The hepatic arterial system variations: A systematic review with meta-analysis

The hepatic artery (HA) system is essential for the arterial supply of the liver and other abdominal organs. Understanding its anatomical variations is crucial for anatomists, radiologists, and surgeons, particularly in the context of abdominal surgeries and preoperative imaging. While two most recognized classification systems - Michels' and Hiatt's - describe these variants, a comprehensive meta-analysis covering the entire hepatic arterial system is lacking.

This systematic review and meta-analysis followed PRISMA 2020 guidelines and Evidence-based Anatomy Workgroup protocols. A thorough literature search was conducted across major databases, including PubMed, Scopus, Web of Science, and Google Scholar. Studies reporting the prevalence of HA variants were included, and pooled prevalence was calculated using random-effects models. Subgroup analyses were performed based on geographic distribution and study type.

Eighty-five studies with a total of 47,732 patients were included. Typical HA anatomy was identified in 69.96 % (95 % CI: 66.78-73.05) of cases, while 30.04 % exhibited variant anatomy. The most common variation involved the right hepatic artery (RHA) with a pooled prevalence of 11.38 % (95 % CI: 9.45-13.45). Significant differences were observed between populations and study types, with European populations and cadaveric studies showing higher prevalence rates for certain variants.

HA variability is common phenomenon, with approximately one-third of individuals presenting deviations from the typical anatomy. These findings are crucial for surgical planning and risk mitigation in invasive procedures, particularly those involving the hepatobiliary region. Future research should aim to refine classification systems, address heterogeneity, and include gender-specific and morphometric data to enhance anatomical understanding.