CardioVascular and Interventional Radiology

, Volume 40, Issue 6, pp 822–830 | Cite as

Extrahepatic Arteries Originating from Hepatic Arteries: Analysis Using CT During Hepatic Arteriography and Visualization on Digital Subtraction Angiography

  • Kumi OzakiEmail author
  • Satoshi Kobayashi
  • Osamu Matsui
  • Tetsuya Minami
  • Wataru Koda
  • Toshifumi Gabata
Clinical Investigation



To investigate the prevalence and site of origin of extrahepatic arteries originating from hepatic arteries on early phase CT during hepatic arteriography (CTHA) was accessed. Visualization of these elements on digital subtraction hepatic angiography (DSHA) was assessed using CTHA images as a gold standard.

Materials and Methods

A total of 943 patients (mean age 66.9 ± 10.3 years; male/female, 619/324) underwent CTHA and DSHA. The prevalence and site of origin of extrahepatic arteries were accessed using CTHA and visualized using DSHA.


In 924 (98.0%) patients, a total of 1555 extrahepatic branches, representing eight types, were found to originate from hepatic arteries on CTHA. CTHA indicated the following extrahepatic branch prevalence rates: right gastric artery, 890 (94.4%); falciform artery, 386 (40.9%); accessory left gastric artery, 161 (17.1%); left inferior phrenic artery (IPA), 43 (4.6%); posterior superior pancreaticoduodenal artery, 33 (3.5%); dorsal pancreatic artery, 26 (2.8%); duodenal artery, 12 (1.3%); and right IPA, 4 (0.4%). In addition, 383 patients (40.6%) had at least one undetectable branch on DSHA. The sensitivity, specificity, and accuracy of visualization on DSHA were as follows: RGA, 80.0, 86.8, and 80.4%; falciform artery, 53.9, 97.7, and 80.0%; accessory LGA, 64.6, 98.6, and 92.3%; left IPA, 76.7, 99.8, and 98.7%; PSPDA, 100, 99.7, and 99.9%; dorsal pancreatic artery, 57.7, 100, and 98.8%; duodenal artery, 8.3, 99.9, and 98.7%; and right IPA, 0, 100, and 99.6%, respectively.


Extrahepatic arteries originating from hepatic arteries were frequently identified on CTHA images. These arteries were frequently overlooked on DSHA.


Extrahepatic arteries originating from hepatic arteries CT during hepatic arteriography Digital subtraction hepatic angiography Transcatheter arterial chemoembolization 



We deeply appreciate the support of late Prof. Masayuki Suzuki (Department of Quantum Medical Technology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan) toward our study.

Compliance with Ethical Standards

Conflict of interest

All authors have no conflicts of interest and financial disclosures.


  1. 1.
    Matsui O, Kadoya M, Yoshikawa J, et al. Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology. 1993;188:79–83.CrossRefPubMedGoogle Scholar
  2. 2.
    Yamakado K, Nakatsuka A, Takaki H, et al. Early-stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology. 2008;247:260–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Salem R, Lewandowski RJ, Atassi B, et al. Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival. J Vasc Interv Radiol. 2005;16:1627–39.CrossRefPubMedGoogle Scholar
  4. 4.
    Kim HC, Chung JW, Lee W, Jae HJ, Park JH. Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics. 2005;25:S25–39.CrossRefPubMedGoogle Scholar
  5. 5.
    Hirakawa M, Iida M, Aoyagi K, Matsui T, Akagi K, Fujishima M. Gastroduodenal lesions after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Am J Gastroenterol. 1988;83:837–40.PubMedGoogle Scholar
  6. 6.
    Gibo M, Hasuo K, Inoue A, et al. Hepatic falciform artery: angiographic observations and significance. Abdom Imaging. 2001;26:515–9.CrossRefPubMedGoogle Scholar
  7. 7.
    López-Benítez R, Radeleff BA, Barragán-Campos HM, et al. Acute pancreatitis after embolization of liver tumors: frequency and associated risk factors. Pancreatology. 2007;7:53–62.CrossRefPubMedGoogle Scholar
  8. 8.
    Chung JW, Park JH, Han JK, Choi BI, Kim TK, Han MC. Transcatheter oily chemoembolization of the inferior phrenic artery in hepatocellular carcinoma: the safety and potential therapeutic role. J Vasc Interv Radiol. 1998;9:495–500.CrossRefPubMedGoogle Scholar
  9. 9.
    Ishigami K, Yoshimitsu K, Irie H, et al. Accessory left gastric artery from left hepatic artery shown on MDCT and conventional angiography: correlation with CT hepatic arteriography. AJR Am J Roentgenol. 2006;187:1002–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Tajima T, Yoshimitsu K, Irie H, et al. Hepatic falciform ligament artery in patients with chronic liver diseases: detection on computed tomography hepatic arteriography. Acta Radiol. 2009;50:743–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Burgmans MC, Too CW, Kao YH, et al. Computed tomography hepatic arteriography has a hepatic falciform artery detection rate that is much higher than that of digital subtraction angiography and 99mTc-MAA SPECT/CT: implications for planning 90Y radioembolization? Eur J Radiol. 2012;81:3979–84.CrossRefPubMedGoogle Scholar
  12. 12.
    Matsui O, Kadoya M, Kameyama T, et al. Benign and malignant nodules in cirrhotic livers: distinction based on blood supply. Radiology. 1991;178:493–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Ueda K, Matsui O, Kawamori Y, et al. Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography. Radiology. 1998;206:161–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Hayashi M, Matsui O, Ueda K, et al. Correlation between the blood supply and grade of malignancy of hepatocellular nodules associated with liver cirrhosis: evaluation by CT during intraarterial injection of contrast medium. AJR Am J Roentgenol. 1999;172:969–76.CrossRefPubMedGoogle Scholar
  15. 15.
    Williams DM, Cho KY, Ensminger WD, et al. Hepatic falciform artery: anatomy, angiographic appearance, and clinical significance. Radiology. 1985;156:339–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Song SY, Chung JW, Lim HG, Park JH. Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients. J Vasc Interv Radiol. 2006;17:461–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Lee AJ, Gomes AS, Liu DM, Kee ST, Loh CT, McWilliams JP. The road less traveled: importance of the lesser branches of the celiac axis in liver embolotherapy. Radiographics. 2012;32:1121–32.CrossRefPubMedGoogle Scholar
  18. 18.
    Liu DM, Salem R, Bui JT, et al. Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol. 2005;16:911–35.CrossRefPubMedGoogle Scholar
  19. 19.
    Gwon DI, Ko GY, Yoon HK, et al. Inferior phrenic artery: anatomy, variations, pathologic conditions, and interventional management. Radiographics. 2007;27:687–705.CrossRefPubMedGoogle Scholar
  20. 20.
    Nakamura H, Uchida H, Kuroda C, et al. Accessory left gastric artery arising from left hepatic artery: angiographic study. AJR Am J Roentgenol. 1980;134:529–32.CrossRefPubMedGoogle Scholar
  21. 21.
    VanDamme JP, Bonte J. Vascular anatomy in abdominal surgery. Stuttgart: Georg Thieme Verlag; 1990. p. 33–42.Google Scholar
  22. 22.
    Ibukuro K, Tsukiyama T, Mori K, Inoue Y. Hepatic falciform ligament artery: angiographic anatomy and clinical importance. Surg Radiol Anat. 1998;20:367–71.CrossRefPubMedGoogle Scholar
  23. 23.
    Bertelli E, Di GF, Bertelli L, Civeli L, Mosca S. The arterial blood supply of the pancreas: a review. II. The posterior superior pancreaticoduodenal artery. An anatomical and radiological study. Surg Radiol Anat. 1996;18:1–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Bertelli E, Di GF, Mosca S, Bastianini A. The arterial blood supply of the pancreas: a review. V. The dorsal pancreatic artery: an anatomic review and a radiologic study. Surg Radiol Anat. 1998;20:445–52.CrossRefPubMedGoogle Scholar
  25. 25.
    Bianchi HF, Albanèse EF. The supraduodenal artery. Surg Radiol Anat. 1989;11:37–40.CrossRefPubMedGoogle Scholar
  26. 26.
    Sahani D, Mehta A, Blake M, Prasad S, Harris G, Saini S. Preoperative hepatic vascular evaluation with CT and MR angiography: implications for surgery. Radiographics. 2004;24:1367–80.CrossRefPubMedGoogle Scholar
  27. 27.
    Ishigaki S, Itoh S, Satake H, Ota T, Ishigaki T. CT depiction of small arteries in the pancreatic head: assessment using coronal reformatted images with 16-channel multislice CT. Abdom Imaging. 2007;32:215–23.CrossRefPubMedGoogle Scholar
  28. 28.
    Miyayama S, Matsui O, Yamashiro M, et al. Detection of hepatocellular carcinoma by CT during arterial portography using a cone-beam CT technology: comparison with conventional CTAP. Abdom Imaging. 2009;34:502–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017

Authors and Affiliations

  • Kumi Ozaki
    • 1
    Email author
  • Satoshi Kobayashi
    • 2
  • Osamu Matsui
    • 1
  • Tetsuya Minami
    • 1
  • Wataru Koda
    • 1
  • Toshifumi Gabata
    • 1
  1. 1.Department of RadiologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
  2. 2.Department of Quantum Medicine TechnologyKanazawa University Graduate School of Medical ScienceKanazawaJapan

Personalised recommendations