• Journal of International Society for Simulation Surgery
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• v.1 no.2
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• pp.87-89
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• 2014

An aberrant left hepatic artery is one of the most common variants of hepatic arteries, and its prevalence has been reported 6.5-30%. During D2 lymph node dissection for gastric cancer, an aberrant left hepatic artery arising from left gastric artery is ligated which may lead to hepatic damage. In this case report, a 66-year-old male patient underwent total gastrectomy with D2 lymph node dissection during which the aberrant left hepatic artery was ligated. Post-operative liver function tests revealed elevated liver enzymes, and ischemic changes in the left lateral hepatic section was seen on the CT scan. On retrospective review of preoperative CT images, a replaced left hepatic artery from left gastric artery could have been identified. The information on the presence of aberrant LHA and its supplying area is clinically important when planning curative gastrectomy for gastric cancer, because extended lymph node dissection requires division of the left gastric artery and this may lead to severe liver damage. By using preoperative CT scan, detection of aberrant left hepatic artery could be done.

• Kosin Medical Journal
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• v.33 no.3
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• pp.463-467
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• 2018

The hepatic artery can have numerous variations. However, a common hepatic artery originating from the left gastric artery and the entire hepatic blood supply furnished by the left gastric artery is an extremely rare anomaly. We encountered this anomaly in a patient with advanced gastric cancer. A surgeon should recognize this image appearance and identify the anomaly. Without knowledge of this anomaly and given the strategy for extensive lesser sac dissection generally employed during gastric cancer surgery, a surgeon could easily inadvertently divide this vessel, resulting in critical liver damage. We report a case of common hepatic artery originating from left gastric artery and review of the literatures.

• Anatomy and Cell Biology
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• v.56 no.2
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• pp.276-279
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• 2023

The arterial support of the liver is most commonly from the celiac trunk via the proper hepatic artery (PHA). The PHA divides into left and right branches: the right hepatic artery (RHA) supplies the right and caudate lobes while the left hepatic artery (LHA) supplies the left and quadrate lobes. Aberrant hepatic arteries are relatively common, and the most frequent contributors are the superior mesenteric artery and left gastric artery. Herein we present findings from postmortem dissection of an abdominal cavity that revealed a rare combination of reported variations. Specifically, this subject had three extrahepatic arteries - a replaced LHA (rLHA), a PHA, and a replaced RHA (rRHA). The rLHA originated from the left gastric and the rRHA originated from the superior mesenteric artery. Knowledge of these variations is important for surgical and radiological procedures to avoid complications during treatment and improve patient outcomes.

• Anatomy and Cell Biology
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• v.55 no.3
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• pp.269-276
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• 2022

Vascular anomalies are a serendipitous finding during surgeries and diagnostic angiography. Such variations are frequently encountered in the abdominal region. These anomalies are usually asymptomatic but the presence of hepatic arterial variations may lead to injuries of the liver during surgery. The present study was conducted on 35 adult embalmed cadavers, 31 males, 4 females from August 2015 to December 2021 in the Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi. In this study of 35 cadavers, we present 3 variants: an accessory right hepatic artery, replaced common hepatic artery, replaced common hepatic artery anastomosis with accessory left hepatic artery and an arc of Buhler. One of our variants has not yielded a precedent in literature search. We have compared these variants with Michels and Hiatt classification. It is known that different variants arise at distinct stages of embryonic development. As specialists in anatomy, we have tried to correlate the variants in our study with their embryological origins.

• Anatomy and Cell Biology
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• v.57 no.3
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• pp.353-362
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• 2024

Celiac trunk and superior mesenteric artery (SMA) are the main blood supply to the liver and pancreas. The data of anatomical variations in these arteries or their branches are very important clinically and surgically. The aim of this study was to describe the different variants in these arteries through the examination of the angiographs of a large series of Egyptian individuals. This research involved 389 selective angiographies to celiac artery, its branches, and the SMA. Anatomy of the target arteries of people who experienced visceral angiograph was reviewed and the data were recorded. From the total available angiograms in this work, 286 patients (73.52%) had the standard anatomy of celiac trunk and superior mesenteric arteries, and 103 patients (26.47%) had a single or multiple vessel variation. The inferior phrenic artery originates from celiac trunk in 2.05% of patients, while quadrifurcation of the celiac trunk was noticed in only 0.51% of patients. Absence of celiac trunk is also found in 0.51% of patients. Left gastric artery showed an abnormal origin from the splenic artery in 0.51% of patients. Quadrifurcation of common hepatic artery was also noticed. Variant anatomy of the left hepatic artery (LHA) was seen in 9.51% of patients, while variations of the right hepatic artery (RHA) were 14.13%. With the different origin of hepatic arteries, the gastroduodenal artery arose either from the LHA (2.82%), RHA (2.31%) or even from the celiac trunk (1.79%).

• Anatomy and Cell Biology
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• v.56 no.4
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• pp.579-583
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• 2023

In human fetuses, the left hepatic artery (LHA) issues the marginal artery that runs along the umbilical vein and, sometimes, reaches the umbilicus. The further observation demonstrated that, in 5 of 12 Japanese midterm fetuses (crown-rump length mm: 46, 50, 54, 59, 102), the marginal artery issued not only a thin umbilical branch but also a liver parenchymal branch that took a posterosuperior recurrent course in a peritoneal fold and supplied the anterior surface of the liver left lobe (segment III). However, in 22 Spanish fetuses of which gestational ages corresponded to the Japanese ones, we did not find the parenchymal branch. Therefore, between human populations, there seemed to be a considerable difference in the incidence as to whether or not the marginal artery issues the liver parenchymal branch. The parenchymal branch might be degenerated at the later stages due to friction between the liver free surface and growing diaphragm.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.33-37
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• 2009

Purpose: Liver transplantation is considered as the treatment of choice in many acute and chronic liver diseases, and it is becoming more common. Since successful microscopic anastomosis of hepatic artery is a crucial requirement of successful liver transplantation, we studied and analyzed the result of hepatic artery anastomosis of liver transplantation in our liver transplantation center. Methods: 145 liver transplantations were performed between February 2005 and May 2008. Male to female ratio of the liver transplantation recipients was 3.4 : 1. Anastomosis of portal vein, hepatic vein and biliary tract was performed by the general surgeon, and anastomosis of hepatic artery was performed by the plastic surgeon under the loupe or microscopic vision. After the hepatic artery was reconstructed, anastomosed site status and flow were checked with Doppler ultrasonography intraoperatively and with contrast enhanced CT or angiography postoperatively if necessary. Results: Out of 145 liver transplantations, cadaveric liver donor was used 37 cases and living donor liver transplantation was performed 108 cases including the 2 dual donor liver transplantations. As for the baseline diseases that resulted in the liver transplantation, there were 57 cases of liver cirrhosis and hepatocellular carcinoma due to hepatitis B, taking up the greatest proportion. Single donor hepatic artery was used in 114 cases, and mean artery diameter was 2.92 mm and mean artery length was 24.25 mm. Hepatic artery was used as the recipient artery in every case except the 8 cases in which gastroepiploic artery was used as alternative. Out of 145 cases of hepatic artery anastomosis, 3 cases resulted in the thrombosis of the hepatic artery, requiring thrombectomy and re - anastomosis. In all 3 cases, thrombosis was found in left hepatic artery and there was no past history of hepatic artery chemoembolization. Conclusion: Incidence of hepatic artery thrombosis after the anastomosis of hepatic artery during liver transplantation was 2.1%, which is considered sufficiently low.

• Korean Journal of Veterinary Research
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• v.32 no.4
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• pp.511-521
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• 1992

The distribution of the hepatic arteries within the liver in 30 Korean native cattle were observed. Vinylite solution was injected into the hepatic arteries of 10 livers for cast preparation. The angiography was prepared in 20 livers by injected 30% barium sulfate solution into the hepatic arteries and then radiographed on X-ray apparatus. The results were summarized as follow ; 1. The hepatic arteries were divided into the Ramus (R.) sinister, R. dexter and R. intermedius. The intrahepatic arteries were derived from the R. sinister and R. dexter. The R. intermedius divided into the Arteria(A.) gastrica dextra, A. gastroduodenalis and A. cystica. 2. The right branch (ramus dexter) of the hepatic artery supplies the right lobe and caudate process. It consisted of the A. dorsalis lobi dextri, A. ventralis lobi dextri and A. lobi caudati. They formed one common trunk with three arteries(6 cases, 20%), and two arteries formed common trunk with the A. ventralis lobi dextri and A. lobi caudati (16 cases, 52.8%), or with A. dorsalis lobi dextri and A. lobi caudati (5 cases, 16.5%). The three arteries arose from the A. hepatia independently(3 cases, 10%). 3. The left branch (ramus sinister), larger than the right and often double (6 cases, 20%), supplies the caudate, quadrate and left lobes, and often gives origin to the A. gastrica dextra. 4. The branches of hepatic artery in the left lobe were derived from A. dorsalis lobi sinistri, A. ventralis lobi sinistri and A. intermedius lobi sinistri. The A. intermedius lobi sinistri were absent in some cases (3 cases, 10%). They almostly originated a single branch and often two branches. 5. The A. cystica arose from the R. intermedius(27 cases, 90%) and A. hepaica(3 cases, 10%). 6. The Rami processus papillarum arose from dorsal border of the Pars transversa of the left branch(19 cases, 62.7%), the left branch and right branch (9 cases, 30%) or A. hepatica(2 cases, 6.6%). 7. The A. lobi quadrata arose from either the Pars transversa of left branch (12 cases, 40%) or A. hepatica(4 cases, 13.2%). It also arose from both Pars transversa of left branch and A. ventralis lobi sinistri (3 cases, 10%). 8. The anastomosis on the branches of A. hepatica was observed in intrahepatic and cystic arteries. The left and right branches ramified several secondary radiating branches within the liver. 9. The hepatic arteries formed a very short common trunk of the right branch ($18.75{\pm}11.89$ : 2.20~44.8mm) and a long Pars transversa of the left branch($72.85{\pm}20.04$ : 28.2~104.1mm). 10. The ramified angles at the A. dorsalis lobi dextri, A. ventralis lobi dextri, A. lobi sinistri, A. ventralis lobi sinistri, A. lobi quadrata, A. cystica and Rami processus papillarum were 50-80, 270-300, 340-20, 120-160, 160-290, 200-230, 250~290, 230~280 and 80~120 degrees, respectively.

• Journal of Trauma and Injury
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• v.19 no.2
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• pp.196-200
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• 2006

We report a case of celiac artery dissection after abdominal blunt trauma. A 29-year-old man visited the emergency room for acute left periumbilical pain after abdominal blunt trauma from his child. Computed tomography showed a wedge-shaped splenic infarction with splenic artery thrombus. He was hospitalized for careful observation, and after two days, follow-up computed tomographic angiography showed a progressed celiac artery dissection that involved common hepatic artery and an increased extent of splenic infarction. He underwent conventional angiography, and a self-expandable stent was placed between the celiac axis and the common hepatic artery. After two days, follow-up computed tomographic angiography showed good hepatic arterial blood flow via the stent and no progression of splenic infarction. After ten days, he was discharged without complications.

• Anatomy and Cell Biology
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• v.57 no.3
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• pp.370-377
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• 2024

Anticipating a wide range of morphological variations of arterial anatomy of foregut derivatives beyond the classical pattern, a precise understanding is pertinent to preoperative diagnosis, operative procedure and to avoid potentially devastating post-operative outcome during various traumatic and non-traumatic vascular insult of foregut. The study aimed to revisit the morphological details and update unusual configurations of arteries of foregut to establish clinico-anatomical correlations. This study described the detailed branching pattern of coeliac trunk (CT) as principal artery of foregut with source & course of hepatic, gastric, duodenal and pancreatic branches in 58 cadaveric dissections. Based on morphology, different types and subtypes were made. The descriptions were explained using figures and pertinent tables. Among classical branches of CT, splenic artery was found as most stable whereas other two branches were found to be most variable with missing common hepatic artery in 11 cases. In addition to classical trifurcation (65.52%), different types of bifurcation (12.07%) and tetrafurcations (22.41%) of CT were observed. Regarding variations of hepatic arteries (27.59%), both non-classical origin and accessory hepatic branches were found. In case of gastric branches, more variant origins were seen with right gastric (50%) as compared to left gastric artery (34.48%). Other morphological variations included non-classical origin of gastro-duodenal artery (18.96%) along with presence of accessory pancreatic (17.13%) and duodenal arteries (6.38%). Awareness of anatomical variations regarding circulatory dynamics of foregut is worth knowing in order to facilitate successful planning of surgery involving upper abdominal organs with least complications.