepatic arteries. Conforming the usual description of the hepatic arterial anatomy. Multidetector Computed Tomography (MDCT) with intravenous contrast has demonstrated significant advantages, allowing multiplanar and 3D reconstructions of high diagnostic value.

The purpose was to describe the frequency of anatomical variants of the hepatic artery and correlate these anatomical variants with possible complications at the time of surgery.

A review of electronic medical history, reports and preoperative images of TCMD of the Diagnostic Imaging Service of the Italian Hospital of Córdoba was carried out. They were studied patients undergoing CPD between January / 2016 and December / 2018.  A 16-row MDCT, automatic pump injection, 100-150 ml volume of non-ionic contrast, speed 5 ml / sec., late arterial phase (10 seconds after the aortic enhancement peak) was used. Michels’ Classification was used to describe them and the statistical analysis was done with Microsoft® Excel.

17 type I variants (73.91%) and 5 type III (21.74%) were identified according to the selected classification. A case is described that did not meet any of the parameters to include it in that classification, in which, from the emerging celiac trunk in addition to the 3 usual branches, an aberrant right hepatic artery arises. The surgical sheets did not reveal more information about the anatomical variant seen in the surgery or related complications.

Anatomical variations of the hepatic artery type I and III are the most common in the population studied, and do not affect the course of surgery.