Replaced right hepatic artery

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...

Fig. 5.1. White arrow points to SMA. Black arrows demonstrate replaced right hepatic artery...

Fig. 20.3a,b. Hepatic arterial anatomy according to Hiatt. aMIP reconstruction of Hiatt s type 1 anatomy i.e., conventional anatomy with the common hepatic artery arising from the celiac axis to the gastroduodenal and proper hepatic arteries. The proper hepatic artery divides distally into right and left branches, b MIP reconstruction of Hiatt s type 3 anatomy i.e., a replaced right hepatic artery originating from the superior mesenteric artery... 

Fig. 2.5.4a-c. Common variations in hepatic arterial supply, a Conventional celiac (TC) and hepatic arterial anatomy (55%). b Replaced left hepatic artery (LHA) arising from the left gastric artery (LGA) (20%). c Replaced right hepatic artery (RHA) arises from the superior mesenteric artery (SMA) (6%)... 

Fig. 2.5.5. Replaced right hepatic artery (RHA) from the superior mesenteric artery (AMS)...

The hepatic and splenic arteries typically arise from the celiac axis, which has its origin at the T12/ LI level of the abdominal aorta. The three main branches of the celiac include the splenic, left gastric, and common hepatic arteries. The splenic artery is typically large and tortuous and supplies small branches to the pancreas. The common hepatic branches into the gastroduodenal and proper hepatic arteries. There is significant variant anatomy of the hepatic arteries Aat the interventionist should be aware of. The most common variation is the replaced right hepatic artery, which arises from the superior mesenteric artery (SMA). This occurs in 12%-15% of the population. Other less frequent variations include the replaced left hepatic from the left gastric artery (11%) and the completely replaced common hepatic from the SMA (2%). 

III Replaced right hepatic artery arising from superior mesenteric artery... 

VIII Replaced right hepatic artery with accessory left hepatic artery or replaced left hepatic artery with accessory right hepatic 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). 

IV Replaced left hepatic artery and right hepatic artery... 

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). 

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