Evidence map›Paper›PMID 41193902›Full record

SynthesisSurgical and radiologic anatomy : SRA2025

The anatomy and surgical implications of the middle hepatic artery: a systematic review with meta-analysis.

George Triantafyllou, Orestis Lyros, Panagis M Lykoudis, Fotis Demetriou, Panagiotis Kokoropoulos, Nikolaos Arkadopoulos, Maria Piagkou

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Surgical and radiologic anatomy : SRA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

George TriantafyllouDepartment of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527, Athens, Greece.
Orestis LyrosFourth Department of Surgery, School of Medicine, Faculty of Health Sciences, Attikon University Hospital, National and Kapodistrian University of Athens, 12462, Athens, Greece.
Panagis M LykoudisFourth Department of Surgery, School of Medicine, Faculty of Health Sciences, Attikon University Hospital, National and Kapodistrian University of Athens, 12462, Athens, Greece.
Fotis DemetriouDepartment of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527, Athens, Greece.
Panagiotis KokoropoulosFourth Department of Surgery, School of Medicine, Faculty of Health Sciences, Attikon University Hospital, National and Kapodistrian University of Athens, 12462, Athens, Greece.
Nikolaos ArkadopoulosFourth Department of Surgery, School of Medicine, Faculty of Health Sciences, Attikon University Hospital, National and Kapodistrian University of Athens, 12462, Athens, Greece.
Maria PiagkouDepartment of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527, Athens, Greece. mapian@med.uoa.gr.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposesThe middle hepatic artery (MHA)-the arterial supply to segment 4-is variably defined and frequently under-reported, despite clear implications for transplantation, hepato-pancreato-biliary surgery, and intra-arterial oncologic therapies. We conducted an evidence-based systematic review and meta-analysis to estimate the prevalence and origins of the MHA and to summarize its surgical relevance.

methodsFollowing evidence-based anatomy principles and the PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar. Proportion meta-analyses employed random effects and small-study effects were assessed with DOI plot and LFK index.

resultsFifteen studies (n = 3,819) were included. The pooled prevalence of an identifiable MHA was 81.15% (95% CI 64.70-93.40). The most common origins were the left hepatic artery (LHA) (47.86%, 95% CI 37.09-58.73) and right hepatic artery (RHA) (43.87%, 95% CI 34.85-53.07). Less frequently, the MHA originated from the common hepatic artery (CHA) (8.99%, 95% CI 0.00-32.68), and rarely from a replaced RHA (0.58%), proper hepatic artery (0.28%), or replaced LHA (0.06%). Across studies, the MHA consistently supplied segment 4; rare extensions to segments 2/3 were reported.

conclusionsAn MHA can be identified in most individuals, usually originating from the LHA or RHA. Due to inconsistent terminology across studies, standardized language distinguishing a hilar MHA from intrahepatic A4 branches is necessary. Routine preoperative arterial mapping and the preservation or reconstruction of the MHA should be considered in liver transplantation, pancreatoduodenectomy, and selective intra-arterial therapies to reduce ischemic and biliary complications.

Indexed as

Anatomic VariationHepatic ArteryLiverHepatectomyHumansEvidence-based anatomyHepatic arterial systemLiver transplantationMeta-analysisMiddle hepatic arteryPancreatoduodenectomyRadioembolizationSegment 4

Identifiers

PMID41193902

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.