Hepatic Artery Diseases

  • Ton Lisman
  • Robert J. Porte
Part of the Molecular Pathology Library book series (MPLB, volume 5)


Blood supply to the liver is accomplished via a dual vascular system consisting of the hepatic artery and portal vein. With respect to blood flow, the liver is a unique organ in that the majority of the blood entering the liver is venous blood, which enters the liver from the portal vein. The portal vein is responsible for 65–75% of the blood flow to the liver, whereas the remainder of the blood enters the liver through the hepatic artery. The liver’s oxygen demand is met by the arterial blood for approximately 50%, while the other half is derived from the portal blood [1]. The arterial inflow of blood is tightly related to the venous inflow, so that the total blood flow through the liver remains constant. This regulatory mechanism is mediated by the hepatic artery, as the portal vein is unable to regulate blood flow. Arterial flow is regulated by site-specific release of adenosine, a powerful vasodilator. When portal flow is high, adenosine is rapidly washed away, resulting in arterial vasoconstriction. Vice versa, when portal flow is low, adenosine-mediated arterial vasodilation enables the arterial flow to increase [2].


Portal Vein Hepatic Artery Early Postoperative Period Polycythemia Vera Arterial Flow 
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. 1.
    Tygstrup N, Winkler K, Mellemgaard K, Andreassen M. Determination of the hepatic arterial blood flow and oxygen supply in man by clamping the hepatic artery during surgery. J Clin Invest. 1962;41:447–54.PubMedCrossRefGoogle Scholar
  2. 2.
    Lautt WW, Greenway CV. Conceptual review of the hepatic vascular bed. Hepatology. 1987;7:952–63.PubMedCrossRefGoogle Scholar
  3. 3.
    Parks RW, Chrysos E, Diamond T. Management of liver trauma. Br J Surg. 1999;86:1121–35.PubMedCrossRefGoogle Scholar
  4. 4.
    Kim DK, Kinne DW, Fortner JG. Occlusion of the hepatic artery in man. Surg Gynecol Obstet. 1973;136:966–8.PubMedGoogle Scholar
  5. 5.
    Madding GF, Kennedy PA. Hepatic artery ligation. Surg Clin North Am. 1972;52:719–28.PubMedGoogle Scholar
  6. 6.
    Bekker J, Ploem S, de Jong KP. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transplant. 2009;9:746–57.PubMedCrossRefGoogle Scholar
  7. 7.
    Pasha SF, Gloviczki P, Stanson AW, Kamath PS. Splanchnic artery aneurysms. Mayo Clin Proc. 2007;82:472–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Finley DS, Hinojosa MW, Paya M, Imagawa DK. Hepatic artery pseudoaneurysm: a report of seven cases and a review of the literature. Surg Today. 2005;35:543–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Abbas MA, Fowl RJ, Stone WM, Panneton JM, Oldenburg WA, Bower TC, et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg. 2003;38:41–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Messina LM, Shanley CJ. Visceral artery aneurysms. Surg Clin North Am. 1997;77:425–42.PubMedCrossRefGoogle Scholar
  11. 11.
    Cooper SG, Richman AH. Spontaneous rupture of a congenital hepatic artery aneurysm. J Clin Gastroenterol. 1988;10:104–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Porter III LL, Houston MC, Kadir S. Mycotic aneurysms of the hepatic artery. Treatment with arterial embolization. Am J Med. 1979;67:697–701.PubMedCrossRefGoogle Scholar
  13. 13.
    Krus S. Turjman MW. Fiejka E Comparative morphology of the hepatic and coronary artery walls Part I Differences in the distribution and intensity of non-atherosclerotic intimal thickening and atherosclerosis Med Sci Monit. 2000;6:19–23.Google Scholar
  14. 14.
    Carr SC, Mahvi DM, Hoch JR, Archer CW, Turnipseed WD. Visceral artery aneurysm rupture. J Vasc Surg. 2001;33:806–11.PubMedCrossRefGoogle Scholar
  15. 15.
    Carmeci C, McClenathan J. Visceral artery aneurysms as seen in a community hospital. Am J Surg. 2000;179:486–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Busuttil RW, Brin BJ. The diagnosis and management of visceral artery aneurysms. Surgery. 1980;88:619–24.PubMedGoogle Scholar
  17. 17.
    Zachary K, Geier S, Pellecchia C, Irwin G. Jaundice secondary to hepatic artery aneurysm: radiological appearance and clinical features. Am J Gastroenterol. 1986;81:295–8.PubMedGoogle Scholar
  18. 18.
    Howling SJ, Gordon H, McArthur T, Hatfield A, Lees WR. Hepatic artery aneurysms: evaluation using three-dimensional spiral CT angiography. Clin Radiol. 1997;52:227–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Alhawsawi AM, Aljiffry M, Walsh MJ, Peltekian K, Molinari M. Hepatic artery aneurysm associated with prune belly syndrome: a case report and review of the literature. J Surg Educ. 2009;66:43–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Carr SC, Pearce WH, Vogelzang RL, McCarthy WJ, Nemcek Jr AA, Yao JS. Current management of visceral artery aneurysms. Surgery. 1996;120:627–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Jonsson K, Bjernstad A, Eriksson B. Treatment of a hepatic artery aneurysm by coil occlusion of the hepatic artery. AJR Am J Roentgenol. 1980;134:1245–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Baker KS, Tisnado J, Cho SR, Beachley MC. Splanchnic artery aneurysms and pseudoaneurysms: transcatheter embolization. Radiology. 1987;163:135–9.PubMedGoogle Scholar
  23. 23.
    Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection. AJR Am J Roentgenol. 1986;147:383–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Narumi S, Hakamda K, Toyoki Y, Noda H, Sato T, Morohashi H, et al. Endovascular treatment of life-threatening pseudoaneurysm of the hepatic artery after pancreaticoduodenectomy. Hepatogastroenterology. 2007;54:2152–4.PubMedGoogle Scholar
  25. 25.
    Shanley CJ, Shah NL, Messina LM. Common splanchnic artery aneurysms: splenic, hepatic, and celiac. Ann Vasc Surg. 1996;10:315–22.PubMedCrossRefGoogle Scholar
  26. 26.
    Tessier DJ, Fowl RJ, Stone WM, McKusick MA, Abbas MA, Sarr MG, et al. Iatrogenic hepatic artery pseudoaneurysms: an uncommon complication after hepatic, biliary, and pancreatic procedures. Ann Vasc Surg. 2003;17:663–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Duffy JP, Hong JC, Farmer DG, Ghobrial RM, Yersiz H, Hiatt JR, et al. Vascular complications of orthotopic liver transplan­tation: experience in more than 4, 200 patients. J Am Coll Surg. 2009;208:896–903.PubMedCrossRefGoogle Scholar
  28. 28.
    Sieders E, Peeters PM, TenVergert EM, de Jong KP, Porte RJ, Zwaveling JH, et al. Early vascular complications after pediatric liver transplantation. Liver Transpl. 2000;6:326–32.PubMedCrossRefGoogle Scholar
  29. 29.
    Gunsar F, Rolando N, Pastacaldi S, Patch D, Raimondo ML, Davidson B, et al. Late hepatic artery thrombosis after orthotopic liver transplantation. Liver Transpl. 2003;9:605–11.PubMedCrossRefGoogle Scholar
  30. 30.
    Stange BJ, Glanemann M, Nuessler NC, Settmacher U, Steinmuller T, Neuhaus P. Hepatic artery thrombosis after adult liver transplantation. Liver Transpl. 2003;9:612–20.PubMedCrossRefGoogle Scholar
  31. 31.
    Mueller AR, Platz KP, Kremer B. Early postoperative complications following liver transplantation. Best Pract Res Clin Gastroenterol. 2004;18:881–900.PubMedGoogle Scholar
  32. 32.
    Yao FY, Kinkhabwala M, LaBerge JM, Bass NM, Brown Jr R, Kerlan R, et al. The impact of pre-operative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma. Am J Transplant. 2005;5:795–804.PubMedCrossRefGoogle Scholar
  33. 33.
    Silva MA, Jambulingam PS, Gunson BK, Mayer D, Buckels JA, Mirza DF, et al. Hepatic artery thrombosis following orthotopic liver transplantation: a 10-year experience from a single centre in the United Kingdom. Liver Transpl. 2006;12:146–51.PubMedCrossRefGoogle Scholar
  34. 34.
    Oh CK, Pelletier SJ, Sawyer RG, Dacus AR, McCullough CS, Pruett TL, et al. Uni- and multi-variate analysis of risk factors for early and late hepatic artery thrombosis after liver transplantation. Transplantation. 2001;71:767–72.PubMedCrossRefGoogle Scholar
  35. 35.
    Madalosso C, de Souza NF, Jr., Ilstrup DM, Wiesner RH, Krom RA. Cytomegalovirus and its association with hepatic artery thrombosis after liver transplantation. Transplantation 1998; 66: 294–297.Google Scholar
  36. 36.
    Lisman T, Porte RJ. Antiplatelet medication after liver transplantation: does it affect outcome? Liver Transpl. 2007;13:644–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Lisman T, Porte RJ. Hepatic artery thrombosis after liver transplantation: more than just a surgical complication? Transpl Int. 2009;22:162–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Schuurs TA, Gerbens F, van der Hoeven JA, Ottens PJ, Kooi KA, Leuvenink HG, et al. Distinct transcriptional changes in donor kidneys upon brain death induction in rats: insights in the processes of brain death. Am J Transplant. 2004;4:1972–81.PubMedCrossRefGoogle Scholar
  39. 39.
    Sindram D, Porte RJ, Hoffman MR, Bentley RC, Clavien PA. Platelets induce sinusoidal endothelial cell apoptosis upon reperfusion of the cold ischemic rat liver. Gastroenterology. 2000;118:183–91.PubMedCrossRefGoogle Scholar
  40. 40.
    Kobayashi Y, Yoshimura N, Nakamura K, Yamagishi H, Oka T. Expression of tissue factor in hepatic ischemic-reperfusion injury of the rat. Transplantation. 1998;66:708–16.PubMedCrossRefGoogle Scholar
  41. 41.
    Cywes R. Mullen JB, Stratis MA, Greig PD, Levy GA. Harvey PR et al Prediction of the outcome of transplantation in man by platelet adherence in donor liver allografts Evidence of the importance of prepreservation injury Transplantation. 1993;56:316–23.Google Scholar
  42. 42.
    Heemskerk JW, Bevers EM, Lindhout T. Platelet activation and blood coagulation. Thromb Haemost. 2002;88:186–93.PubMedGoogle Scholar
  43. 43.
    Rahbar A, Soderberg-Naucler C. Human cytomegalovirus infection of endothelial cells triggers platelet adhesion and aggregation. J Virol. 2005;79:2211–20.PubMedCrossRefGoogle Scholar
  44. 44.
    Lisman T, de Groot PG. Hemostatic dysfunction related to liver diseases and liver transplantation. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, Seligsohn U, editors. Hematology. New York: McGraw-Hill; 2006. p. 1953–8.Google Scholar
  45. 45.
    Stahl RL, Duncan A, Hooks MA, Henderson JM, Millikan WJ, Warren WD. A hypercoagulable state follows orthotopic liver transplantation. Hepatology. 1990;12:553–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Pereboom IT, Adelmeijer J, van Leeuwen Y, Hendriks HG, Porte RJ, Lisman T. Development of a severe von Willebrand factor/ADAMTS13 dysbalance during orthotopic liver transplantation. Am J Transplant. 2009;9:1189–96.PubMedCrossRefGoogle Scholar
  47. 47.
    Lisman, T, Bakhtiari K, Pereboom IT, Hendriks HG, Meijers JC, Porte RJ. Normal to increased thrombin generation in patients undergoing liver transplantation despite prolonged conventional coagulation tests. J Hepatol. 2010;52:355–61.Google Scholar
  48. 48.
    Kluft C, Verheijen JH, Jie AF, Rijken DC, Preston FE, Sue-Ling HM, et al. The postoperative fibrinolytic shutdown: a rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-type plasminogen activator after trauma. Scand J Clin Lab Invest. 1985;45:605–10.PubMedCrossRefGoogle Scholar
  49. 49.
    Hirshfield G, Collier JD, Brown K, Taylor C, Frick T, Baglin TP, et al. Donor factor V Leiden mutation and vascular thrombosis following liver transplantation. Liver Transpl Surg. 1998;4:58–61.PubMedCrossRefGoogle Scholar
  50. 50.
    Dunn TB, Linden MA, Vercellotti GM, Gruessner RW. Factor V Leiden and hepatic artery thrombosis after liver transplantation. Clin Transplant. 2006;20:132–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Bispo M, Marcelino P, Freire A, Martins A, Mourao L, Barroso E. High incidence of thrombotic complications early after liver transplantation for familial amyloidotic polyneuropathy. Transpl Int. 2009;22:165–71.PubMedCrossRefGoogle Scholar
  52. 52.
    Drazan K, Shaked A, Olthoff KM, Imagawa D, Jurim O, Kiai K, et al. Etiology and management of symptomatic adult hepatic artery thrombosis after orthotopic liver transplantation (OLT). Am Surg. 1996;62:237–40.PubMedGoogle Scholar
  53. 53.
    Hidalgo E, Cantarell C, Charco R, Murio E, Lazaro JL, Bilbao I, et al. Risk factors for late hepatic artery thrombosis in adult liver transplantation. Transplant Proc. 1999;31:2416–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Borg MA, van der Wouden EJ, Sluiter WJ, Slooff MJ, Haagsma EB, van den Berg AP. Vascular events after liver transplantation: a long-term follow-up study. Transpl Int. 2008;21:74–80.PubMedGoogle Scholar
  55. 55.
    Stegall MD, Everson G, Schroter G, Bilir B, Karrer F, Kam I. Metabolic complications after liver transplantation. Diabetes, hypercholesterolemia, hypertension, and obesity. Transplantation 1995; 60: 1057–1060.Google Scholar
  56. 56.
    Moon JI, Barbeito R, Faradji RN, Gaynor JJ, Tzakis AG. Negative impact of new-onset diabetes mellitus on patient and graft survival after liver transplantation: Long-term follow up. Transplantation. 2006;82:1625–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Vivarelli M, La BG, Cucchetti A, Lauro A, Del GM, Ravaioli M, et al. Can antiplatelet prophylaxis reduce the incidence of hepatic artery thrombosis after liver transplantation? Liver Transpl. 2007;13:651–4.PubMedCrossRefGoogle Scholar
  58. 58.
    Kok T, Slooff MJ, Thijn CJ, Peeters PM, Verwer R, Bijleveld CM, et al. Routine Doppler ultrasound for the detection of clinically unsuspected vascular complications in the early postoperative phase after orthotopic liver transplantation. Transpl Int. 1998;11:272–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Flint EW, Sumkin JH, Zajko AB, Bowen A. Duplex sonography of hepatic artery thrombosis after liver transplantation. AJR Am J Roentgenol. 1988;151:481–3.PubMedCrossRefGoogle Scholar
  60. 60.
    Kaneko J, Sugawara Y, Akamatsu N, Kishi Y, Kokudo N, Makuuchi M. Implantable Doppler probe for continuous monitoring of blood flow after liver transplantation. Hepatogastroenterology. 2005;52:194–6.PubMedGoogle Scholar
  61. 61.
    Sheiner PA, Varma CV, Guarrera JV, Cooper J, Garatti M, Emre S, et al. Selective revascularization of hepatic artery thromboses after liver transplantation improves patient and graft survival. Transplantation. 1997;64:1295–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Lisman T, Caldwell SH, Leebeek FW, Porte RJ. Is chronic liver disease associated with a bleeding diathesis? J Thromb Haemost. 2006;4:2059–60.PubMedCrossRefGoogle Scholar
  63. 63.
    Warnaar N, Lisman T, Porte RJ. The two tales of coagulation in liver transplantation. Curr Opin Organ Transplant. 2008;13:298–303.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of SurgeryUniversity Medical Center GroningenGroningenThe Netherlands

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