[Variations in the hepatic artery in the surgery of portal hypertension]

The effect of anatomical variations of the hepatic artery on the performance of the anastomosis was assessed during 390 portacaval shunt operations as well as the degree to which technical difficulties could be anticipated from preoperative arteriography. Variations were detected in 25 p. cent of 130 patients examined by angiography but were confirmed during portal vein dissection in only 11 p. cent of cases. Technical difficulties due to hepatic artery variations were encountered in only 2 p. cent of the 390 anastomosis. Accidental section of a right hepatic artery occurred once only, and this before the routine use of angiography. Treatment was by aortohepatic by-pass using a saphenous graft. Portacaval anastomosis can be conducted in the presence of an hepatic artery variation bat technical difficulties cannot be predicted by preoperative digestive angiography.