Anatomical Variations of the Hepatic Artery: A Systematic Review with Relevance to Hepatobiliary and Transplant Surgery

Anatomical Variations of the Hepatic Artery

Abstract

Hepatic arterial anatomy shows substantial variation, and recognizing these patterns is important during hepatobiliary, pancreatic, and transplant procedures. Objectives: To systematically summarize current evidence on hepatic artery variations reported in recent imaging and cadaveric studies and to compare the frequency of major anatomical patterns with contemporary literature. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Searches of PubMed, Scopus, and the Cochrane Library were conducted for studies published between January 1, 2017, and December 31, 2024, and additional full-text articles were sought through reference lists and targeted searches in Web of Science and Google Scholar. Inclusion criteria covered observational imaging studies and cadaveric dissections reporting hepatic arterial anatomy using Michel, Hiatt, or modified classifications. After screening, eleven studies met the criteria for inclusion in the final synthesis. Data were extracted on study design, population, imaging modality, and reported arterial patterns. Results: Across the included studies, classic Michel Type I anatomy was the most frequent configuration, whereas Types II and III were the most common variants. Minor differences were observed between adult, pediatric, and cadaveric cohorts, likely reflecting population heterogeneity and variations in imaging resolution. The findings were descriptive, as none of the studies evaluated surgical outcomes. Conclusions: Contemporary evidence confirms that non-classic hepatic artery patterns are common across diverse populations. While modern CT angiography and multidetector imaging facilitate consistent identification of these variants, current literature remains descriptive. Further prospective studies are required to determine their clinical impact.