Surgical and Radiologic Anatomy

, Volume 41, Issue 3, pp 355–358 | Cite as

Aberrant arc between the common hepatic artery and a replaced right hepatic artery resulting in misperfusion in a patient with a hepatic arterial infusion pump

  • Omar Hasan
  • Stephanie Greco
  • Timothy Kennedy
  • Darren Carpizo
  • Jeffrey Kempf
  • John NosherEmail author
Anatomic Variations


Hepatic arterial infusion pumps are increasingly utilized as an option for liver directed therapy in the treatment of metastatic colorectal carcinoma. After skeletonization of the hepatic artery through the ligation of extra-hepatic branches, these pumps are implanted surgically with their tip placed in the common hepatic artery. Subsequently, a nuclear medicine pump study is performed to ensure homogeneous perfusion of the liver and detect any extrahepatic perfusion. We report a peripheral arc between the superior mesenteric artery and celiac axis, which caused misperfusion on the SPECT nuclear medicine scan.


Hepatic artery variants Hepatic artery Celiac artery Superior mesenteric artery Misperfusion Hepatic artery infusion pump Colorectal cancer 


Author contributions

OH: Manuscript writer/editor, interventional radiology fellow, participated in the interventional radiology portion of the case. SG: Manuscript writer/editor, surgical oncology fellow, participated in the surgical portion of the case. TK: Manuscript writer/editor, attending surgeon for the pump insertion. DC: Manuscript writer/editor, attending surgeon assisting with pump insertion. JK: Manuscript writer/editor, nuclear medicine attending, interpreted pump studies. JN: Manuscript writer/editor, interventional radiology attending for angiographic portion of the case.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Catalano OA et al (2008) Vascular and Biliary variants in the liver: implications for liver surgery Radiographics 28(2):359–378CrossRefGoogle Scholar
  2. 2.
    Covey AM et al (2002) Variant Hepatic arterial anatomy revisited: Digital subtraction angiography performed in 600 patients. Radiology 224(2):542–547CrossRefGoogle Scholar
  3. 3.
    Creasy JM et al (2018) Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure? Surgery 163(6):1238–1244CrossRefGoogle Scholar
  4. 4.
    D’Angelica MI et al (2015) Phase II trial of hepatic artery infusional and systemic chemotherapy for patients with unresectable hepatic metastases from colorectal cancer: conversion to resection and long-term outcomes. Ann Surg 261(2):353–360CrossRefGoogle Scholar
  5. 5.
    De Jong MC et al (2009) Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patient. Ann Surg 250(3):440–448Google Scholar
  6. 6.
    Hess KR et al (2006) Metastatic patterns in adenocarcinoma. Cancer 1;106(7):1624–1633CrossRefGoogle Scholar
  7. 7.
    Michels NA. (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 112(3):337–347CrossRefGoogle Scholar
  8. 8.
    Michels NA (1955) Blood supply and anatomy of the upper abdominal organs. J.B.Lippincott, PhiladelphiaGoogle Scholar
  9. 9.
    Rihimaki M et al (2016) Patterns of metastasis in colon and rectal cancer. Sci Rep 15:6:29765CrossRefGoogle Scholar
  10. 10.
    Sofocleous CT et al (2006) Arterial embolization for salvage of hepatic artery infusion pumps. J Vasc Interv Radiol 17(5):801–806CrossRefGoogle Scholar
  11. 11.
    Song SY et al (2010) Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology 255(1):278–288CrossRefGoogle Scholar
  12. 12.
    Tomlinson JS et al (2007) Actual 10 year survival after resection of colorectal liver metastasis defines cure. J Clin Oncol 25(29):4575–4580CrossRefGoogle Scholar
  13. 13.
    Vigano L et al (2008) Liver surgery for colorectal metastases: results after 10 years follow up. Long term survivors, late recurrences, and prognostic role of morbidity. Ann Surg Oncol 15(9):2458–2464CrossRefGoogle Scholar
  14. 14.
    Zervoudakis A et al (2017) Treatment options in colorectal liver metastases: hepatic arterial infusion. Visc Med 33(1):47–53CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyRutgers Robert Wood Johnson Medical SchoolNew BrunswickUSA
  2. 2.Department of Surgical OncologyRutgers Cancer Institute of New JerseyNew BrunswickUSA

Personalised recommendations