Implications of a Completely Replaced Right Hepatic Artery and Pancreatoduodenectomy

The presence of an anomalous right hepatic artery (ARHA) and its anatomical course may have a significant impact on surgical and oncological outcomes for pancreatoduodenectomy for pancreatic adenocarcinoma. These anomalies occur in 17–26% of the population, and the most common of the anomalies is the complete replacement of the Right Hepatic Artery (RHA), followed by an accessory right hepatic artery, both arising from the superior mesenteric artery. The most common course of the ARHA is posterior to the head of the pancreas, and as such can usually be preserved. Preoperative arterial phase computer-aided tomography is able to accurately detect the type of anomaly and course the RHA anatomy with a high degree of reliability. This is important for preoperative planning regarding whether or not the anomalous artery can be preserved, sacrificed, or reconstructed during PD to provide the best chance to achieve an R0 resection.