Replaced 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. 2.5.4a-c. Common variations in hepatic arterial supply, a Conventional celiac (TC) and hepatic arterial anatomy (55%). b Replaced left hepatic artery (LHA) arising from the left gastric artery (LGA) (20%). c Replaced right hepatic artery (RHA) arises from the superior mesenteric artery (SMA) (6%)... 

Celiacangiogram-injectionof4 cc/secfor 12-15 cc. This allows for the assessment of normal hepatic branch anatomy, the presence of a replaced left hepatic artery, or other variant arteries without reflux of contrast into the aorta. 

II Replaced left hepatic artery arising from left gastric artery... 

VIII Replaced right hepatic artery with accessory left hepatic artery or replaced left hepatic artery with accessory right hepatic artery... 

Fig. 4.2.31. Coronal MIP image of CT angiogram shows replaced left hepatic artery (arrows) originating from the left gastric 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. 3.2. Axial image (left) shows hypo-vascular pancreatic cancer (arrow) in continuity with peripancreatic artery (arrowhead). Volume rendered angiogram from same data set shows the vessel is a replaced common hepatic artery arising from the superior mesenteric artery (arrow)...

Fig. 20.3a,b. Hepatic arterial anatomy according to Hiatt. aMIP reconstruction of Hiatt s type 1 anatomy i.e., conventional anatomy with the common hepatic artery arising from the celiac axis to the gastroduodenal and proper hepatic arteries. The proper hepatic artery divides distally into right and left branches, b MIP reconstruction of Hiatt s type 3 anatomy i.e., a replaced right hepatic artery originating from the superior mesenteric artery... 

The hepatic and splenic arteries typically arise from the celiac axis, which has its origin at the T12/ LI level of the abdominal aorta. The three main branches of the celiac include the splenic, left gastric, and common hepatic arteries. The splenic artery is typically large and tortuous and supplies small branches to the pancreas. The common hepatic branches into the gastroduodenal and proper hepatic arteries. There is significant variant anatomy of the hepatic arteries Aat the interventionist should be aware of. The most common variation is the replaced right hepatic artery, which arises from the superior mesenteric artery (SMA). This occurs in 12%-15% of the population. Other less frequent variations include the replaced left hepatic from the left gastric artery (11%) and the completely replaced common hepatic from the SMA (2%). 

Fig. 15.4a-c. Fibrolamellar hepatocellular carcinoma in the left lobe in a 21-year-old woman, a Non-enhanced transverse CT scan shows a large mass (long thin arrows) replacing the left lobe of the liver, hypoattenuating to the non-neoplastic parenchyma, with central calcifications (short thick arrow), b Hepatic arterial contrast-enhanced transverse CT scan demonstrates moderate, heterogeneous enhancement within the tumor (arrows), with a central hypoattenuating scar, c Portal venous contrast-enhanced transverse CT scan shows isoattenuation of the tumor. Note septa (arrows) radiating from the center to the periphery... 

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