Anatomic Variations Pre and Post Liver Transplantation

Variations in the splanchnic arterial anatomy occur in more than 40% of patients (Fig. 9). For this reason, pre-operative vascular planning for hepatic resections, liver transplantations, resection of retroperitoneal masses, chemoinfusion pump

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Fig. 10a-c. DSA (a, b) as well as the coronal MIP image (c) obtained from an arterial phase breath-hold FLASH 3D acquisition reveal a Michels class VIII hepatic arterial variant - the left hepatic artery arises from the left gastric artery (arrows) and the right hepatic artery arises from the superior mesenteric artery (arrowheads)

b placement, surgical shunting, or other abdominal operations may require mapping of the visceral arterial anatomy. Generally, this is done by conventional angiography for the fine detail necessary to identify variations involving tiny arteries. To evaluate the splanchnic artery origins and major branches, 3D CE MRA is frequently sufficient. When patients are undergoing renal revasculariza-tion, it is important to know the splanchnic arterial anatomy in case a spleno-renal or hepato-renal bypass is needed to avoid clamping the aorta. The most common variation is a replaced (17%) or accessory (8%) right hepatic artery, most commonly from the SMA (Fig. 10). Less common variations include the left hepatic artery arising from the left gastric artery (Fig. 11), the common hepatic artery arising from the SMA (2.5%) or directly from the aorta (2%), the left gastric artery arising from the aorta (1%-2%), or a celiaco-mesenteric trunk (<1%). Other even more complex variations may also occur.

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