The purpose of the current case is to describe a very rare coexistence of a replaced common hepatic artery (rCHA) and dorsal pancreatic agenesis with notable surgical implications. Preoperative computed tomography angiography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography were performed in a 53-year-old female with cholangiocarcinoma. Imaging revealed an rCHA arising from the superior mesenteric artery (SMA) and coursing anterior to the pancreatic head, supplying the right and left hepatic arteries, right gastroepiploic artery, and both the superior and inferior pancreaticoduodenal arteries. The gastroduodenal artery was absent. Dorsal pancreatic agenesis was confirmed, with the absence of the pancreatic body and tail. This configuration places the rCHA at high intraoperative risk and eliminates a major coeliac–SMA collateral route. Detailed preoperative vascular mapping and tailored surgical strategies are essential to prevent catastrophic ischemia during pancreatic or hepatic surgery and to guide appropriative operative approach.

Gonadal arteries (GAs) and gonadal veins (GVs) display substantial anatomical variation, which has direct implications for surgical procedures, radiological interpretation, and fertility management. This study aimed to systematically review and meta-analyze the prevalence, origin, course, and drainage patterns of gonadal vessels in human anatomy. A systematic review and meta-analysis were conducted in line with current Evidence-Based Anatomy and PRISMA 2020 guidelines. A comprehensive search of major databases and anatomical journals yielded 31 eligible studies, comprising data on 2,875 gonadal vessels. The typical GA anatomy (single artery arising from the abdominal aorta) was observed in 98.72% of cases. Accessory GAs were found in 1.12%, most commonly arising from the renal artery (5.52%), with rare origins (<0.01%) from the accessory renal or suprarenal arteries. A normal arterial course was present in 90.24%, while an arched course occurred in 9.76%. The typical GV pattern (single vein draining into the inferior vena cava [IVC] or renal vein) was seen in 94.97%, and accessory GVs in 5.03%. The right GV drained into the IVC in 96.51%, with aberrant drainage to the right renal vein in 4.41%. The left GV drained into the left renal vein in 95.35%, with aberrant IVC drainage in 4.17%. Although the typical gonadal vascular anatomy predominates, variants, especially in GA origin and GV drainage, are not rare and must be recognized. These findings underscore the clinical importance of anatomical awareness in surgical planning, radiological evaluation, and the management of urological and reproductive conditions.

Inferior vena cava aneurysms (IVCAs) are rare yet potentially lethal, especially if they are symptomatic or complicated. Among the IVCAs reported in the literature, only a few are associated with congenital vascular anomalies, including congenital IVC obstruction, tetralogy of Fallot, left-sided IVC, duplicated IVC, Ehlers–Danlos syndrome, blue rubber bleb nevus syndrome, and Klipper-Trenaunay syndrome.We present the case of an 8-cm symptomatic saccular IVCA in a patient with tetralogy of Fallot, treated successfully with surgical repair. Although rare venous pathologies can sometimes be managed with endovascular treatment, open surgical reconstruction remains the mainstay of durable and definitive repair.

Inferior vena cava aneurysms (IVCAs) are rare yet potentially lethal, especially if they are symptomatic or complicated. Among the IVCAs reported in the literature, only a few are associated with congenital vascular anomalies, including congenital IVC obstruction, tetralogy of Fallot, left-sided IVC, duplicated IVC, Ehlers–Danlos syndrome, blue rubber bleb nevus syndrome, and Klipper-Trenaunay syndrome.We present the case of an 8-cm symptomatic saccular IVCA in a patient with tetralogy of Fallot, treated successfully with surgical repair. Although rare venous pathologies can sometimes be managed with endovascular treatment, open surgical reconstruction remains the mainstay of durable and definitive repair.

Inferior vena cava aneurysms (IVCAs) are rare yet potentially lethal, especially if they are symptomatic or complicated. Among the IVCAs reported in the literature, only a few are associated with congenital vascular anomalies, including congenital IVC obstruction, tetralogy of Fallot, left-sided IVC, duplicated IVC, Ehlers–Danlos syndrome, blue rubber bleb nevus syndrome, and Klipper-Trenaunay syndrome.We present the case of an 8-cm symptomatic saccular IVCA in a patient with tetralogy of Fallot, treated successfully with surgical repair. Although rare venous pathologies can sometimes be managed with endovascular treatment, open surgical reconstruction remains the mainstay of durable and definitive repair.

Inferior vena cava aneurysms (IVCAs) are rare yet potentially lethal, especially if they are symptomatic or complicated. Among the IVCAs reported in the literature, only a few are associated with congenital vascular anomalies, including congenital IVC obstruction, tetralogy of Fallot, left-sided IVC, duplicated IVC, Ehlers–Danlos syndrome, blue rubber bleb nevus syndrome, and Klipper-Trenaunay syndrome.We present the case of an 8-cm symptomatic saccular IVCA in a patient with tetralogy of Fallot, treated successfully with surgical repair. Although rare venous pathologies can sometimes be managed with endovascular treatment, open surgical reconstruction remains the mainstay of durable and definitive repair.

Inferior vena cava aneurysms (IVCAs) are rare yet potentially lethal, especially if they are symptomatic or complicated. Among the IVCAs reported in the literature, only a few are associated with congenital vascular anomalies, including congenital IVC obstruction, tetralogy of Fallot, left-sided IVC, duplicated IVC, Ehlers–Danlos syndrome, blue rubber bleb nevus syndrome, and Klipper-Trenaunay syndrome.We present the case of an 8-cm symptomatic saccular IVCA in a patient with tetralogy of Fallot, treated successfully with surgical repair. Although rare venous pathologies can sometimes be managed with endovascular treatment, open surgical reconstruction remains the mainstay of durable and definitive repair.