Artera hepatică dreaptă în aspect anatomoclinic

Abstract

Background Studying of individual variations of hepatic and cystic artery architectonics, including the derivation, angle of convergence, bifurcation, sizes, etc.; defining the anatomic diversity of biliary tracts and cystic duct; confirmation of literature data about a constant detection of the Calot’s triangle in its classical borders, as an anatomical landmark for localization and mobilization of a single or multiple cystic arteries. Material and methods Part of the material was examined by the method of anatomical dissection, another considerable part of it – 45 preparations – by injection with self-solidifying plastic mass «REDONT – 03®» and subsequent etching. Results The right hepatic artery (RHA) in its classic version has a path oriented between the hepatic artery proper and the hepatic portal vein, but in some cases it presents a variable direction in relation to the main bile path. In 40 cases (88.8%) the right hepatic artery was located between the other two important formations of the hepatoduodenal ligament and only in 5 cases (11.2%) the RHA presents a path anterior to the main bile path. Conclusions The right hepatic artery in relation to the main bile path is located predominantly between the common hepatic duct and the hepatic portal vein (90.5% of cases on macroscopic pieces and 88.8% on injected ones) and only sometimes (9.5% and 11.2% respectively) passes anterior to the common hepatic duct approaching the wall of the gallbladder, its neck or duct, with which it can come into direct contact. The right hepatic artery, being anterior to the common hepatic duct, can form a curve with an anteriorly oriented convexity, called the „caterpillar hump” (4.4%) or can serve as a source of multiple cystic arteries (6.6%). The atypical location of the right hepatic artery can complicate cholecystectomy, constituting a major risk factor in causing iatrogenic complications.