Evaluation of Variants in Hepatic Artery Anatomy on Conventional Angiography in Patients Undergoing Transarterial Chemoembolization (TACE): Experience at SIUT

Syed Muhammad Faiq, Ameet Jesrani, Muniba Jamal, Ameet Lalwani

Abstract


Objective: The purpose of this research is to evaluate common and uncommon variant of hepatic arterial anatomy that
usually come across during Hepatic Angiographies.
Study Design: Cross sectional study.
Methods: This study included 50 patients having history of Hepatocellular Carcinoma from May to October 2015. Hepatic
Angiography (Transarterial chemoembolization for management of Hepatoma and identification of classical and variant
anatomy of hepatic artery) was evaluated in angiography unit. All procedures were performed on Digital Subtraction
Angiography (DSA) machine (Toshiba KXO100 G). Selective DSA of the superior mesenteric artery and celiac trunk is
performed initially to evaluate the frequency of normal and variant arterial anatomy and secondly to determine origin and
course of tumor-feeding vessels. Evaluation of common and uncommon variants of hepatic arteries was done by using
Michel’s classification as reference standard.
Results: Age of the patient range from 40 – 80 years, 35 of whom were males. Fifty patients underwent angiographic
procedure of viscera. Normal anatomy of hepatic artery was found in twenty eight (56%) cases. In six (12%) cases we
found the replaced form of right hepatic artery (RHA) originating from visceral superior mesenteric artery. In five (10%)
cases we found the replaced form of left hepatic artery (LHA) originating from left gastric artery (LGA), the combination
of both these anomalies in one (2%) patient. Four (8%) cases had the left gastric artery giving rise to accessory left hepatic
artery in conjunction with the common hepatic artery of celiac axis giving rise to typical right or left hepatic artery. In
another four (8%) cases anatomic variation was noted in form of a dual arterial supply noted as common hepatic artery
of celiac axis giving rise to typical left or right hepatic artery in conjunction with superior mesenteric artery giving rise
to accessory right hepatic artery. In two (4%) cases superior mesenteric artery had replaced the celiac trunk completely.
Conclusion: Visceral angiography with evaluation of common and uncommon variants of hepatic artery are very crucial
not only for proper preoperative evaluation in hepato biliary surgeries but also in many diagnostic and therapeutic
interventional procedures. We have found that it is of utmost importance to have a detailed and complete information and
understanding of anatomic variations of hepatic artery both common and uncommon variants in order to avoid hazardous
complications which can happen with incomplete information

Keywords


Variants, Hepatic artery, Angiography, Transarterial Chemoembolization.

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