Application of CRL-classification (J. Yan et al., 2020) principles for description of rare hepatic artery anomalies
Oleg Korotkov2, Natalya Trushel2, Ivan Shturich1, Sergey Korotkov1, Aleksey Shcherba1, Oleg Rummo1.
1Transplant department, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus; 2Department of Normal Anatomy, Belarusian State Medical University, Minsk, Belarus
Background: Nowdays publications dedicated to the anatomy of the hepatic artery (HA) continue to be published and associated with rather high its variability.
Objective: The aim of the study was to establish the variants of HA; apply morden principles for description of rare HA anomalies.
Materials: Study included a retrospective analysis of CT-angiography data of 60 patients Variants of the anatomy of the hepatic arteries were classified according to the proposed in 2020 by J. Yan et al. hepatic artery anatomy classification based on the three-dimensional CT. This classification is based on such parameters as the type of the aberration and the place of origin for the three main hepatic arteries: common hepatic artery (CHA) – «C», right hepatic artery (RHA) – «R» and left hepatic artery (LHA) – «L». In this case, the first letter indicates the described vessel (C, R, L), the second letter - the nature of the aberration (a - additional, r - replaced), the third letter - the place of origin (A - aorta, C – truncus celiacus, G - gastroduodenal artery (GDA), L – left gastric artery (LGA), S - superior mesenteric artery (SMA), O - other).
Results: Normal HA anatomy was observed in 41 patients (68.3%). Anomalies of the LHA)were observed in 6 (10.0%) patients. At the same time, the LHA arisesd from the LGA: accessory LHA (CRLaL) – 4, replaced LHA (CRLrL) – 2. Anomalies of the RHA with origin from the SMA and GDA were observed in 3 (5.0%) patients: replaced RHA from the SMA (CRrSL) was noted in 1 patient, an additional RHA from the GDA (CRaGL) – in 2 patients. Simultaneous atypical arising of the left and right HA was noted in 5 (8.3%) patients. LHA arised from the LGA, RHA from the SMA in 3 cases (CRrSLrL), the RHA from the GDA in 2 cases (CRrLLrG). Separate arising of the CHA from the SMA (CSRL) or LGA (CLRL) was not revealed, its anomalous origin was combined with anomalous arysing of other hepatic arteries. Such combined variants were revealed by us as rare and were observed in 5 cases (8.3%). To unify the rare variants with the CRL classification, we proposed to use the same letter designations for the "non-hepatic" arteries, separating them from the "hepatic" ones with square brackets, for example: [CRL]LA - classical anatomy of the CHA, RHA, LHA + LGA from aorta; [CSRL]LA - CHA from SMA + LGA.
Conclusions: 1) Anomalies of the HA occur frequently: almost third of patients (31.7%) had abnormal variant of HA, while a combination of several anomalies (16.7%) is possible; 2) proposed classification is convenient for protocoling anomalies of the HA; 3) application of the proposed CRL-classification allows exactly indicate the peculiarity of rare and combined anomalies of the HA, as well as take into account the peculiarity of non-hepatic arteries that vascularizate organs of hepatopancreatobiliary area.
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