Selective Hepatic Arteriography

DETAILED examination of the hepatic arterial tree can often demonstrate diseases of the liver not readily diagnosed by other means. In many cases, selective arterial catheterization may be the most important study leading to a definitive diagnosis. If hepatic surgery or chemotherapy is contemplated, it is most desirable to outline the normal vascular anatomy and variations of the hepatic arterial tree. This presentation will illustrate various catheterization technics for selective celiac and hepatic arteriography. In a series of cases the normal anatomy and anatomic variations will be dearly demonstrated, as well as a variety of pathological conditions with emphasis on primary and secondary neoplastic processes. Diagnostic criteria of these lesions will be discussed. Methods Arterial catheterization may be performed by either the needle replacement technic or a cut-down technic (1, 2). A polyethylene, nylon, or Teflon catheter with a preformed tip is inserted via the femoral, axillary, or brachial artery. Depending on the anatomy of the celiac axis, the catheter tip can often be guided directly into the hepatic artery (3). The superior mesenteric artery must also be catheterized frequently because it may serve as the origin of the right hepatic artery or the entire hepatic artery (4). A low-pressure injection of 10–15 ml of 50 per cent diatrizoate sodium is then made, and serial radiographs are obtained, 2 per second, in the anteroposterior projection. Normal Anatomy The conventional textbook description of the arterial blood supply of the liver (Fig. 1, A) occurs in about 55 per cent of the population (4 and 5). In the remaining 45 per cent less common variations attest the versatile anatomy of the celiac artery. When typical and complete, this artery has three branches: the left gastric, the splenic, and the hepatic. The hepatic artery supplies three branches to the liver; namely, the right, left, and middle hepatic arteries (Fig. 1, A). The middle hepatic artery furnishes the blood supply to the quadrate lobe (medial segment of the left lobe) and in 90 per cent of the cases is derived from either the right or left hepatic artery (4). The right hepatic artery divides into two large branches as does the left hepatic. Commonly, a relatively large branch of the right hepatic runs inferiorly to supply the caudate lobe. Terminal branches of the hepatic arteries are distributed to single pyramidal lobules of the liver. Anatomic Variations The right or left hepatic arteries have a source other than the celiac hepatic artery 25 per cent of the time (4). They are then known as replaced hepatics, the right hepatic usually arising from the superior mesenteric artery and the left hepatic from the left gastric artery (Figs. 1, B and C ; 2).