Arterial Variations of the Celiac Axis and Hepatic Artery: A Systematic Review of Imaging and Surgical Studies
TL;DR
Routine preoperative MDCTA is essential for safe surgical planning and reduction of operative complications in hepatopancreatobiliary procedures, and nearly one-third of individuals demonstrate variant arterial anatomy.
Abstract
Objective: Variations of the celiac axis and hepatic artery are common and clinically significant in hepatobiliary and pancreatic surgery. Unrecognized arterial variants may result in hemorrhage, hepatic ischemia, or postoperative complications. The objective of the study was to systematically review primary imaging-based and surgical studies describing celiac axis and hepatic arterial variations and evaluates their clinical relevance. Methods: This PRISMA 2020–compliant systematic review (PROSPERO: CRD420251085845) included original studies published between January 2000 and December 2025. PubMed, Dimensions, and DOAJ were searched. Eligible studies reported extractable quantitative data on arterial variations identified by multidetector CT angiography (MDCTA), digital subtraction angiography, intraoperative assessment, or cadaveric dissection, with standardized anatomical classification. Owing to heterogeneity, formal meta-analysis was not performed; however, weighted pooled prevalence estimates were calculated for major arterial variants. Results: Of 1,587 identified records, 20 primary studies met inclusion criteria. Twelve imaging-based studies included 13,703 patients, and eight surgical/cadaveric studies included 1,333 subjects. Classic hepatic arterial anatomy (Michels type I) was observed in 58–72%. The most frequent variant was a replaced right hepatic artery from the superior mesenteric artery (10–16%). Replaced left hepatic artery occurred in 6–11%, accessory right hepatic artery in 4–8%, and accessory left hepatic artery in 3–7%. Common hepatic artery originating from the superior mesenteric artery was reported in 1–4%. Celiac trunk variants included hepatosplenic trunk (3–8%), gastrosplenic trunk (2–6%), and rare celiacomesenteric trunk (<1%). Imaging findings demonstrated strong concordance with surgical observations. Conclusion: Nearly one-third of individuals demonstrate variant arterial anatomy. Routine preoperative MDCTA is essential for safe surgical planning and reduction of operative complications in hepatopancreatobiliary procedures.