From the Guidelines
The aberrant right hepatic artery is most commonly found arising from the superior mesenteric artery, nearly always supplied from this artery and detected at operation as pulsation posterior to the bile duct. This anatomical variation is significant in the context of pancreatic cancer diagnosis and treatment, as discussed in the guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas 1. The aberrant right hepatic artery is detected at operation, and its identification is crucial to prevent complications during surgical procedures.
Some key points to consider when identifying the aberrant right hepatic artery include:
- The artery is nearly always an aberrant right hepatic artery supplied from the superior mesenteric artery 1
- It is detected at operation as pulsation posterior to the bile duct 1
- Intraoperative ultrasonography can confirm the presence of the aberrant right hepatic artery 1
- The aberrant right hepatic artery is clinically significant during surgical procedures such as pancreaticoduodenectomy, liver transplantation, and hepatobiliary surgeries, where inadvertent injury could lead to ischemia of the right hepatic lobe.
The guidelines highlight the importance of accurate diagnosis and staging of pancreatic cancer, and the aberrant right hepatic artery is a critical anatomical variation that surgeons must be aware of to prevent complications during surgery 1.
From the Research
Location of Aberrant Right Hepatic Artery (RHA)
- The aberrant right hepatic artery (RHA) is most commonly found arising from the superior mesenteric artery (SMA) 2, 3, 4.
- In a study of 60 embalmed adult cadavers, the presence of aberrant RHA was found in 8 specimens (13.3%), with 5 specimens (8.3%) having a replaced RHA arising from the SMA and 3 specimens (5%) having an accessory RHA arising from the SMA 2.
- Another study reported that an aberrant right hepatic artery arising from the SMA is present in 10 to 20% of cases, and its course is usually retro-pancreatic, but can also cross into the pancreatic head in up to 10% of cases 3.
- Other studies have also reported the presence of aberrant RHA arising from the gastroduodenal artery (GDA) 5 and the inferior pancreaticoduodenal artery (IPDA) 4.
Course of Aberrant RHA
- The course of the aberrant RHA can vary, with some studies reporting that it can course dorsal to the duct system to enter the Calot's triangle 2, 3.
- In some cases, the aberrant RHA can also course ventral to the duct system to reach the Calot's triangle 2.
- The aberrant RHA can also have an intrapancreatic course, which is a rare anomaly 6.