Hepatic artery: embryology, anatomy and liver transplantation implications

Abstract

Introduction: The hepatic artery (HA) arises from the celiac trunk (CT), originating from the aorta, but certain changes, in different stages of human development in the embryonic period, may generate several changes in the normal conformation of the vasculature. Knowledge of both normal and anomalous arterial distribution is a crucial factor for the success of complex surgeries, such as liver transplantation, avoiding vascular complications that may lead to graft loss. Purpose: To review the literature in order to contribute to the knowledge of professionals and students in the area and to preserve the individuals who need these procedures. Methods: A literature review was performed at PUBMED. The English descriptors used were: 'hepatic artery', 'liver transplantation' and 'anatomy'. Results: Hepatic blood supply in embryogenesis is performed by the left gastric artery, the common hepatic artery and the superior mesenteric artery. The anatomy of hepatic irrigation is quite diverse, which makes the radiological, angiographic and surgical evaluation difficult if there is not a good knowledge of the classical and anomalous anatomy by the medical team. Hiatt's classification is simple and practical, using only 6 types of variations instead of 10 as Mitchels. Careful assessment of vascular and biliary structures prior to transplantation is of utmost importance for the prevention of complications such as hepatic artery thrombosis. Conclusion: The impact of vascular complications is enormous and it is therefore essential that surgeons have full knowledge of vascular anatomy and its variations in order to gradually reduce the incidence of complications.