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Case One Hundred Eight - Replaced Hepatic Artery

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Clinical History: Patient for mesenteric angiogram to localize GI bleed.

Findings: Mesenteric angiogram - selective SMA injection. Entirely replaced hepatic artery arising from the SMA.

Diagnosis: Replaced hepatic artery.

Discussion: Variant Arterial Anatomy: In 10% of the population the hepatic artery is replaced; i.e., a portion of the hepatic blood supply is from the SMA. The entire hepatic arterial supply is from the SMA in 2.5% and from the aorta in 2% of individuals.

In 23% of individuals, either a branch of the left hepatic artery or the entire left hepatic artery arises from the left gastric artery.

Drawings show some of the variant anatomy of splanchnic vessels.
aRH = accessory right hepatic; GD = gastroduodenal; H = common hepatic; LG = left gastric; LH = left hepatic; RH = right hepatic; S = splenic; SM = superior mesenteric arteries (Drawings after Kadir)

References:
Kadir S. Diagnostic Angiography, W.B. Saunders Co., Philadelphia, 1986.

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Submitted by:
Anne H. Nicklas, M.D.
Joseph LiPuma, M.D.