Hepatic Artery Lesions

Abstract

Lesions of the hepatic artery and those injuries and diseases which may require hepatic artery ligation have been reviewed. A survey of experimental studies of the effects of hepatic artery ligation shows some disagreement, in part due to differences in technic. In adult dogs, death commonly occurs after ligation due to the toxic effects of the growth of gas-forming, anerobic bacillus which is a normal inhabitant of the adult dog liver. Collateral circulation carrying adequately oxygenated blood will prevent this growth, as will antibiotics. Anatomic studies of the arterial supply of the liver in humans show considerable variation. The most dependable collateral pathway after hepatic artery ligation is via the gastroduodenal branch through the pancreatic vessels and the superior mesenteric artery. Michels describes 26 possible routes for blood to reach the liver after hepatic artery ligation. Aneurysms are usually arteriosclerotic in cause, and located in the common or right hepatic. Pain, hemorrhage and jaundice are most often present; a pulsating mass may be felt. Approximately 135 cases have been reported and 27 successfully operated upon, most often by excision. An hepatoportal arteriovenous fistula is usually congenital and is manifested by portal hypertension and its complications. Five of the 9 reported patients have been treated by a surgical procedure, either by ligation or closure, with recovery. Accidental injury and ligation of the hepatic artery appears to be uncommon, but does occasionally occur. Occlusion by arteriosclerosis or tumor is also seldom reported; increased utilization of aortography and arteriography may well show this to be a common development. Severe inflammatory reaction is suggested as the cause of hepatic artery occlusion in 2 personal cases. Deliberate ligation of the hepatic artery for portal hypertension is now infrequently employed. Such ligation to extend the resection for carcinoma of the stomach may be justified. Ligation may be necessary as an emergency procedure to control hemorrhage from a traumatic laceration of the liver. Deliberate ligation has been successfully employed in 3 cases of traumatic hemobilia.