Clinical significance and contemporary approaches to the assessment of celiac–mesenteric vascular anatomy according to the planned surgical intervention

Objective: To systematize current evidence on variations in hepatic vascular anatomy, analyze the risks and complications associated with inadvertent injury to atypical vascular structures in the absence of preoperative assessment, and substantiate the need for a differentiated topographic approach to the celiac–mesenteric vascular basin from a practical surgical perspective. Key points. The vascular anatomy of the celiac–mesenteric basin demonstrates considerable individual variability. Among deviations from the “classical” anatomy of the visceral branches of the abdominal aorta, variations in hepatic arterial architecture are most common, with a reported prevalence ranging from 20% to 50%. Insufficient awareness of clinically significant anatomical variants increases the risk of intraoperative vascular injury and subsequent ischemic complications. The classifications proposed by N. Michels and J. Hiatt remain the traditional frameworks for describing hepatic arterial variants; however, they do not encompass the full spectrum of anatomical diversity identified in contemporary studies. Determination of the type of extrahepatic arterial architecture represents a critical step in preoperative planning and surgical decision-making. Accordingly, optimization of diagnostic algorithms for assessing vascular anatomy within the operative field is of particular importance. The literature search was conducted using international databases covering the period from 1994 to 2025; studies based on instrumental imaging techniques and autopsy findings were included in the analysis. Conclusion. Identification of hepatic vascular anatomical variants is a key component of preoperative planning. Comprehensive preoperative evaluation of arterial architecture using modern imaging modalities reduces the risk of intraoperative complications and improves surgical safety.