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Hepatic
Artery Occlusion
Causes of hepatic artery occlusion include thrombosis (eg, due to hypercoagulability disorders, severe arteriosclerosis, or vasculitis), emboli (eg, due to endocarditis, tumors, therapeutic embolization, or chemoembolization), iatrogenic causes (eg, ligation during surgery), vasculitis (via nonthrombotic mechanisms), structural arterial abnormalities (eg, hepatic artery aneurysm), eclampsia, cocaine use, and sickle cell crisis. Usually, the result is an hepatic infarct. In patients with a liver transplant or preexisting portal vein thrombosis, hepatic artery thrombosis causes ischemic hepatitis (see Vascular Disorders of the Liver: Ischemic Hepatitis). Because of the liver's dual blood supply, the liver is somewhat resistant to ischemic hepatitis and infarction.
Hepatic artery occlusion does not elicit symptoms without hepatic infarction or ischemic hepatitis. Hepatic infarction may be asymptomatic or cause right upper quadrant pain, fever, nausea, vomiting, and jaundice. Leukocytosis and a high aminotransferase level are common.
Diagnosis of hepatic artery occlusion is confirmed by imaging with Doppler ultrasonography, usually followed by angiography. The choice between CT angiography, magnetic resonance angiography, and celiac arteriography largely depends on availability and expertise. CT may detect a wedge-shaped area of low attenuation.
Treatment is directed at the cause.
Aneurysms
Aneurysms of the hepatic artery are uncommon. They tend to be saccular and multiple. Causes include infection, arteriosclerosis, trauma, and vasculitis. Untreated aneurysms may cause death by rupturing into the common bile duct (producing hemobilia), peritoneum (producing peritonitis), or adjacent hollow viscera. Hemobilia may cause jaundice, upper GI bleeding, and abdominal pain in the right upper quadrant.
Diagnosis is suspected if typical symptoms occur or if imaging tests detect an aneurysm. Doppler ultrasonography, followed by contrast CT, is required for confirmation.
Treatment is embolization or surgical ligation.
Last full review/revision December 2007 by Eldon A. Shaffer, MD
Content last modified December 2007
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