Anatomy of the Hepatic Artery Branches

The left hepatic artery enters the liver on the left side of Rex's recessus; the middle hepatic artery, through the right side of Rex's recessus; the right hepatic artery more frequently runs between the portal vein and the bile duct, posterior to the confluence. The right hepatic artery divides into the anterior branch that runs between the bile duct and the portal vein, and posterior branch that turns caudally to the right portal vein and enters the liver (see Fig. 1) [3].

Variations of the hepatic artery are very common: more than 10 types of anatomic variants including the presence of accessory or replaced artery, have been described. The principal types of anatomic variants are:

- Type 1: the right, middle and left hepatic artery arise from the common hepatic artery (71-72%)

- Type 2: the right hepatic artery arises from the superior mesenteric artery (13-14%)

- Type 3: the left hepatic artery arises from the left gastric artery (11-12%)

- Type 4: the common hepatic artery arises from the superior mesenteric artery (2-5%) [5] (Fig. 7)

Fig. 7 Anatomical variations of the main hepatic artery. R, Right hepatic artery; M, middle hepatic artery; L, left hepatic artery; SMA, superior mesenteric artery; LGA, left gastric artery; SA, spleen artery

Regarding the relationship between proper hepatic artery, portal vein and biliary tract, the proper hepatic artery more frequently (76% of cases) runs behind the biliary tract and rarely (24% of cases) has an anterior course. Finally, in 9% of cases the right hepatic artery runs dorsally to the portal vein.

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