Artery accessory

Loukas M, Fergurson A, Louis RG Jr, Colborn GL (2006) Multiple variations of the hepatobiliary vasculature including double cystic arteries, accessory left hepatic artery and hepatosplenic trunk a case report. Surg Radiol Anat 28 525-528... 

BAC bed nucleus of the anterior commissure 21, 81,102-103 BAOT bed nucleus of the accessory olfactory tract 26-29, 84,90-91 Bar Barrington s nucleus 56-60,99-100 bas basilar artery 45-66, 79... 

Ml primary motor cortex 7-34, 81-89, 112-116 M2 secondary motor cortex 6-34, 80-86, 114-116 m5 motor root of the trigeminal nerve 46-59, 84-85, 90-97 MA3 medial accessory oculomotor nucleus 40-43, 79-80, 101-103 mcer middle cerebral artery 81 mch medial corticohypothalamic tract 21-22, 98-101 MCLH magnocellular nucleus of the lateral hypothalamus 31-33, 83, 94-95... 

Fig. 4.2. Aberrant replaced right hepatic artery coming of the superior mesenteric artery (arrow) and aberrant accessory left hepatic artery (arrowhead) coming of the left gastric artery...

An aberrant hepatic artery refers to a branch that does not arise from its usual source (i.e. proper hepatic artery from the celiac trunk). This type of artery may be a substitute for the usual hepatic artery that is absent, in which case it is referred to as an aberrant replaced hepatic artery. In other cases there may be an additional artery to the one normally present hence the term aberrant accessory artery. 

Fig. 4.6. a Small, yet important, accessory gastric artery (arrow) coming off segment III hepatic artery only seen after superselective catheterisation, b Existence of venous gastric stain confirms the presence of the artery... 

The typical origin of this vessel is the right hepatic artery in as many as 95% of patients [25], but it may also come up from the left hepatic artery (7%), common hepatic artery (3%), replaced or accessory right hepatic arteries (18%), as well as the gastroduodenal artery (1%) or superior mesenteric artery [26-29]. There is a 2%-15% incidence of double cystic artery [26, 30] (Fig. 4.12). 

The Zuckerkandl organs arc para-aortic bodies of chromaffin tissue, which arc located retroperitoneally at the, level of the origin of the inferior mesenteric artery. These organs function as an accessory tissue to the autonomic nervous system in early life they usually start to degenerate during the first postnatal year. 

A type II endoleak corresponds to the retrograde filling of the aneurysm mainly from lumbar arteries and/or IMA but also in rare situations from sacral, gonadal or accessory renal artery (Figs. 14.3,14.4). 

Michels classic autopsy series of200 dissections, published in 1966, defined the basic anatomic variations in hepatic arterial supply, and has served as the benchmark for all subsequent contributions in this area (Table 20.1). Variant patterns occurred in 45% of cases, and the commonest arterial variant has been shown to be an aberrant right hepatic supply, which is seen in 13%-18% of patients (Coinaud 1986). Michels motivation was to maximize the database of the surgeon performing procedures in and around the porta hepatis, so as to avoid injury to vascular and ductal structures. A modification of the Michels classification was developed to reflect the presence of vessels that were either accessory or replaced, so that Michels original ten groups could be reduced to five major types and a most rare sixth variant (Hiatt et al. 1994) (Table 20.2) (Fig. 20.3). 

Type V accessory left HA arising from left gastric artery Type VI accessory right HA arising from SMA... 

Type 2 a replaced or accessory left HA arising from the left gastric artery... 

Fig. 23.4a-d. Multidetector CT evaluation in a potential renal donor. VR3D images, obtained in the multiple phases of renal enhancement, perfectly demonstrate (a) normal renal arteries with left accessory artery, (b) normal renal veins, (c) regular renal dimensions, morphology and parenchyma condition, and (d) normal collecting systems... 

The main source of blood supply to the penis (Fig. 2.2a) is usually through the internal pudendal artery, a branch of the internal iliac artery. In many instances, however, accessory arteries arise from the external iliac, obturator, vesical, and/or femoral arteries, and may occasionally become the dominant or only arterial supply to the corpus cavernosum (Breza et al. 1989). Damage to these accessory arteries during radical prostatectomy or cystectomy may result in vasculogenic erectile dysfunction (ED) after surgery (Aboseif et al. 1994 Kim et al. 1994). 

Common anatomical variations of penile arteries include asymmetry, bifurcated cavernosal artery, multiple cavernosal arteries, presence of recurrent branches, unilateral origin of all cavernosal branches, accessory cavernosal branches, and aberrant origin from the dorsal artery (Fig. 5.5). Occasionally the cavernosal artery consists of multiple short, rapidly tapering segments, periodically reconstituted by perforating vessels from the dorsal penile artery (Juskiewenski et al. 1982 Wahl et al. 1997). 

Fig. 5.5a-c. Anatomical variations of cavernosal arteries at color Doppler ultrasound, a-c Longitudinal scans on the ventral aspect of the penis showing a bifurcated cavernosal artery (arrowheads), b recurrent cavernosal branch (curved arrow), and c accessory cavernosal artery (open arrow)... 

In principle, SIRT is based on the general vascular accessibility of the liver and the hepatic tumor load. Therefore, detailed knowledge of the hepatic vascular anatomy and the specific tumor supply is mandatory. It is particularly necessary to identify the accessory right arteries and a potential middle hepatic artery to assess the entire supply. 

Selective left hepatic arteriogram-injection of 2 cc/ sec for 8 cc. In cases of normal anatomy, this allows for the assessment of flow to segments 2,3,4A, and 4B. Special attention should be paid to the falciform, phrenic, right or accessory gastric arteries. 

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