Retrospective Analysis of Aberrant Hepatic Artery in 1250 Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization.

Aim: Aberrant hepatic artery is particularly common, and its diversity and complexity play a critical role in surgery. The aim of this study was to describe the incidence and type of aberrant hepatic artery, and to compare differences in transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) with vs without aberrant hepatic artery.

Methods: This was a retrospective study of patients with HCC who received TACE at the same intervention center between March 15, 2020 and December 31, 2022. All patients who met inclusion criteria were divided into two groups based on whether or not they had aberrant hepatic artery. The aberrant hepatic artery was systematically classified according to variations in origin. We compared differences in baseline characteristics, operation duration, and postoperative hospitalization between the two groups. Postoperative adverse events and laboratory data were also compared.

Results: A total of 1250 patients hospitalized with HCC were included in the study (mean age, 58 ± 10 years, 1019 [81.5%] males). A high incidence of aberrant hepatic artery was found during TACE (21.3%, 266 of 1250), mainly involving a single variation of the aberrant left hepatic artery (aLHA) (6.1%, 76 of 1250) or aberrant right hepatic artery (aRHA) (10.9%, 136 of 1250) origin, as well as complex variations of the aLHA and aRHA origin (2.4%, 30 of 1250). When comparing patients with vs without aberrant hepatic artery, the TACE operation duration was significantly different (p < 0.001), and tended to be greater for patients with aberrant hepatic artery. In addition, differences between aberrant and normal hepatic artery groups in postoperative nausea and vomiting were statistically significant (40.2% vs 30.8%, respectively, p = 0.004). Postoperative laboratory examinations revealed significant differences in aspartate aminotransferase, alanine aminotransferase, and neutrophil percentage between the two groups (p < 0.05).

Conclusions: The incidence of aberrant hepatic artery is extremely high, and the condition is characterized by complex variations. Moreover, aberrant hepatic artery may have a critical impact on the course of TACE treatment.