Surg Radiol Anat (2007) 29:93–95 DOI 10.1007/s00276-006-0159-z 13 ANATOMIC VARIATIONS Common hepatic artery arising from the left gastric artery: a rare anatomic variation identiWed on a cadaveric liver donor Pablo Uva · Antonios Arvelakis · Gonzalo Rodriguez-Laiz · Susan Lerner · Sukru Emre · Gabriel Gondolesi Received: 15 June 2006 / Accepted: 28 September 2006 / Published online: 1 November 2006  Springer-Verlag 2006 Abstract Anatomical variations of the arterial supply of the liver are not uncommon. The typical normal “textbook” anatomy of the hepatic artery is found only in approximately half of the cases. Some of the varia- tions such as the presence of a right or left hepatic branch are more common, but other ones are extremely rare. We describe here a rare case in which the common hepatic artery arose from the left gastric artery, found during a cadaveric liver donor harvesting and conWrmed with imaging studies. Cases like this one highlight the importance of knowing the hepatic arte- rial anatomy and the possibility of its numerous varia- tions by the transplant and hepatobiliary surgeon. Keywords Anatomy · Hepatic artery · Left gastric artery · Liver transplant · Variations Introduction The knowledge of the potential hepatic artery ana- tomic variations is essential for a transplant surgeon in order to prevent vascular damage to the graft during the harvesting and back-table procedures. This knowl- edge becomes even more important when other team performs the harvesting, and the evaluation of the liver vascular anatomy is done on the bench, when the graft is isolated from its normal surrounding anatomy. Sur- prises can occur. The hepatic arterial anatomy, as considered normal by the classic textbook descriptions, is only found in 52–80% of the cases. This is the common hepatic artery arising from the celiac trunk, dividing into gastroduo- denal artery and proper hepatic artery, which then divides into right and left hepatic arteries at the hilum [5–9, 12–14]. After studying 200 cadavers, Michels [9] proposed an internationally recognized classiWcation of the hepatic artery variations into ten types, which was simpliWed later on into six types by Hiatt [6] in 1994, and further simpliWed by our group in a recently reported classiWcation in 2004, where more than 95% of the cases were categorized into just Wve types [14]. We herein report a case of a common hepatic artery arising from the left gastric artery, as the only arterial blood supply to the liver, found in a cadaveric donor. Case report A cadaveric liver was procured by another team, and sent to us for transplantation. It was retrieved using the rapid Xush technique, and the harvesting team informed us that the liver had a normal vascular anat- omy. During the back-table dissection, the celiac trunk was found to give rise to only two branches: the splenic and the left gastric arteries. No common hepatic artery was identiWed at this time. Instead, a long gastroduode- nal artery was found to cross all the hilar structures from left to right. Further dissection on the left gastric artery showed the beginning of an artery that entered P. Uva · A. Arvelakis · G. Rodriguez-Laiz (&) · S. Lerner · S. Emre · G. Gondolesi Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1104, New York, NY 10029-6574, USA e-mail: gonzalo.rodriguez-laiz@mountsinai.org