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Hepatic Artery Occlusion

by Nicholas T. Orfanidis, MD

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 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 unless hepatic infarction or ischemic hepatitis is present. 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

  • Vascular imaging

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

Treatment is directed at the cause.

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