Radiology: Hepatic artery stenosis

The hepatic artery, a branch of the celiac axis that leaves the abdominal aorta, is one of several important anastamoses that are part of liver transplantation.  The hepatic artery supplies blood to the biliary tree.  Thrombosis in the immediate post-transplant setting is an emergency and these patients are usually relisted for transplant.

It is important to recognize that, in addition to thrombosis, the hepatic artery is susceptible to stenosis and kinking.  Stenosis usually occurs at the site of surgical anastamosis.  When this occurs, the liver function tests may continue to be entirely normal! Alternatively, there may be a rise in alkaline phosphatase (reflecting the biliary tree’s reliance on the hepatic artery for perfusion) and/or transaminases. 

In the angiogram above, the arrow points to a stenosis in the common hepatic artery.  Angioplasty, usually with stenting, is an appropriate therapeutic step.  These patients will then require aspirin +/- plavix to maintain stent patency.

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