Replaced Common Hepatic Artery Variations: Anatomical Considerations and Implications for Surgery: A Review and Case Report

Cadaver organ donors have been an excellent resource for studying vascular systems since precise anatomical details can be identified and assessed. From these studies over the past several decades, anatomical variations have been categorized into classification and modeling systems. These systems have been used as procedural guides and planning by anatomists, surgeons and interventional radiologists. This has helped to predict and strive for optimal surgical and clinical outcomes, as well as help reduce procedural complications associated with anatomical knowledge deficiencies. Aberrations of the celiac trunk have been studied quite extensively because it is generally prone to variations and because of its juxtaposition and contribution to the pancreas, liver, duodenum and hepatic biliary tree. Six of the common classification systems currently used by surgeons and interventional radiologists include those created by Lipshutz, Adachi, Morita, Uflacker, Hiatt and Michels. All six classification systems acknowledge the rare variant characterized by a common hepatic artery arising from the superior mesenteric artery, which is referred to as the replaced common hepatic artery or the celiacomesenteric trunk. This variant can have significant clinical implications owing to its proximity to the pancreatic head. As imaging modality advancements continue to evolve, it is expected that anatomical modeling will also likely enhance. We are entering a time when more centralized and cohesive arterial classification systems are needed to help further our understanding of vascular variant patterns.