Orthotopic liver transplantation represents the ideal opportunity to examine the surgical anatomy of the blood supply to the liver. We describe an interesting anatomic variation of the hepatic artery that was observed in four procurements from our center.
According to our policy for procurements in our institution, we initially perform a meticulous dissection of the portal triad and the lesser omentum to precisely identify aberrant or replaced hepatic arteries.
During these four harvests, an arterial pulsation was identified behind the portal vein. This vessel was believed to be an aberrant right hepatic artery because the proper hepatic artery was clearly dividing in a right and a left branch. After flushing the intra-abdominal organs with cold University of Wisconsin solution, further dissection showed that this "aberrant" right hepatic artery was originating from the very proximal celiac artery trunk, not from the superior mesenteric artery. It then ran behind the portal vein and was positionedlateral to the bile duct, entering separately in the liver, just like an aberrant right hepatic artery (Fig. 1).
The celiac artery trunk was harvested with an aortic cuff, and the superior mesenteric artery was examined again; no aberrant vessels originated from it.
During transplantation, rearterialization of the liver was achieved with anastomosis between the aortic cuff and the recipient proximal hepatic artery.
All four patients showed excellent arterial flow after reperfusion, as shown in the operating room, but also with postoperative duplex examinations of the grafts.
To our knowledge, this arterial variant has not been described in the literature. [1][2][3] We believe this variation is underreported and should raise caution in cases of split-liver harvesting, as well as in cases of living donor liver transplantation, because these vessels behave like terminal vessels. 4,5