Pre-Transplant Assessment of Hepatic Vascular Variations Using CT Angiography: A Case Study

Anatomical variations of hepatic vasculature are frequent findings that require careful evaluation during the preoperative assessment for liver transplantation. We present the case of a 59-year-old patient with advanced hepatic cirrhosis complicated by portal hypertension, who was evaluated as a transplant candidate. Computed tomography angiography of the abdomen revealed an unusual vascular pattern characterized by the absence of the celiac trunk—classified as type V in Morita’s system—with aberrant arteries arising directly from the aorta. Specifically, the left hepatic artery originated from the left gastric artery. The portal vein was noted to be patent, dilated, and exhibiting trifurcation. Additional imaging findings consistent with cirrhosis included hypertrophy of segment I, splenomegaly, and prominent esophageal collateral vessels. This report highlights the importance of identifying such complex vascular anomalies prior to transplantation, given their significant implications for surgical planning and postoperative outcomes. The coexistence of both arterial and portal vein variations in this patient underscores the need for thorough vascular mapping in transplant candidates.