Hepatic Arterial Anatomy and Variations

The hepatic arterial system typically originates from the celiac trunk, giving rise to the common hepatic artery which then divides into the proper hepatic artery and the gastroduodenal artery. The proper hepatic artery usually bifurcates into right and left hepatic arteries, with the cystic artery arising from the right branch. Classic descriptions of these vessels are encapsulated in the Michels and Hiatt classification schemes, which categorise variants such as replaced and accessory hepatic arteries. Anatomical variations occur in up to half of individuals, including origins of the right hepatic artery from the superior mesenteric artery or of the left hepatic artery from the left gastric artery, as well as rare anastomoses such as the arc of Buhler. These variants are increasingly delineated by high‐resolution imaging, particularly multidetector computed tomography angiography, and carry profound implications for liver transplantation, hepatobiliary resections, pancreatic surgery and interventional radiology. A detailed understanding of arterial patterns underpins surgical planning, minimises perioperative complications and informs the design of endovascular procedures.

Research from Nature Portfolio

Recent meta‐analytic work has established the prevalence and clinical significance of the arc of Buhler, a persistent embryonic connection between the celiac trunk and the superior mesenteric artery. Analysis of thousands of patients across radiological, computed tomography and angiographic studies has yielded a pooled prevalence estimate of approximately 1.7%. This anastomosis, although uncommon, can provide critical collateral flow in the setting of celiac axis stenosis and should be recognised when planning arterial reconstructions or embolisation procedures to avoid inadvertent ischaemia.

Hepatic Arterial Anatomy and Variations publication trend

The graph below shows the total number of articles in hepatic arterial anatomy and variations across all publications each year (not limited to Nature Index journals).

Technical terms

Celiac trunk: The first major abdominal branch of the aorta, typically trifurcating into the left gastric, splenic and common hepatic arteries.

Common hepatic artery: A branch of the celiac trunk that supplies the liver, stomach and duodenum, dividing into the proper hepatic and gastroduodenal arteries.

Proper hepatic artery: Continuation of the common hepatic artery that ascends within the hepatoduodenal ligament to supply the liver.

Replaced/accessory hepatic artery: A variant vessel that originates from an artery other than the common hepatic, supplying either the right or left hepatic lobe in addition to or instead of the usual branch.

Arc of Buhler: An uncommon persistent embryonic anastomosis between the celiac trunk and the superior mesenteric artery, providing collateral flow.

MDCT angiography: Multidetector computed tomography technique that produces high‐resolution three‐dimensional images of vascular anatomy for non‐invasive assessment.

References

1. The meta-analysis and systematic review of prevalence and clinical anatomy of the arc of Buhler. Scientific Reports (2023).
2. Importance of Anatomical Variation of the Hepatic Artery for Complicated Liver and Pancreatic Surgeries: A Review Emphasizing Origin and Branching. Diagnostics (2023).
3. Aortic Origins of the Celiac Trunk and Superior Mesenteric Artery. Diagnostics (2021).
4. ANATOMIC VARIATIONS OF HEPATIC ARTERY: A STUDY IN 479 LIVER TRANSPLANTATIONS. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) (2017).
5. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography*. Radiologia Brasileira (2015).