All roads lead to the liver - a clinical and anatomical case report on an absent proper hepatic artery.

Background: The arterial supply of the liver originates from the celiac trunk, which gives rise to the common hepatic artery. This artery subsequently bifurcates into the gastroduodenal artery and the proper hepatic artery, of which the latter further divides into the right and left hepatic arteries. This anatomical variability is described in order to highlight the high incidence of arterial hepatic vascular variations, to underline their clinical significance, and to classify the missing of proper hepatic artery within the framework of established hepatic arterial variation typologies.

Case report: The observed variation was identified during routine anatomical dissection of a 77-year-old female cadaver, who had voluntarily donated her body for scientific purposes as part of the Body Donation Program conducted by the Department of Anatomy of Wroclaw Medical University. Our case report presents an anatomical variant in which the proper hepatic artery is absent. Instead, the common hepatic artery gives rise to a common trunk that trifurcates into the right and left hepatic arteries, along with the gastroduodenal artery. Another part of this variation was that the right gastric artery originated from the left hepatic artery instead of the proper hepatic artery.

Conclusions: A thorough understanding of hepatic arterial anatomy is essential for a variety of surgical interventions, including liver transplantation, hepatic resection, cholecystectomy, and embolization of the right gastric artery. In cases of hepatocellular carcinoma, hepatic arteries may also serve as a route for intra-arterial chemotherapy. Therefore, precise knowledge of hepatic vascularization is of critical importance in the diagnosis and treatment of liver pathologies.