Replaced right hepatic artery arising from inferior pancreaticoduodenal artery, in association with left multiple renal arteries: a case report using MDCT angiography

The authors illustrate a case of a 61-year-old male who presented an extremely rare association of anatomical variations highlighted by multi-detector computed tomography (MDCT) angiography, with a replaced right hepatic artery (RRHA) arising from inferior pancreaticoduodenal artery (IPDA), in association with left multiple renal arteries (RAs). The celiac trunk (CT) arises from the abdominal aorta (AA), at the level of middle 1∕3 of L1 vertebral body. The superior mesenteric artery (SMA) origin was located at the anterior aspect of AA, at 2.5 mm below the origin of CT, at the level of L1∕L2 intervertebral discs. The SMA has at origin an endoluminal diameter of 11.3 mm. At 22.7 mm from its aortic origin, from the right aspect of the SMA trunk, arises IPDA. At 10.4 mm from its origin in IPDA, arises RRHA with a 78.5 mm artery length and the endoluminal diameter at origin of 2.9 mm. From the arising point, the RRHA is oriented ascending to the right, passing initially posterior to the hepatic portal vein and the head of the pancreas, then lateral to the head of the pancreas and posterior to the hepatic portal vein, after entering the hepatic parenchyma to bifurcate into the anterior and posterior branches. From left aspect of AA arise three RAs: one main, one additional (from AA), and an accessory renal (from left common iliac artery). Knowledge of this hepatic and renal anatomical variation is important for interventional radiologists, vascular experts, oncologists, vascular, hepatic and urologic surgeons.