Accessory hepatic artery is an incidental finding during hepatobiliary, pancreatic surgery and may be found during hepatic transplantation surgery on angiogram. This artery should be carefully identified & preserved during these surgeries. Failure to do so can lead to hepatic ischemia or infarction. The most common accessory hepatic artery is a replaced or accessory right hepatic artery (RHA) originating from the superior mesenteric artery (SMA). Less commonly, one may encounter a replaced or accessory left hepatic artery (LHA) arising from the left gastric artery. Preoperative imaging with CT angiography or MR angiography is helpful in identifying these variations. Intraoperative Doppler ultrasound can also be used to confirm the presence and course of these arteries before any dissection or transection. Careful dissection around the porta hepatis and meticulous attention to detail are crucial to ensure the preservation of these vital vessels. Ligation of the accessory hepatic artery, especially a replaced RHA, can have devastating consequences for the liver parenchyma and should be avoided if at all possible.
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