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Objective To assess the preoperative detection of hepatic arterial anomalies in patients undergoing pancreaticoduodenectomy using multi-slice computed tomographic angiography (MSCTA).Methods Between January 2014 and December 2017,60 patients who underwent pancreaticoduodenectomy were included in this retrospective study.The clinical and imaging data were analyzed.The types of hepatic artery found by preoperative MSCTA based on the Michels classification were compared with the actual hepatic arterial anatomy detected during surgery.Results Hepatic arterial anomalies were detected by MSCTA in 12 of 60 patients (20.0％).Using the Michels classification,there were 3 patients with type Ⅱ (25.0％),6 patients with type Ⅲ (50.0％),1 patient with type Ⅵ (8.3％),and 1 patient with type Ⅸ (8.3％).One patient (8.3％,1/12) had an anomaly which was not included in the Michels typing.All the hepatic arterial anomalies detected by MSCTA corresponded to those found in surgery (12 patients).The rates of accuracy,sensitivity,and specificity of MSCTA were all 100％.Conclusions MSCTA provided a high accuracy in diagnosing hepatic arterial anomalies.MSCTA should be routinely used before pancreaticoduodenectomy.
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Background: With increase in the number of laparoscopic procedures, oncologic surgical interventions and organ transplant cases, anatomy and variations of hepatic arterial systemhave become increasingly important. Variations in these vessels may predispose the patients to inadvertent injury during open surgical procedures or percutaneous interventions. Aims: The present study is intended to contribute to the pre-existing data regarding the variations in the branching pattern of hepatic artery and throw light on their clinical implications. Methods: Extrahepatic branching pattern of hepatic arteries were studied in 40 embalmed cadavers of both sexes by dissection method. Results: Classical text book pattern of hepatic arterial anatomy was seen in 30(75%) cases and ten (25%) cases showed the presence of aberrant hepatic arteries. 12 aberrant hepatic arteries were seen in these ten cases, eight (20%) cases with single aberrant hepatic artery and two (5%) with combination of aberrant right and left hepatics. Aberrant right hepatic arteries were seen in four (10%) cases and all of them were replaced right hepatics arising directly from celiac trunk. Aberrant left hepatic arteries were seen in eight (20%) cases, of which six (15%) were accessory, two (5%) were replaced and all of them arose from the left gastric artery. Conclusion: Because of high incidence of variations in branching pattern of hepatic artery it is very important to have a thorough knowledge of these variants and identify them so as to prevent iatrogenic injuries and increase rate of success of the surgical and interventional procedures in hepatobiliary region.
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Objective To assess the value of multi-slice computed tomography angiography (MSCTA) in the preoperative detection of aberrant hepatic arteries in patients scheduled to undergo pancreaticoduodenectomy.Methods Patients with pancreatic and peri-ampullary tumors were preoperatively studied using contrast-enhanced abdominal CT angiography (CTA).The results on hepatic arterial anatomy were compared with those obtained from digital subtraction angiography (DSA) and on surgical findings.Results Eighty-one patients were included into this study.DSA was carried out in 29 patients to evaluate tumor resectability,and 66 patients received surgery.Anomalous hepatic arteries were detected in 17 (21％) patients on CTA.Thirteen (16.0％) patients had a single arterial variant,and 4 (4.9％) patients had two arterial variants.One patient each was seen in the Michels type Ⅳ,Ⅶ,and Ⅷ respectively,while 2 patients each were seen in the Michels type Ⅲ and Ⅴ respectively.Five patients were diagnosed as the Michels type Ⅵ,and four as the Michels type Ⅸ.One patient demonstrated a rare variant which was not included into the Michels classification.MSCTA had an accuracy of 100％,a sensitivity of 100％,and a specificity of 100％.Regarding the traceability scores of hepatic arterial segment,there were no statistically significant differences between MSCTA and DSA.Conclusions MSCTA is an effective imaging tool to assess arterial anatomical variation around the pancreatic head.It is non-invasive,and it provides valuable information on the peri-pancre atic vascular anatomy before pancreaticoduodenectomy.