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Plate 1-79  Liver

Internal thoracic arteries


Umbilicus (turned up)
Falciform and round ligaments with arteries
Right, middle and left hepatic arteries
Short gastric arteries
Cystic
artery Intercostal
arteries

5
6 2

Vascular Disturbances: 4 3
Arterial 1

The hepatic artery branches off the celiac artery and Inferior Left gastro-
supplies approximately one third of the hepatic blood phrenic omental (gas-
flow, with two thirds supplied by the portal vein. The artery troepiploic)
effects of hepatic artery occlusion have a lot to do with Gastroduodenal artery artery
timing and location. Slower occlusion is better toler- Common hepatic artery Left gastric
ated than sudden occlusion. Simultaneous occlusion of Posterior superior artery
the portal vein can be fatal. The location of the occlu- pancreatico-
sion also plays a significant role, depending on the avail- duodenal artery Celiac
ability of collaterals able to provide sufficient oxygenated Anterior superior trunk
blood to the liver. Unfortunately, the existence and effi- pancreatico-
duodenal artery Splenic artery
ciency of such collaterals cannot be portended in an
individual case. An enormous variability has been estab- Right gastro-omental Dorsal
lished by anatomic studies. As a rule, obstruction of the (gastroepiploic) artery pancreatic
hepatic artery between the celiac trunk and the origin of artery
Right gastric artery
the gastroduodenal artery (zone A) is innocuous. The Superior
result of an obstruction between the gastroduodenal
Inferior pancreatico- mesenteric
duodenal artery artery
artery and the hilus of the liver (zone B) is unpredictable,
but in such instances, quite often, an extensive central Omental (epiploic) arteries Inferior pancreatic
zone of the lobules follows, which is more sensitive to artery
anoxemia than is the peripheral zone. Obstruction of
the intrahepatic branches (zone C) of the hepatic artery
almost always causes ischemic necrosis and infarction, Omental
because in these vessels sufficient collaterals do not (epiploic)
exist, with the exception of the immediate subcapsular arterial arc C C C
portion.
The gastroduodenal artery may bring blood from the
Cystic Capsular
splenic artery via the gastroepiploic, pancreatic, and
epiploic arteries and from the superior mesenteric Accessory or replaced arteries Right B
artery via the pancreaticoduodenal arteries. The right 1.Right or common hepatic gastric
gastric artery can carry blood shunted from the left A
2.Left hepatic Gastroduodenal
gastric artery, short gastric artery (spleen), or inferior 3.Right hepatic
phrenic artery or through anastomoses with esophageal 4.Cystic
arteries. The inferior phrenic artery may send branches Anastomoses of corresponding arteries Effects of hepatic A. Zone of relative safety
directly to the liver into the fossa for the ductus venosus 5.Inferior phrenic/left gastric left hepatic artery obstruction B. Zone of questionable effects
and into the bare area; it may also shunt blood from the 6.Right left hepatic C. Zone of inevitable infarction
intercostal arteries and from the right superior phrenic
artery (branch of the internal mammary artery) by anas-
tomoses through the diaphragm and through the inter- arise from the superior mesenteric artery (1), or acces- and left hepatic artery (5), or the right hepatic artery
costal muscles. Arteries in the falciform and teres ligaments sory arteries may branch off from this vessel. The left and left hepatic artery (6), may also become instrumen-
anastomose with branches of the left and middle hepatic artery or a corresponding accessory artery may tal in supplying arterial blood to the liver.
hepatic arteries and carry blood from the internal originate from the left gastric artery, or vice versa (2). It is important to note that the hepatic artery
mammary arteries as well as from the abdominal arter- Furthermore, a replaced or accessory right hepatic artery forms a capillary plexus around the bile ducts and is a
ies. The arteries for the common bile duct and the cystic may proceed from the gastroduodenal artery (3), or major source of the blood supply. Obstruction of the
artery may also supply areas of the liver, as does the even from the retroduodenal artery, and an anomalous hepatic artery, particularly after liver transplantation,
subcapsular plexus. Anomalous or accessory arteries may or replaced cystic artery (4) may do likewise. Abnormal typically results in biliary ischemia, which is manifested
also provide an important collateral arterial supply to anastomoses, such as one between the left gastric artery as biliary strictures, a major problem following liver
the liver. The right or the common hepatic artery may and left hepatic artery (2), the inferior phrenic artery transplantation.

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS 81

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