Common hepatic artery
The common hepatic artery is a major branch of the celiac trunk that plays a vital role in supplying arterial blood to the liver, stomach, pancreas, and duodenum. Its anatomical course, branching pattern, and variations are of great clinical significance, particularly in hepatobiliary and pancreatic surgeries. A clear understanding of its structure is essential for both anatomists and clinicians.
Introduction
The vascular anatomy of the abdomen is complex, and the common hepatic artery is an important component of this network. It is one of the primary vessels responsible for hepatic perfusion and also contributes to the blood supply of surrounding gastrointestinal organs. Knowledge of its origin, branches, and variations is crucial for diagnostic imaging, surgical interventions, and interventional radiology.
Anatomy of the Common Hepatic Artery
Origin
The common hepatic artery arises as one of the three major branches of the celiac trunk, along with the left gastric artery and the splenic artery. It typically originates at the level of the upper border of the pancreas, near the twelfth thoracic or first lumbar vertebra.
Course
From its origin, the common hepatic artery travels to the right, passing along the upper border of the pancreas and coursing anterior to the portal vein. It then continues toward the hepatoduodenal ligament where it eventually divides into its terminal branches.
Relations with Adjacent Structures
The common hepatic artery lies in close association with several important anatomical structures, including:
- The pancreas, which lies posterior to its initial course.
- The portal vein and bile duct, which accompany its terminal portion within the hepatoduodenal ligament.
- The inferior vena cava and duodenum, which are located nearby and may be relevant during surgical procedures.
Branches of the Common Hepatic Artery
Gastroduodenal Artery
The gastroduodenal artery is one of the first major branches of the common hepatic artery. It descends posterior to the first part of the duodenum and supplies:
- The pylorus and proximal duodenum
- The head of the pancreas
- Via its terminal branches, the right gastroepiploic and superior pancreaticoduodenal arteries
Right Gastric Artery
The right gastric artery often arises from the common hepatic artery, although in some cases it may originate from the proper hepatic artery. It courses along the lesser curvature of the stomach, anastomosing with the left gastric artery and supplying the stomach wall.
Proper Hepatic Artery
The proper hepatic artery is the terminal continuation of the common hepatic artery after the origin of the gastroduodenal artery. It enters the hepatoduodenal ligament and divides into right and left hepatic arteries, which supply the liver parenchyma. The right hepatic artery typically gives off the cystic artery to supply the gallbladder.
Variations of the Common Hepatic Artery
Anatomical Variations
The common hepatic artery shows significant anatomical variability, which has important clinical and surgical implications. Variations may include:
- Replaced hepatic arteries: A hepatic artery that arises from an atypical source, such as the superior mesenteric artery.
- Accessory hepatic arteries: Additional arteries that coexist with the normal hepatic branches, supplying a portion of the liver.
- Aberrant origins: The common hepatic artery may arise from the superior mesenteric artery, left gastric artery, or directly from the aorta in rare cases.
Clinical Relevance of Variations
Recognition of arterial variations is vital in surgical and interventional procedures. Failure to identify these patterns can lead to complications such as inadequate hepatic perfusion, ischemia, or inadvertent vascular injury. Preoperative imaging with CT angiography or MR angiography is often recommended to map these variations before complex hepatobiliary or pancreatic surgeries.
Blood Supply and Functional Importance
Contribution to Hepatic Circulation
The common hepatic artery provides oxygenated blood to the liver through its continuation as the proper hepatic artery. Although the liver receives the majority of its blood flow from the portal vein, the arterial contribution is critical for maintaining hepatocyte metabolism and bile production.
Supply to Stomach, Pancreas, and Duodenum
Beyond the liver, the common hepatic artery and its branches supply several gastrointestinal organs:
- Stomach: The right gastric and right gastroepiploic arteries contribute to the gastric arterial arcade.
- Pancreas: The superior pancreaticoduodenal artery provides blood to the head of the pancreas.
- Duodenum: The proximal duodenum receives blood supply from branches of the gastroduodenal artery.
Collateral Circulation
The common hepatic artery participates in anastomotic networks with other major abdominal vessels. These collateral pathways provide alternative routes of blood flow in cases of arterial blockage, ensuring continued perfusion to vital organs.
Imaging of the Common Hepatic Artery
Ultrasound
Doppler ultrasound can be used to assess blood flow within the hepatic artery and detect abnormalities such as narrowing or occlusion. It is noninvasive but may be limited by patient body habitus or overlying bowel gas.
CT Angiography
CT angiography offers high-resolution visualization of the common hepatic artery and its branches. It is frequently used in preoperative planning for liver transplantation, pancreatic surgery, or tumor resections.
MRI and MR Angiography
MR angiography provides detailed images of vascular anatomy without ionizing radiation. It is particularly useful in patients with renal impairment or when soft tissue assessment is required alongside vascular imaging.
Conventional Angiography
Conventional catheter-based angiography is the gold standard for detailed vascular assessment. It not only allows precise visualization but also enables interventional procedures such as embolization or stenting when needed.
Surgical and Clinical Significance
Importance in Hepatobiliary Surgery
The common hepatic artery is a key structure encountered during surgeries involving the liver, gallbladder, and bile ducts. Surgeons must be cautious when ligating or mobilizing the artery to avoid compromising hepatic blood supply, which could result in ischemia or necrosis.
Role in Liver Transplantation
In liver transplantation, arterial reconstruction is crucial for graft viability. Variations in the origin and branching pattern of the common hepatic artery can affect the choice of surgical technique and increase the complexity of anastomosis.
Relevance in Pancreatic Surgery
During pancreaticoduodenectomy (Whipple procedure), the gastroduodenal artery and branches of the common hepatic artery are carefully managed. Inadvertent injury can cause significant bleeding or postoperative ischemic complications.
Interventional Radiology Procedures
The artery is frequently targeted in interventional procedures such as transarterial chemoembolization (TACE) for hepatocellular carcinoma. Accurate identification of hepatic arterial anatomy is critical for the success of these treatments.
Pathologies of the Common Hepatic Artery
Aneurysm
Aneurysms of the common hepatic artery are rare but clinically significant. They may present with abdominal pain or rupture, leading to life-threatening hemorrhage. Endovascular or surgical repair may be required.
Stenosis and Occlusion
Narrowing or blockage of the hepatic artery can lead to ischemia of the liver and upper gastrointestinal organs. Causes include atherosclerosis, post-transplant complications, or external compression by masses.
Trauma-related Injury
Blunt or penetrating abdominal trauma can damage the common hepatic artery, resulting in hemorrhage or pseudoaneurysm formation. Prompt recognition and intervention are necessary to prevent fatal outcomes.
Compression by Tumors or Masses
Adjacent tumors, such as pancreatic or gastric cancers, may compress or encase the common hepatic artery. This can complicate surgical resection and contribute to ischemic changes in the supplied organs.
Complications and Clinical Presentations
Ischemia
Compromised blood flow through the common hepatic artery can result in hepatic ischemia. This condition may present with elevated liver enzymes, abdominal pain, and in severe cases, hepatic failure. Prompt recognition and intervention are critical to restore perfusion.
Hemorrhage
Rupture of an aneurysm or traumatic injury to the common hepatic artery can lead to massive intra-abdominal bleeding. Clinical manifestations include hypovolemic shock, abdominal distension, and acute pain. Emergency surgical or endovascular intervention is required.
Biliary Complications
Insufficient arterial supply to the biliary tree, particularly after liver transplantation or surgical ligation, can lead to ischemic cholangiopathy. Patients may develop bile leaks, strictures, or recurrent infections that complicate recovery.
Prevention and Management
Surgical Precautions
Surgeons handling hepatobiliary or pancreatic operations must be aware of anatomical variations of the common hepatic artery. Careful dissection, vascular mapping, and preservation of arterial branches help prevent inadvertent injury and ischemic complications.
Endovascular Approaches
Endovascular therapy is increasingly used in managing hepatic artery pathologies. Techniques such as stenting, embolization, and coiling are effective in treating aneurysms, stenosis, or hemorrhage while preserving organ perfusion when possible.
Medical Management
Medical therapy may include antiplatelet or anticoagulant drugs in cases of arterial stenosis or thrombosis. Postoperative patients may also require antibiotics, liver support measures, and long-term surveillance with imaging to monitor for vascular complications.
References
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