De Blasi Vito, Makkai-Popa Silviu-Tiberiu, Arru Luca, Pessaux Patrick, Azagra Juan Santiago
Department of General and Minimally Invasive Surgery, Centre Hospitalier de Luxembourg, 4, rue Ernest Barblé, 1210, Luxembourg City, Luxembourg.
Department of Digestive and Endocrine Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg, France.
Surg Radiol Anat. 2019 Mar;41(3):343-345. doi: 10.1007/s00276-018-2163-5. Epub 2018 Dec 13.
Our aim is to present a rare case of anatomic variation of the arterial blood supply to the liver because preoperative knowledge of hepatic vascular variations is mandatory in hepatic surgery and liver transplantation.
We present a case of unusual arterial blood supply to the liver, a right hepatic artery coming from the splenic artery, associated to a classical common hepatic artery and a left hepatic artery from the left gastric artery. Preoperative diagnosis was made using CT-scan and 3D reconstruction.
The right hepatic artery was found behind the portal vein and its diameter showed its importance in the vascularisation of the liver. To our knowledge this type of variation has only twice been described before. The accuracy of the 3D reconstruction allowed us to adopt the best surgical strategy to avoid lesions of the two accessory arteries which proved important sources of blood supply.
Precise preoperative evaluation of liver blood supply has great importance on surgical, transplantation strategy and outcome and rare anatomic variations have to be known to avoid lesions of potentially important arteries. New techniques of 3D reconstruction can ease the preoperative recognition of such difficult anatomic variations.
我们的目的是呈现一例肝脏动脉血供解剖变异的罕见病例，因为肝脏手术和肝移植术前了解肝脏血管变异是必不可少的。
我们展示了一例肝脏动脉血供异常的病例，一条右肝动脉发自脾动脉，与一条经典的肝总动脉以及一条发自胃左动脉的左肝动脉并存。术前通过CT扫描和三维重建进行诊断。
右肝动脉位于门静脉后方，其直径显示了它在肝脏血管化中的重要性。据我们所知，这种变异类型此前仅被描述过两次。三维重建的准确性使我们能够采用最佳手术策略，避免损伤这两条作为重要血供来源的副动脉。
术前对肝脏血供进行精确评估对于手术、移植策略及结果至关重要，必须了解罕见的解剖变异以避免损伤潜在的重要动脉。三维重建新技术能够便于术前识别此类复杂的解剖变异。
