SURGICAL ANATOMY OF THE HEPATIC ARTERIES IN 1000 CASES

Objective Anatomic variations in the hepatic arteries were studied in donor livers that were used for orthotopic transplantation. Summary Ba ckground Data Variations have occurred in 25% to 75% of cases. Donor l ivers represent an appropriate model for study because extrahepatic ar terial anatomy must be defined precisely to ensure complete arterializ ation of the graft at time of transplantation.. Methods Records of 100 0 patients who underwent liver harvesting for orthotopic transplantati on between 1984 and 1993 were reviewed. Results Arterial patterns in o rder of frequency included the normal Type 1 anatomy (n = 757), with t he common hepatic artery arising from the celiac axis to form the gast roduodenal and proper hepatic arteries and the proper hepatic dividing distally into right and left branches; Type 3 (n = 106), with a repla ced or accessory right hepatic artery originating from the superior me senteric artery; Type 2 (n = 97), with a replaced or accessory left he patic artery arising from the left gastric artery; Type 4 (n = 23), wi th both right and left hepatic arteries arising from the superior mese nteric and left gastric arteries, respectively; Type 5 (n = 15), with the entire common hepatic artery arising as a branch of the superior m esenteric; and Type 6 (n = 2), with the common hepatic artery originat ing directly from the aorta. Conclusions These data are useful for the planning and conduct of surgical and radiological procedures of the u pper abdomen, including laparoscopic operations of the biliary tract.