Right hepatic artery

Fig. 3.8. Male patient suffering from a multifocal hepatocellular carcinoma (HCC), treated with repeated sessions of transarterial chemoembolization (TACE). Dyna-CT (Siemens Medical Solutions, Erlangen, Germany) image started together with injection of 10 ml iodinated contrast agent via a super-selective catheter system placed in the right hepatic artery compared with a corresponding MDCT section in the arterial phase after i.v. injection of 120 ml iodinated contrast agent. Note the excellent, direct depiction of arterial blood supply of the HCC nodule in liver segment 5/8 (arrow). The artifacts in the left and right liver lobe are caused by spots of Lipiodol in already treated HCC nodules after earlier transarterial chemoembolization...

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... 

Fig. 4.4. A rare anatomical variant consisting in the origin of the right hepatic artery (arrow) from the celiac trunk...

Fig. 4.5. Another rare variant, not described by Michel, consisting in a segmental right hepatic artery (arrowhead) originating from the gastroduodenal artery (arrow)...

The dorsal pancreatic artery is the first major pancreatic branch, usually coming off the splenic artery, although many variations have been described (right hepatic artery, SMA, and celiac artery) [15]. After supplying the dorsal surface of the neck of the pancreas, it divides into a left branch, the transverse pancreatic, and into a right branch (branches), which unites with the gastroduodenal or the superior pancreatoduodenal [14]. 

Fig. 4. 7a,b. Patient with a stenosis of the celiac trunk, a Superior mesenteric angiography demonstrates reversed flow through the pancreatoduodenal arcade (arrow) with opacification of the hepatic artery (arrowhead), b Tumour was treated after selective catheterization of the right hepatic artery through the collateral network... 

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, 4.16. 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... 

Fig. 5.1. White arrow points to SMA. Black arrows demonstrate replaced right hepatic artery...

Right hepatic angiogram - Injection of 2 cc/s for 10-12 cc. Vessels of interest include the middle hepatic artery, supraduodenal artery, and cystic artery. Rarely, the right hepatic artery may arise directly from the aorta. 

Yu et al. [58] reported on 49 patients who underwent 78 administrations of SIR-Spheres via intraarterial infusion in the left or right hepatic artery. Of these patients, 26 had a diagnosis of colorectal... 

As has been mentioned, infusion of microspheres distal to the cystic artery is ideal but it is often not feasible. This is because the microspheres should be infused at a location that will allow admixture of microspheres with flowing blood, resulting in even and flow-dependent distribution. The cystic artery often arises deep within the right hepatic artery near its bifurcation into anterior (segments 5/8) and posterior (6/7) sectorial vessels. When this is the case and when the cystic artery arises distal to the ideal location for infusion, avoiding micro-sphere flow into the gall bladder becomes impossible [24]. 

Fig.7.9a,b. A 52-year-old woman with a recent history of gall stone pancreatitis was admitted with further abdominal pain. A CECT scan suggested an aneurysm of uncertain origin. Angiography revealed a true (Type la) aneurysm of an aberrant right hepatic artery (a). CECT had revealed a patent portal vein and so proximal and distal coil embolization was performed (b). There were no further complications and the patient is alive and well at 36 months... 

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... 

Fig. 9.4a-c. Hepatocellular carcinoma (HCC), chemoembolization CDDP, Adria/Gelfoam. a Common hepatic arteriography. Note the hypervascularity of this hepatic neoplasm (HCC). b Status post chemoembolization of the right hepatic artery note the speckled gas within the neoplasm due to air introduced during the embolization, tissue necrosis or both, c Reduction in the size of the defect as seen 2 years later... 

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... 

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%)... 

Fig. 2.5.5. Replaced right hepatic artery (RHA) from the superior mesenteric artery (AMS)...

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