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[Anatomical variation of the donor hepatic arteries: analysis of 843 cases]
Yang Yang1, Nan Jiang, Min-Qiang Lu
1Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University/Institute of Organ Transplantation, Sun Yat-sen University, Guangzhou 510630, China. yysysu@163.com
Insights
Hepatic artery variations occur in 20.4% of liver transplant donors, increasing the risk of accidental injury. Understanding these anatomical differences is crucial for safe graft procurement and reconstruction.
Area of Science:
- Vascular anatomy
- Surgical anatomy
- Transplantation surgery
Context:
- Orthotopic liver transplantation (OLT) involves complex surgical procedures.
- Donor hepatic artery anatomy exhibits significant variations.
- Accidental injury to the hepatic artery can lead to severe complications.
Purpose:
- To investigate the anatomical variations of donor hepatic arteries.
- To identify measures to prevent accidental hepatic artery injury during liver graft procurement and reconstruction.
Summary:
- A review of 843 orthotopic liver transplantations revealed a 20.4% rate of donor hepatic artery anatomical variations.
- Common variations include replaced or accessory arteries originating from the superior mesenteric artery or left gastric artery.
- Hepatic artery variations increase the likelihood of accidental injury during graft procurement and reconstruction.
Impact:
- Awareness of hepatic arterial variations is essential for surgical teams.
- Maintaining the integrity of the superior mesenteric artery and celiac trunk is key to reducing iatrogenic injuries.
- This knowledge aids in improving patient outcomes in liver transplantation.
Objective:
To investigate the anatomical variations of donor hepatic artery and explore the measures that can be taken to avoid accidental hepatic artery injury during graft procurement and reconstruction.
Methods:
The data of totally 843 consecutive patients undergoing orthotopic liver transplantation (OLT) during the period from April 2001 to July 2006 was reviewed in relation to anatomical variation of the donor hepatic arteries. The variations of the hepatic artery, the relationship between the anomalous hepatic artery and accidental injury of the hepatic artery were analyzed.
Results:
In the 843 cases of OLT, the total anatomical variation rate of the donor hepatic arteries was 20.4% (172/843). The common variations included replaced or accessory right hepatic arteries originated from superior mesenteric artery (6.67%, 57/843), replaced or accessory left hepatic arteries originated from the left gastric artery (6.41%, 54/843) or from the celiac trunk and gastro-duodenal artery (1.66%, 14/843), replaced or accessory right hepatic arteries originated from the celiac trunk, common hepatic artery and gastro-duodenal artery (1.54%,13/843), replaced or accessory right hepatic arteries and left hepatic arteries coexistence (0.83%, 7/843), variation of the common hepatic artery from the superior mesenteric artery (1.54%, 13/843) or from the abdominal aorta (0.95%, 8/843).
Conclusion:
During graft procurement and reconstruction, accidental injury of the hepatic artery is more likely in the presence of hepatic arterial variation, which can be a common clinical entity. Acquaintance with hepatic arterial variation and maintenance of the integrity of the superior mesenteric artery and celiac trunk are key to reducing potential hepatic artery injuries.
