Left hepatic artery

Fig. 4.2. Aberrant replaced right hepatic artery coming of the superior mesenteric artery (arrow) and aberrant accessory left hepatic artery (arrowhead) coming of the left gastric artery...

LHA, left hepatic artery RHA, right hepatic artery LGA, left gastric artery SMA, superior mesenteric artery CHA, common hepatic artery... 

The typical origin of this vessel is the right hepatic artery in as many as 95% of patients [25], but it may also come up from the left hepatic artery (7%), common hepatic artery (3%), replaced or accessory right hepatic arteries (18%), as well as the gastroduodenal artery (1%) or superior mesenteric artery [26-29]. There is a 2%-15% incidence of double cystic artery [26, 30] (Fig. 4.12). 

Fig. 4.11. a Inconspicuous falciform artery (arrow) arising from a branch of the left hepatic artery, b Selective catheterisation of the left hepatic artery confirms the presence of a falciform artery which is subsequently entered with a microcatheter (c) in order to coil it, thus preventing nontarget radioembolization... 

Fig, 4.16. a Relapse of a hepatocellular carcinoma fed mainly by branches of the right hepatic artery. A common trunk (arrow) between the left hepatic artery and the left phrenic artery is also seen, b Selective catheterisation of the mentioned common trunk also shows gastric branches (arrowhead), c Superselective catheterisation demonstrates tumor uptake (arrowheads) from this artery... 

Loukas M, Fergurson A, Louis RG Jr, Colborn GL (2006) Multiple variations of the hepatobiliary vasculature including double cystic arteries, accessory left hepatic artery and hepatosplenic trunk a case report. Surg Radiol Anat 28 525-528... 

Fig. 5.3. a White arrowhead points to gastrohepatic trunk. Black arrows point to left hepatic artery that arises off gastrohepatic trunk, b White arrows point to gastrohepatic trunk. Black arrows point to left hepatic artery... 

Special mention must be made of the replaced left hepatic artery from a gastrohepatic (GH) trunk. The presence of this vessel can often be prospectively identified on cross sectional imaging, where the vessel is seen to provide flow to the liver as it traverses the fissure for ligamentum venosum. The... 

Fig. 5.4. a Injection of medial branch of left hepatic artery demonstrates a falciform artery and the falciform complex (black arrows). Gallstone noted (white arrows), b Black arrow demonstrates coils in falciform artery. Gallstone noted (white arrows)... 

The first method developed for resin microspheres was clinically derived with the added data of intraoperative activity calculations [24-26,38]. There are important details regarding the differences in these patients and those now treated worldwide with resin microspheres. First, patients were previously untreated by chemotherapy or early in a course of standard 5-fluorouracil and Leucovorin. Typical patients with breast, colorectal and primary cancers of the liver have often received multiagent chemotherapy reducing overall and liver-specific tolerance to additional anticancer therapies. Second, the volume treated included both lobes at the same time. This is not much different to current treatment approaches which try to treat all of the tumors in each lobe with placement of microcatheters in more than one position or at the bifurcation of the right and left hepatic arteries. However, if less than the whole liver is intended for treatment, this must be accounted for with a proportional reduction in the calculated activity planned for delivery. Third, concurrent infusion of the vasoactive agent angiotensin II shifted... 

Fig. 8. 13a,b, Post-therapeutic right-to-left dose distribution. Example (a) shows the desired right-to-left ratio of 2 1, while example (b) exhibits a ratio that is significantly higher than intended due to vasospasm of the left hepatic artery during... 

The blood supply to the bile duct system was studied by Northover and Terblanche in 1979 [29]. They found that the right and left hepatic ducts were supplied by numerous small vessels from the right and left hepatic arteries. The upper common bile duct is supplied by axial vessels from the retroduodenal or gastroduodenal arteries [30]. Therefore, necrosis of the right and left hepatic ducts may occur after radioembolization when the catheter is placed at the... 

Fig. 5.2. DSA of the hepatic artery with a 5-F Cobra catheter. Gastroduodenal artery (white arrow/zeads),rightgastroepiploic artery (black arrowheads), right gastric artery (white arrow) branching from the left hepatic artery, arcade (white arrows) connecting right and left gastric artery (black arrows)...

Following the initial anatomic survey, superselective right or left hepatic artery catheterization is then performed. While this is often possible with standard 4- to 5-F diagnostic angiographic catheters, coaxial microcatheter systems for all chemoembolization procedure are preferred. Microcatheter systems are easier to negotiate through tortuous hepatic arterial anatomy and probably reduce catheter-related spasm, thrombosis, and dissection. When tumor occupies more than 50% of the liver, or when the portal vein is occluded, microcatheter systems facilitate further... 

Fig. 41.2a-c. Portal venous phase CT in a patient with cho-langiocellular carcinoma (a). The corresponding FDG PET/ CT (b) demonstrates vital tumor tissue at the rim. Corresponding C-arm CT with the catheter in the right hepatic artery (c) displays that the tumor must be supplied not only from the right, but also from the left hepatic artery. Furthermore, the area of high contrast enhancement in C-arm CT corresponds well to the location of the FDG uptake... 

The classic common hepatic artery (CHA) lies in the hepatoduodenal ligament to the left of the common bile duct and anterior to the portal vein (Lee et al. 2002). In general, the CHA divides into a right and left hepatic artery (Fig. 2.5.4). However, the anatomy of the arterial supply of the liver often shows congenital variations. Common variants of the hepatic artery are having the origin of the left hepatic artery... 

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