Variations in the Origin of Middle Hepatic Artery in Living Liver Donors using CT Angiography in South Indian Population: A Retrospective Study

Introduction: The middle hepatic artery is an artery which supplies blood to the fourth segment of the liver. Most commonly, it originates from the right hepatic artery. Injury to the middle hepatic artery during liver transplant surgeries may lead to ischaemia and also may lead to life threatening conditions like hepatic artery thrombosis in donor as well as recipient. The variations in the origin of the middle hepatic artery in the living donors were focused in the present study as it has surgical importance in the liver transplantations. Aim: To find out the incidence of the variations in the origin of the middle hepatic artery in living liver donors using Computed Tomography (CT) angiography. Materials and Methods: This was a retrospective observational study conducted from August 2018 to October 2021 in the Department of Anatomy, Deccan College of Medical Sciences, Hyderabad, Telangana, India. The images of CT angiographies of 100 living liver donors were collected from the Department of Radiology, Global Hospital, Hyderabad, Telangana, India. All the CT angiographs of the living liver donors were observed for any variations in the origin of the middle hepatic artery and recorded and the percentage of each variation was calculated. Results: Out of 100 CT angiographs studied, the incidence of the origin of middle hepatic artery was reported as 55% from right hepatic artery, 34% from the left hepatic artery, 5% from replaced left hepatic artery, 2% from the hepatic artery proper, 1% from the common hepatic artery, 1% from left gastric artery. Double middle hepatic arteries were observed in 1% of cases. Accessory middle hepatic artery was observed in 1% cases. Conclusion: To increase the success rate of liver transplantations, the clear knowledge on the possible variations of the middle hepatic artery is needed. The variations of the middle hepatic artery reported in this study are rare and will be useful for the liver transplant surgeons