Intricacies in Surgery: Analyzing the Impact of Replaced Common Hepatic Arteries

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Co-authors:

Joanna Klansek - Medical Student, School of Medicine, Uniformed Services University of Health Sciences; Chase Schulte - Medical Student, School of Medicine, Uniformed Services University of Health Sciences; Eungjae Kim - Medical Student, School of Medicine, Uniformed Services University of Health Sciences; Matthew Miller - Medical Student, School of Medicine, Uniformed Services University of Health Sciences; Jae Choi, M.D. - Professor of Surgery, Department of Surgery, USF Morsani College of Medicine South Tampa Center for Advanced Healthcare; Kerrie Lashley, M.D. - Assistant Professor, Department of Surgery, George Washington University School of Medicine and Health Sciences; Benjamin Freedman - Medical Student, Uniformed Services University of Health Sciences; Kyle Carr - School of Medicine - Uniformed Services University of Health Sciences; Gary Wind, M.D., FACS - Professor of Surgery, Department of Surgery, Uniformed Services University of Health Sciences; Guinevere Granite, M.S., M.A., Ph.D - Director of Human Anatomy, Department of Surgery, Uniformed Services University of Health Sciences; Maria Leighton, M.D. - Assistant Professor, Department of Surgery, Uniformed Services University of Health Sciences; Elizabeth Maynes, M.D. - Assistant Professor, Department of Surgery, Uniformed Services University of Health Sciences

Abstract Body : Introduction/Objective: The Common Hepatic Artery (CHA) has fascinated researchers due to its pivotal role in liver blood supply and anatomical significance. Described initially as part of a trifurcation, recent studies revealed diverse variants, notably the replaced common hepatic artery (RCHA) arising from the superior mesenteric artery. This meta-analysis explores demographics, surgical methods, and imaging for managing RCHAs, aiming to foster consensus on pre-, intra-, and postoperative strategies for this complex anatomical variation.

Method: An electronic search was conducted across databases including MEDLINE, EMBASE, and CINAHL, focusing on case reports and series involving patients identified to have a RCHA during preoperative or operative assessments with exclusion criteria in place. Following data extraction, descriptive statistics including medians, interquartile ranges, and percentages for demographics were utilized to assess the data. Individual patient outcomes were organized into descriptive tables and analyzed using R software (version 3.5.1).



Results: Out of 212 initially identified articles, 38 cases involving 42 patients met the inclusion criteria. These patients, mostly male (69%) with a median age of 62, commonly exhibited RCHA variations, predominantly posterior to the pancreas (74%). Jaundice (31%) and epigastric pain (17%) were common pre-operative symptoms, and imaging methods such as general arterial imaging (92%) and MRI (20%) were crucial for preoperative RCHA identification. The Whipple procedure (80%) was the most common procedure performed. Notably, patients with posterior artery variants had a longer hospital stay (mean 19.6 days) compared to those with anterior variants (mean 10.7 days), (p-value 0.09)

Conclusion: This meta-analysis emphasizes preoperative screening importance for RCHA in hepatic-pancreatic-duodenal conditions. Imaging techniques like CT angiogram or MRI are vital to prevent complications. While statistically inconclusive, posterior RCHA variants are potentially associated with prolonged hospital stays ( >14 days). Surgical strategies, including artery-first approaches (47%), exhibited success in managing RCHA variants, emphasizing the need for tailored surgical approaches. Further research with larger scales is necessary to validate associations and optimize outcomes for patients with RCHA, aiming to establish consensus in surgical management.