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. (See also Overview of Vascular Disorders of the Liver.)
Usually, the result is hepatic infarction. In patients with a liver transplant or preexisting portal vein thrombosis, hepatic artery thrombosis causes 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 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.