Anomalous branching pattern of common hepatic artery: a case report.

A number of hepatic artery variations exists which is continuously proving a hindrance for the surgeons and radiologists. During routine dissection in the subhepatic region in 50 year old male cadaver for undergraduate teaching, a variation in the branching pattern of common hepatic artery was noticed. We observed an unusual branching of the common hepatic artery into seven terminal branches, of which two were left hepatic arteries, two were right gastric arteries and the remaining three were right hepatic artery, cystic artery and gastroduodenal artery. Hepatic artery proper was absent. Embryological basis of these variations were discussed. The present case is a rarity and will further throw light on the knowledge of the hepatic artery variations, thus assisting surgeons and radiologists in various surgical and diagnostic procedures.

Origin of cystic artery from hepatic artery proper and its surgical implications.

Cystic artery is usually a branch of right hepatic artery given in the Calot’s triangle. Variations in the origin of cystic artery have been reported but there is paucity of literature regarding these in Indian subjects. The present case describes the origin of cystic artery from the hepatic artery proper, with an unusual course, which was detected during routine cadaveric dissection. The development of biliary vasculature is quite complex and it accounts for many variations. Knowledge of cystic artery variability facilitates intraoperative identification of vessels in both classical and laparoscopic surgery of the bile ducts. This emphasises the importance of a thorough knowledge of the cystic arterial variations that often occur and may be encountered during both laparoscopic and open cholecystectomy. Uncontrolled bleeding from the cystic artery and its branches is a serious problem that may increase the risk of intraoperative lesions to vital vascular and biliary structures during hepatobiliary surgery.

Continuous occlusion of hepatic artery for prevention of blood loss in partial hepatectomy for ruptured hepatocellular carcinoma / 中华消化外科杂志

Objective To investigate the value of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver in partial hepatectomy for ruptured hepatocellular carcinoma(HCC).Methods The clinical data of 36 patients(test group)who received partial hepatectomy for ruptured HCC by adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver at the Southwest Hospital were retrospectively analyzed.Thirty-six patients(control group)who received intermittent Pringle maneuver only were selected as the control.All data were analyzed using the chi-square test,Fisher exact probability and analysis of variance.Results The mean hepatic artery occlusion time of the test group was 58 minutes(range,36-98 minutes).The median blood loss of the test group was 400 ml,which was significantly less than 750 ml of the control group(F =16.47,P ＜ 0.05);78%(28/36)of patients in the test group did not receive blood transfusion,which was significantly more than 53%(19/36)of the control group(x2 =6.01,P ＜0.05).The levels of postoperative serumaspartate transaminase and total bilirubin of the 2 groups were peaked at postoperative day 2 and then decreased to the normal level 1 week later.There were no significant differences in the incidences and levels of complications between the 2 groups(x2 = 1.83,0.89,P ＞ 0.05).Conclusion The addition of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver significantly reduces intraoperative blood loss and doesn't bring any adverse effects to hepatic function for partial hepatectomy in patients with ruptured HCC when compared with intermittent Pringle maneuver alone.