HEPATIC ARTERIAL VARIATIONS AND ITS IMPLICATIONS ON HEPATOBILIARY SURGERY

Aim :To assess the hepatic arterial variations on Multidetector CT and their relevant clinical significance in hepatobiliary procedures. Materials and Methods : This is a retrospective study in which 1000 post-contrast CT scans of the abdomen were reviewed at the Department of Radiology between July 2011 and June 2012. All CT's in which arterial phase imaging was performed were included. Postsurgical cases and cases of vascular thrombosis and arteriovenous malformation were excluded from the study. Results :Out of the 10 Mitchel's hepatic arterial variations, 9 were seen. Type I was most common and 678 (67%) patients had it. Type II variation was seen in 178 (17%) patients, type III in 34 (3.4%) type V in 25 (2.5%) patients. Apart from this, we found 17 types of rare variations in which the most common were common hepatic artery arising directly from aorta (0.7%), right hepatic artery arising from aorta and left hepatic artery arising from left gastric artery (0.6%) and both right and left hepatic arteries arising from celiac axis (0.4%). Conclusion : This is one of the largest studies in Asia on this topic. Majority of Pakistani population has conventional hepatic arterial anatomy but the types of variations noted are more diverse. Of note a greater percentage had type II anatomy which increases complexity of hepatic transplant surgery.