The anatomical structure of the pancreaticoduodenal region is complex and closely related to the surrounding vessels. A variant of the hepatic artery, which is not a rare finding during pancreatic surgery, is prone to intraoperative injury. Inadvertent injury to the hepatic artery may affect liver perfusion, resulting in necrosis, liver abscess, and even liver failure. The preoperative identification of hepatic artery variations, detailed planning of the surgical approach, careful intraoperative dissection, and proper management of the damaged artery are important for preventing hepatic hypoperfusion. Nevertheless, despite the potential risks, planned artery resection has become acceptable in carefully selected patients. Arterial reconstruction is sometimes essential to prevent postoperative ischemic complications and can be performed using various methods. The complexity of procedures such as pancreatectomy with en bloc celiac axis resection may be mitigated by the presence of an aberrant right hepatic artery or a common hepatic artery originating from the superior mesenteric artery. Here, we comprehensively reviewed the anatomical basis of hepatic artery variation, its incidence, and its effect on the surgical and oncological outcomes after pancreatic resection. In addition, we provide recommendations for the prevention and management of hepatic artery injury and liver hypoperfusion. Overall, the hepatic artery variant may not worsen surgical and oncological outcomes if it is accurately identified pre-operatively and appropriately managed intraoperatively.

• Hepatic artery
• Pancreatectomy
• Pancreaticoduodenectomy
• Arterial reconstruction
• Celiac axis resection
• Outcome
• Prognosis

• Celiac Artery/diagnostic imaging
• Celiac Artery/surgery
• Hepatic Artery/diagnostic imaging
• Hepatic Artery/surgery
• Humans
• Liver/blood supply
• Liver/diagnostic imaging
• Liver/surgery
• Pancreatectomy/adverse effects
• Pancreatectomy/methods
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Postoperative Complications/surgery

• Adachi’s classification
• Common hepatic artery
• Gastric cancer
• Inferior phrenic artery
• Portal vein

• Hepatocellular carcinoma
• Inferior phrenic arteries
• Left inferior phrenic artery
• Multidetector computed tomography angiography
• Right inferior phrenic artery

(1) Background. The vertebral level of origin (VLO) of the celiac trunk (CT) and superior mesenteric artery (SMA) has been scarcely investigated. (2) Method. This study used 107 computed tomography angiograms and an eleven type grading system to classify the VLO of the CT and SMA. Each of the T12–L2 vertebra were divided in three horizontal levels. The intervertebral discs were considered distinct levels. (3) Results. The VLO of the CT ranged from the upper third of the T12 vertebra to the lower third of the L1 vertebra. The VLO of the SMA ranged from the lower third of the T12 vertebra to the upper third of the L2 vertebra. There was a highly significant association between the VLO of the CT and SMA (Chi2 = 201, p < 0.001), usually respecting a “plus two” rule. The mean CT–SMA distance was 1.82 +/− 0.66 cm in males and 1.55 +/− 0.411 cm in females, the difference being statistically significant. The mean CT–SMA distance tended to decrease with increasing CT–SMA types, the differences being statistically significant. (4) Conclusions. These characteristics of CT and SMA origins and their relations should be known by surgeons, as they could impact operative management and should be evaluated on a case-by-case basis.

• anatomic variation
• aorta
• celiac-mesenteric axis
• computed tomography
• vertebral column

The rare anatomic variants of the celiac trunk and superior mesenteric artery include the hepatosplenic, hepatosplenomesenteric (HSMT), celiacomesenteric, hepatomesenteric and gastrosplenic trunks. We report a 72-year-old female patient whose computed tomography angiograms indicated a rare anatomic feature whereby the right inferior phrenic artery was inserted in the origin of an HSMT, thus modifying it into a hepatosplenomesentericophrenic trunk (HSMPT). Above the HSMPT, the insertion of the left inferior phrenic artery in the origin of the left gastric artery determined a left gastrophrenic trunk (GPT). Proper identification of this type of rare anatomic variant is of utmost importance prior to different surgical procedures. For example, an HSMT origin of the right inferior phrenic artery is surgically relevant if this artery is an extrinsic pedicle of a hepatocellular carcinoma and is used for embolization of the tumor.

• abdominal aorta
• celiac trunk
• hepatic artery
• inferior phrenic artery
• superior mesenteric artery

• Aged
• Anatomic Variation
• Celiac Artery
• Female
• Hepatic Artery
• Humans
• Liver Neoplasms
• Mesenteric Artery, Superior