A Rare Anatomic Variant During Organ Procurement for Liver Transplantation

Introduction: The knowledge of the vascular anatomy of the liver is key during hepatobiliary and pancreatic surgery, especially for liver transplantation (LT). Liver’s vascularization is guaranteed by the hepatic branches coming from the celiac trunk and sometimes from the superior mesenteric artery when replaced or accessory vessels are present. The gastruodenal artery (GDA) and the inferior pancreatic artery are two conventional anastomotic arches between the celiac trunk and the superior mesenteric artery (SMA). Another potential anastomotic route is a rare physiological phenomenon known as the arc of Bühler, which connects the superior mesenteric artery with the celiac trunk or one of its branches. Methods: We present the case of a rare variant of the hepatic arterial supply observed during liver procurement for transplantation from a 74-year-old female donor died for brain hemorrhage. Results: In our case, we found a replaced right hepatic artery coming from the SMA, a left hepatic artery coming from the celiac trunk, and an anastomotic arch between the GDA and the replaced right hepatic artery. This unconventional anastomotic route was identified during the back-table time, and we were able to preserve the entire anastomotic arc. Anastomosis in the recipient was fashioned on the superior mesenteric artery patch of the donor, closing the anastomotic arc between the two main vessels. Conclusion: Careful backtable dissection should be encouraged to avoid any accidental injuries.