Department of Surgical Sciences, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.
Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
Surgeon. 2020 Apr;18(2):100-112. doi: 10.1016/j.surge.2019.06.002. Epub 2019 Jul 20.
The Aberrant Left Hepatic Artery (ALHA) is replaced when it does not originate from the hepatic artery proper and it is the only supply to that part of the liver, while an accessory artery coexists with a normal artery. The aim of this systematic review is to evaluate the incidence of ALHAs including the one arising from the Left Gastric Artery, also named Hyrtl's artery.
A literature search in PubMed, SCOPUS, WOS and Google Scholar was performed. The risk of bias was assessed by means of the AQUA tool. The main outcome was the prevalence of ALHA. Secondary outcomes were the prevalence of the accessory and replaced left hepatic arteries. A subgroup analysis was conducted by geographic region and type of evaluation.
This review included 57 studies, with a total of 19,284 patients. The majority of the studies involved the use of radiological techniques -especially Angio-CT-and were performed in Asia. The overall risk of bias was moderate. The overall prevalence of the ALHA was 13.52%; the overall prevalence was 8.26% for the Replaced ALHA and 5.55% for the Accessory ALHA. In the 18 studies that employed Michels' classification, Type II had the lowest prevalence (0.36%) and Type VII the highest prevalence (6.62%).
Some of the studies included did not distinguish between the ''replaced'' and ''accessory'' ALHA (34.25%). Some surgical dissection techniques proved insufficient for the localization of other hepatic arteries. These results suggest that an accurate preoperative radiological evaluation is needed to localize replaced arteries.
异常左肝动脉（ALHA）是指它不是发自肝固有动脉，而是肝脏某一部分的唯一供血动脉，同时伴有副肝动脉与正常动脉并存。本系统评价旨在评估包括发自左胃动脉（又名 Hyrtl 动脉）的 ALHA 的发生率。
在 PubMed、SCOPUS、WOS 和 Google Scholar 上进行文献检索。使用 AQUA 工具评估偏倚风险。主要结局是 ALHA 的患病率。次要结局是副肝左动脉和替代肝左动脉的患病率。按地理位置和评估类型进行亚组分析。
本综述纳入了 57 项研究，共 19284 例患者。大多数研究都涉及使用影像学技术，尤其是 Angio-CT，并在亚洲进行。整体偏倚风险为中度。ALHA 的总体患病率为 13.52%；替代 ALHA 的总体患病率为 8.26%，副 ALHA 的总体患病率为 5.55%。在采用 Michels 分类的 18 项研究中，II 型的患病率最低（0.36%），VII 型的患病率最高（6.62%）。
有些纳入的研究没有区分“替代”和“副”ALHA（34.25%）。一些外科解剖技术在定位其他肝动脉时证明不够充分。这些结果表明，需要进行准确的术前影像学评估来定位替代动脉。
