A Rare Anatomic Variant of Double Replaced Hepatic Arteries: A Case Report and Brief Review of the Anomalous Hepatic Vasculature Literature.

BACKGROUND The liver is a frequent site of surgical resection for both benign and malignant lesions. Advanced knowledge of the hepatic arterial system and its variants is crucial to avoid incidental injuries during a resection procedure. Many variants have been previously described in the literature, yet extremely rare cases continue to be encountered in clinical practice. Documentation of these variants can thus allow for proper preoperative procedural planning when considering interventions involving the liver. Our aim is to present one such unique and extremely rare anomaly. CASE REPORT During routine cadaveric dissection of a 78-year-old man who had died of acute myeloid leukemia, a rare anatomic variant of the hepatic vasculature was revealed: a replaced right hepatic artery (rRHA) coming directly from the celiac trunk, a middle hepatic artery (MHA) continuing from the common hepatic artery (CHA), and a replaced left hepatic artery (rLHA) branching from the left gastric artery (LGA). To the best of our knowledge, this anomaly has only been described once before in the literature. CONCLUSIONS We report a rare anatomical variant of the hepatic vasculature. The significance of this variant must be considered during preoperative planning and the intra-arterial infusion of targeted drugs. This case further emphasizes the importance of proper medical imaging and documentation to ensure the best course of treatment for each patient. Given that this variant has only so far been identified in 2 post-mortem subjects, further work should include attempts at characterizing its physiologic effects in a living patient.