Accessory hepatic artery: incidence and distribution

Abstract

Background: Anatomic variations of the hepatic arteries are common. Preoperative identification of these variations is important to prevent inadvertent injury and potentially lethal complications during open and endovascular procedures. Objective: To evaluate the incidence, extra-hepatic course, and presence of side branches of accessory hepatic arteries, defined as an additional arterial supply to the liver in the presence of normal hepatic artery. Methods: Eighty-four human male cadavers were dissected using a transperitoneal midline laparotomy. The supra-celiac aorta, celiac axis, and hepatic arteries were dissected, and their trajectories were identified to describe arterial branching patterns. Results: Normal hepatic arterial anatomy was identified in 95% of the cadavers and six (5%) had accessory hepatic arteries. In five cadavers the accessory hepatic artery followed its course through the fissure for ligamentum venosum, and in one it coursed adjacent to the hepatic artery through the margin of the lesser omentum. One cadaver had a single side branch, which provided arterial blood supply to the left adrenal gland in the absence of any left inferior phrenic artery. Conclusion: Accessory hepatic artery most often follows the course of the hepatic fissure for ligamentum venosum. Albeit uncommonly found in 5% of cases, this finding should be identified during open and endovascular procedures to prevent inadvertent injury.