Vasculature and External Surface Variations of the Cadaveric Liver: Embryological Perspective with Clinical Relevance.

Background: The liver, a highly vascular organ, receives its nourishment from the dual supply of the hepatic artery and portal vein. Variations in this vascular supply of the liver often emerge serendipitously during abdominal surgeries and radiological procedures, revealing the organ's complex anatomy. While many of these vascular and morpho-logical variations remain asymptomatic, a sound knowledge of these variations of the liver is of utmost importance for ensuring successful outcomes in hepatobiliary surgeries. Awareness of these vascular variations can be a safeguard against intraoperative injuries and complications such as hemorrhages, necrosis, postoperative thrombosis, and liver failure. Recognizing and anticipating these variations can significantly enhance surgical precision and patient safety.

Methods: The present study was conducted on 110 formalinfixed cadaveric livers aged 60-90 years in the Department of Anatomy, AIIMS Jodhpur. We observed the variations in the hepatic artery and portal vein, including branching patterns and aberrant branches. We also observed surface variations in the liver.

Results: Variations in arterial supply were found in 25.45% (28/110) of the liver specimens. The most prevalent arterial variation was the trifurcation of the hepatic artery proper, which was observed in 21.81% (24/110) of specimens. Trifurcation of the portal vein was observed in 4.55% (5/110) specimens. Additionally, 16.36% (18) of specimens exhibited arterial and surface variations. The surface variations were noted in 80.9% (89/110) of liver specimens, with 34.55% having multiple surface variations. Vascular and surface morphological variations were observed in 1.8% (2/110) of specimens.

Conclusion: Understanding these vascular and surface variations is crucial for planning and executing hepatobiliary surgeries such as liver transplantation, pancreatoduodenectomy, biliary reconstruction, portal vein embolization, and portosystemic shunts. This knowledge can help minimize complications during these procedures.