Two novel hepatic arterial variations in a living liver donor detected by multidetector computed tomography angiography.

PURPOSE

Considering that the knowledge of variations in the hepatic vascular structure is essential for hepatic surgery and liver transplantation, we aimed to present a rare case of the anatomic variation of arterial blood supply to the liver to help prevent complications and choose suitable donors.

METHODS

We present a novel variant in this case report (living liver donor), an accessory right hepatic artery (supplying segment 6) originating from the dorsal pancreatic artery and a middle hepatic artery (supplying segment 4) arising from the pancreaticoduodenal artery (first branch of the gastroduodenal artery). Preoperative diagnosis was made using computed tomography angiography (CTA) with multiplanar reformate (MPR) images, curved planar reformate (CPR), maximum intensity projection (MIP) images and three-dimensional volume renderings (3D VR).

RESULTS

To the best of our knowledge, this is the first case in the English literature describing this type of variation. A search for new donors began since the living liver donor was not suitable due to the very thin segment 4 artery, posing potential risks for the donor and the thin segment 6 artery being a complicating factor for anastomosis.

CONCLUSIONS

The preoperative knowledge of liver blood supply has great importance in planning surgery and transplantation. CTA, reformate and reconstruction techniques allow for the evaluation of difficult and complex anatomic variations.