Accessory right hepatic artery arising from the left: implications for split liver transplantation.
BACKGROUND
Variant arterial anatomy must be recognized and appropriately managed during split liver transplantation to ensure complete vascular supply to both grafts. We describe an accessory posterior right hepatic artery, arising from the left and passing behind the portal vein bifurcation.


METHODS
Thirty-seven consecutive livers were examined during ex vivo liver-splitting procedures. An abnormal right accessory artery arising from the left hepatic artery was identified high in the porta hepatis. The anatomical variant is described and illustrated by methylene blue injection and arteriography.


RESULTS
The anomaly was encountered in 2 of 37 split liver procedures. The two right lobes with the abnormal artery were discarded.


CONCLUSIONS
Care should be taken during dissection behind the portal vein bifurcation to exclude an accessory segmental right hepatic artery. If present, the liver may not be suitable for splitting without compromising the right lobe, unless the left hepatic artery can be divided distal to the origin of the accessory vessel.
Institute of Liver Studies, King's College Hospital, London, England.
M
M
Rela
J L
JL
McCall
J
J
Karani
N D
ND
Heaton
D006499:Hepatic Artery / Q000002:abnormalities* / Q000033:anatomy & histology*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000098:blood supply; D016031:Liver Transplantation / Q000379:methods*