The Significance Of Anatomic Variations Of Hepatic Artery In Surgical Treatment:Systematic Analysis With DSA

Objective:Digital subtraction angiography(DSA)was used to retrospectively describe and analyze the incidence and types of hepatic artery anatomical variations in patients with liver tumor.We always payed special attention to rare hepatic artery variation,even unreported variation,and to explore its potential impact on clinical surgical treatment.Materials and methods:The 1141 Patients with liver tumor diagnosed clinically or pathologically in Shandong Provincial Hospital from May 2015 to December 2019 were selected as the object of study.The dynamic and continuous imaging data of all patients during digital subtraction angiography were analyzed retrospectively.Meanwhile,the origin,shape and distribution of hepatic artery in each patient were recorded.During the study period,all patients underwent at least one hepatic arteriography in our hospital,and only the data of the first hepatic arteriography were collected.According to the Michels and Hiatt classification,the incidence and specific types of hepatic artery variation in this study were statistically analyzed.Results:Among the 1141 patients with liver tumors in this study,the anatomy of hepatic artery belonged to normal type(76.3%),and the other 270 cases had hepatic artery variation(23.7%).Among the variant hepatic arteries,there were 208 cases according to Michels classification,accounting for 18.3%.Including Michels ???,accounting for 3.5%,7.1%,0.7%,2.7%,1.4%,0.3%,0.4%,2.1%,0.1%,respectively,of which 1 case of Michels ? is a rare mutation.According to the Hiatt classification,there were 209 cases,including Hiatt ???,accounting for 6.2%,8.5%,1.4%,2.1%and 0.2%respectively,of which 2 cases of Hiatt VI was a rare mutation.Having 60 cases of hepatic artery variation was not included in Michels or Hiatt classification,accounting for 5.3%.The origin variation of hepatic artery was found in 30 cases(2.7%),including one hepatic artery variation in 26 cases(2.3%)and two hepatic artery variation in 4 cases(0.4%).Those were the replaced right hepatic artery arising from the superior mesenteric artery meanwhile the accessory right hepatic artery from the gastroduodenal artery;the common hepatic artery arising from the superior mesenteric artery and the accessory left hepatic artery from the left gastric artery;the replaced right hepatic artery originating from the superior mesenteric artery with the replaced left hepatic artery from the gastroduodenal artery;and the replaced left hepatic artery and the replaced right hepatic artery originating from the superior mesenteric artery respectively.The latter two are unreported rare variations.Bifurcation variation of common hepatic artery was found in 18 cases(1.6%),including three bifurcations of common hepatic artery in 15 cases(1.3%)and four bifurcations of common hepatic artery in 3 cases(0.3%).Simultaneous bifurcation variation and origin variation occurred in 3 cases(0.3%).The common hepatic artery originated from the superior mesenteric artery and the three bifurcations of the common hepatic artery,and the three bifurcations of the common hepatic artery and the left accessory hepatic artery originated from the left gastric artery.1 case of common hepatic artery bifurcation and replaced left hepatic artery arose from left gastric artery,which has not been reported.In addition,it was found that the root of the celiac trunk was narrow or occluded,and a circuitous arterial anastomotic ring was formed between the common hepatic artery and the lateral branches of the superior mesenteric artery in 8 cases(0.7%).It was found 1 rare case(0.1%)that the liver cancer with situs inversus totalis.Conclusion:The overall variation rate of hepatic artery anatomy is basically consistent with the existing research data,but the incidence of unclassified hepatic artery variation is high.It can be seen that the anatomical variation of hepatic artery is diverse and complex.Combined with a large number of literature reports and this clinical study shows that Michels classification or Hiatt classification cannot fully cover the types of variation,hepatic artery variation includes:origin,bifurcation,origin and bifurcation variation.In particular,3 cases of previously unreported hepatic arteries variation were found in this study.For the hepatobiliary surgeons and interventional radiologists,it is very important to understand the type and incidence of hepatic artery abnormalities,which is helpful to shorten the operation time,improve the success rate of operation and reduce related complications.