Introduction : the presence of anatomic variations of the arterial hepatic vascular supply presents particular interest in cases in which extended hepato-pancreatic lesions are suspected especially if surgery is planned

Methods : we present a case series of three patients in whom anatomic variants of the arterial supply were found during the preoperative investigations as well as the implication of these particularities.

Results : the first case had been initially diagnosed with locally advanced pancreatic head adenocarcinoma in the presence of a right hepatic artery originating from the superior mesenteric artery; after completing the neoadjuvant chemotherapy the resectability was achieved and the adequate liver perfusion was successfully preserved; the other two cases had been initially diagnosed with large common hepatic or right hepatic aneurisms and were submitted to aneurysmal resection and ligation, the adequate liver perfusion being maintained through the left hepatic artery originating from the left gastric artery in the first case and respectively through the left hepatic artery originating from the common hepatic artery in the last case. However, in none of these cases liver resection was not needed due to the preservation of an adequate vascular supply; in the last two cases the presence of functional collateral blood vessels provided the good hepatic vascularization.

Conclusions : knowing the anatomical variants in cases in which hepato-bilio-pancreatic resections are proposed is mandatory in order to perform the most adequate surgical procedure and to avoid unnecessary resections.