Management of the Accessory or Replaced Right Hepatic Artery (A/R RHA) During Multiorgan Retrieval When the Inferior Pancreaticoduodenal Artery Shares a Common Origin With A/R RHA

The accessory or replaced right hepatic artery (A/R RHA), which arises from the superior mesenteric artery (SMA), represents a challenge to the surgeon during combined procurement of liver and whole pancreas allografts. We have herein described an angiographic investigation of this aberrant artery among 553 patients who underwent angiography of both the celiac axis and SMA trunks to measure the diameters of the arteries to be anastomosed as well as to clarify the locational relationship between the inferior pancreaticoduodenal artery (IPDA) and A/R RHA. Sixty-nine (12.5%) of 553 patients had an unambiguous site of the A/R RHA. In 6 patients the IPDA was not visible. We separated the remaining 63 patients into 2 groups: group A whose A/R RHA shared a common origin with IPDA, and group B whose A/R RHA had a noncommon origin with IPDA. Fifteen (23.8%) of these 63 patients had a common origin of IPDA and A/R RHA. The results showed that the diameters of A/R RHA and gastroduodenal artery (GDA) were matched in both groups whether or not the IPDA shared a common origin with A/R RHA. The similar vascular diameters between A/R RHA and GDA in these 2 groups simplified the anastomosis, but management of the A/R RHA with different locational relationships between the IPDA and A/R RHA remains a problem. We recommend a safe method to be applied to all donors with an A/R RHA regardless of the origin of the IPDA.