# Unique Hepatic Arterial Pattern Associated With the Presence of Accessory Proper Hepatic Artery and Middle Hepatic Artery

## TL;DR

This case report describes a new liver artery pattern involving a trifurcated common hepatic artery and a middle hepatic artery, which is important for surgical and interventional procedures.

## Contribution

The paper reports a previously undocumented hepatic arterial variation involving a trifurcated common hepatic artery and a middle hepatic artery.

## Key findings

- The common hepatic artery trifurcates into the proper hepatic artery, gastroduodenal artery, and accessory proper hepatic artery.
- The accessory proper hepatic artery branches into two arteries supplying the right lobe of the liver.
- A middle hepatic artery, originating from the proper hepatic artery, drains segment IV of the liver.

## Abstract

Vascular variations of the coeliac trunk are relatively common, with documented occurrences including trifurcation of the common hepatic artery (CHA) and the presence of accessory and replaced hepatic arteries. This case report describes a novel variation wherein the CHA trifurcates into the proper hepatic artery (PHA), gastroduodenal artery, and accessory PHA (APHA). This particular trifurcation pattern has not been previously recorded. The APHA further branches into two arteries that supply the right lobe of the liver. Additionally, a middle hepatic artery (MHA), originating from the PHA, was identified alongside the right and left hepatic arteries. The MHA serves as a hilar artery that drains segment IV of the liver. This anatomical variant does not conform to any existing coeliac trunk classifications. Understanding this unique arterial pattern is crucial for liver transplantation, as well as procedures involving the pancreas, duodenum, and gallbladder, and for interventional techniques such as transcatheter arterial chemoembolization and transarterial radionuclide therapy.