Vascular Anatomy and Its Implication in Radioembolization

  • Ramón Saiz-Mendiguren
  • Javier Arias
  • Isabel Vivas
  • José Ignacio Bilbao
Part of the Medical Radiology book series (MEDRAD)


The anatomy of the mesenteric system and the hepatic arterial bed has a high degree of variation. The celiac trunk trifurcates into the left gastric, splenic, and common hepatic arteries. The common hepatic artery divides into the gastroduodenal artery and proper hepatic artery. This itself bifurcates into a right and left branch to supply each of the lobes of the liver. Quite often the hepatic artery has an incomplete set of branches because one or the other of its usual branches arises from a source other than the proper hepatic artery from the celiac trunk. Such a vessel, if from an outside source, is spoken of as ‘aberrant’ (a variation). Aberrant hepatic arteries are of two types, replacing and accessory. An aberrant hepatic artery refers to a branch that does not arise from its usual source (i.e. proper hepatic artery from the celiac trunk). This type of artery may be a substitute for the usual hepatic artery that is absent, in which case it is referred to as an aberrant ‘replaced’ hepatic artery. In other cases there may be an additional artery to the one normally present, hence the term aberrant ‘accessory’ artery. In 1953, Michels published his classical study of hepatic arterial anatomy, which detailed the results following the dissection of 200 cadavers. He defined 10 anatomical variations of the hepatic artery. Later on in 1966, Michels proposed an internationally recognized classification of these hepatic abnormalities, which was later, modified by Hiatt in 1994. When performing a radioembolization procedure, it is of utmost importance to identify and isolate any vessel which may supply blood to organs other than the liver as this may result in non-target 90Y administration. Many hepatic vessels originating from non-hepatic sources and extrahepatic collateral pathways to the liver may be established in various conditions such as following surgical ligation of the hepatic artery or arterial injury induced by repeated endovascular treatments.


Hepatic Artery Gastric Artery Celiac Trunk Common Hepatic Artery Left Gastric Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Arias Fernández J, Martín Martín B, Pinheiro da Silva N et al (2011) Extrahepatic vessels depending on the hepatic artery. Identification and management. Radiologia 53(1):18–26PubMedCrossRefGoogle Scholar
  2. Baba Y, Miyazono N, Ueno K et al (2000) Hepatic falciform artery. Angiographic findings in 25 patients. Acta Radiol 41:329–333PubMedCrossRefGoogle Scholar
  3. Bertelli E, Di Gregorio F, Bertelli L, Mosca S (1995) The arterial blood supply of the pancreas: a review. I. The superior pancreaticoduodenal and the anterior superior pancreaticoduodenal arteries. An anatomical and radiological study. Surg Radiol Anat 17:97–106, 1–3Google Scholar
  4. Bertelli E, Di Gregorio F, Bertelli L, Civeli L, Mosca S (1996a) The arterial blood supply of the pancreas: a review. II. The posterior superior pancreaticoduodenal artery. An anatomical and radiological study. Surg Radiol Anat 18:1–9PubMedCrossRefGoogle Scholar
  5. Bertelli E, Di Gregorio F, Bertelli L, Civeli L, Mosca S (1996b) The arterial blood supply of the pancreas: a review. III. The inferior pancreaticoduodenal artery. An anatomical review and a radiological study. Surg Radiol Anat 18:67–74PubMedCrossRefGoogle Scholar
  6. Bertelli E, Di Gregorio F, Bertelli L, Orazioli D, Bastianini A (1997) The arterial blood supply of the pancreas: a review. IV. The anterior inferior and posterior pancreaticoduodenal aa., and minor sources of blood supply for the head of the pancreas. An anatomical review and radiologic study. Surg Radiol Anat 19:203–212PubMedGoogle Scholar
  7. Bertelli E, Di Gregorio F, Mosca S, Bastianini A (1998) The arterial blood supply of the pancreas: a review. V. The dorsal pancreatic artery. An anatomic review and a radiologic study. Surg Radiol Anat 20:445–452PubMedCrossRefGoogle Scholar
  8. Bianchi HF, Albanese EF (1989) The supraduodenal artery. Surg Radiol Anat 11:37–40PubMedCrossRefGoogle Scholar
  9. Carr BI, Zajko A, Bron K, Orons P, Sammon J, Baron R (1997) Phase II study of Spherex (degradable starch microspheres) injected into the hepatic artery in conjunction with doxorubicin and cisplatin in the treatment of advanced stage hepatocellular carcinoma: interim analysis. Semin Oncol 24(2 Suppl 6):S6;97–S6;99Google Scholar
  10. Carretero C, Munoz-Navas M, Betes M et al (2007) Gastroduodenal injury after radioembolization of hepatic tumors. Am J Gastroenterol 102:1216–1220PubMedCrossRefGoogle Scholar
  11. Cheng LF, Ma KF, Fan WC et al (2010) Hepatocellular carcinoma with extrahepatic collateral arterial supply. J Med Imaging Radiat Oncol 54(1):26–34PubMedCrossRefGoogle Scholar
  12. Chung JW, Park JH, Han JK, Choi BI, Kim TK, Han MC (1998) Transcatheter oily chemoembolization of the inferior phrenic artery in hepatocellular carcinoma: the safety and potential therapeutic role. J Vasc Interv Radiol 9:495–500PubMedCrossRefGoogle Scholar
  13. Chung JW, Kim HC, Yoon JH et al (2006) Transcatheter arterial chemoembolization of hepatocellular carcinoma: prevalence and causative factors of extrahepatic collateral arteries in 479 patients. Korean J Radiol 7:257–266PubMedCentralPubMedCrossRefGoogle Scholar
  14. Cosin O, Bilbao JI, Alvarez S, de Luis E, Alonso A, Martinez-Cuesta A (2007) Right gastric artery embolization prior to treatment with yttrium-90 microspheres. Cardiovasc Intervent Radiol 30:98–103PubMedCrossRefGoogle Scholar
  15. Coskun M, Kayahan EM, Özbek O et al (2005) Imaging of hepatic arterial anatomy for depicting vascular variations in living related liver transplant donor candidates with multidetector computed tomography: comparison with conventional angiography. Transplant Proc 37:1070–1073PubMedCrossRefGoogle Scholar
  16. Daseler EH, Anson BJ, Hambley WC, Riemann AF (1947) The cystic artery and constituents of the hepatic pedicle: a study of 500 specimens. Surg Gynecol Obstet 85:47–63PubMedGoogle Scholar
  17. Gibo M, Hasuo K, Inoue A, Miura N, Murata S (2001) Hepatic falciform artery: angiographic observations and significance. Abdom Imaging 26:515–519PubMedCrossRefGoogle Scholar
  18. Hentati N, Fournier HD, Papon X, Aube C, Vialle R, Mercier P (1999) Arterial supply of the duodenal bulb: an anatomoclinical study. Surg Radiol Anat 21:159–164PubMedCrossRefGoogle Scholar
  19. Hiatt JR, Gabbay J, Busuttil RW (1994) Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 220:50–52PubMedCentralPubMedCrossRefGoogle Scholar
  20. Inaba Y, Arai Y, Matsueda K, Takeuchi Y, Aramaki T (2001) Right gastric artery embolization to prevent acute gastric mucosal lesions in patients undergoing repeat hepatic arterial infusion chemotherapy. J Vasc Interv Radiol 12:957–963PubMedCrossRefGoogle Scholar
  21. Kan Z, Madoff DC (2008) Liver anatomy: microcirculation of the liver. Semin Intervent Radiol 25(2):77–85PubMedCentralPubMedCrossRefGoogle Scholar
  22. Kim DE, Yoon HK, Ko GY, Kwon JS, Song HY, Sung KB (1999) Hepatic falciform artery: is prophylactic embolization needed before short term hepatic arterial chemoinfusion? Am J Roentgenol 172:1597–1599CrossRefGoogle Scholar
  23. Koops A, Wojciechowski B, Broering DC et al (2004) Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 26:239–244PubMedCrossRefGoogle Scholar
  24. Lewandowski RJ, Sato KT, Atassi B et al (2007) Radioembolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol 30:571–592PubMedCrossRefGoogle Scholar
  25. Liu DM, Salem R, Bui JT et al (2005) Angiographic considerations in patients undergoing liver directed therapy. J Vasc Interv Radiol 16:911–935PubMedCrossRefGoogle Scholar
  26. Loukas M, Fergurson A, Louis RG Jr, Colborn GL (2006) Multiple variations of the hepatobiliary vasculature including double cystic arteries, accessory left hepatic artery and hepatosplenic trunk: a case report. Surg Radiol Anat 28:525–528PubMedCrossRefGoogle Scholar
  27. Michels NA (1951) The hepatic, cystic and retroduodenal arteries and their relations to the biliary ducts with samples of the entire celiacal blood supply. Ann Surg 133:503–524PubMedCentralPubMedCrossRefGoogle Scholar
  28. Michels NA (1953) Collateral arterial pathways to the liver after ligation of the hepatic artery and removal of the celiac axis. Cancer 6:708–724PubMedCrossRefGoogle Scholar
  29. Miyayama S, Matsui O, Taki K et al (2006) Extrahepatic blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization. Cardiovasc Intervent Radiol 29:39–48PubMedCrossRefGoogle Scholar
  30. Mlakar B, Gadzijev EM, Ravnik D, Hribernik M (2003) Anatomical variations of the cystic artery. Eur J Morphol 41:31–34PubMedCrossRefGoogle Scholar
  31. Molmenti EP, Pinto PA, Klein J, Klein AS (2003) Normal and variant arterial supply of the liver and gallbladder. Pediatr Transplant 7:80–82PubMedCrossRefGoogle Scholar
  32. Ottery FD, Scupham RK, Weese JL (1986) Chemical cholecystitis after intrahepatic chemotherapy. The case for prophylactic cholecystectomy during pump placement. Dis Colon Rectum 29:187–190PubMedCrossRefGoogle Scholar
  33. Piao DX, Ohtsuka A, Murakami T (1998) Typology of abdominal arteries, with special reference to inferior phrenic arteries and their esophageal branches. Acta Med Okayama 52(189–196):6Google Scholar
  34. Sarkar AK, Roy TS (2000) Anatomy of the cystic artery arising from the gastroduodenal artery and its choledochal branch—a case report. J Anat 197(Pt 3):503–506PubMedCentralPubMedCrossRefGoogle Scholar
  35. Song SY, Chung JW, Kwon JW et al (2002) Collateral pathways in patients with celiac axis stenosis: angiographic-spiral CT correlation. Radiographics 22:881–893PubMedCrossRefGoogle Scholar
  36. Song SY, Chung JW, Lim HG et al (2006) Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients. J Vasc Interv Radiol 17:461–469PubMedCrossRefGoogle Scholar
  37. Song SY, Chung JW, Yin YH et al (2010) Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology 255(1):278–288PubMedCrossRefGoogle Scholar
  38. Sueyoshi E, Hayashida T, Sakamoto I et al (2010) Vascular complications of hepatic artery after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Am J Roentgenol 195(1):245–251CrossRefGoogle Scholar
  39. Takayasu K, Moriyama N, Muramatsu Y et al (1985) Gallbladder infarction after hepatic artery embolization. Am J Roentgenol 144(1):135–138CrossRefGoogle Scholar
  40. Uchikawa Y, Kitamura H, Miyagawa S (2011) Portal blood flow via the peribiliary vascular plexus demonstrated by contrast enhanced ultrasonography with Sonazoid. J Hepatobiliary Pancreat Sci 18(4):615–620PubMedCrossRefGoogle Scholar
  41. Ueno K, Miyazono N, Inoue H, Miyake S, Nishida H, Nakajo M (1995) Embolization of the hepatic falciform artery to prevent supraumbilical skin rash during transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiol 18:183–185PubMedCrossRefGoogle Scholar
  42. Van Damme JP, Bonte J (1990) Vascular anatomy in abdominal surgery. Thiéme, New YorkGoogle Scholar
  43. Wagnetz U, Jaskolka J, Yang P et al (2010) Acute ischemic cholecystitis after transarterial chemoembolization of hepatocellular carcinoma: incidence and clinical outcome. J Comput Assist Tomogr 34(3):348–353PubMedCrossRefGoogle Scholar
  44. Williams DM, Cho KJ, Ensminger WD, Ziessman HA, Gyves JW (1985) Hepatic falciform artery: anatomy, angiographic appearance, and clinical significance. Radiology 156:339–340PubMedGoogle Scholar
  45. Yamagami T, Nakamura T, Iida S, Kato T, Nishimura T (2002) Embolization of the right gastric artery before hepatic arterial infusion chemotherapy to prevent gastric mucosal lesions: approach through the hepatic artery versus the left gastric artery. Am J Roentgenol 179:1605–1610CrossRefGoogle Scholar
  46. Yamagami T, Kato T, Tanaka O et al (2005) Influence of hepatopetal flow of the retroportal artery on efficiency of repeated hepatic arterial infusion chemotherapy. J Vasc Interv Radiol 16(10):1391–1395Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ramón Saiz-Mendiguren
    • 1
  • Javier Arias
    • 1
  • Isabel Vivas
    • 1
  • José Ignacio Bilbao
    • 1
  1. 1.Department of RadiologyUniversity Hospital of NavarraPamplonaSpain

Personalised recommendations