Proper hepatic artery !

The proper hepatic artery carries oxygen-rich blood into the liver, running beside the bile duct and portal vein; it is the only blood supply to the bile ducts.

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What it is

The continuation of the common hepatic artery, climbing in the hepatoduodenal ligament beside the bile duct and portal vein, then splitting into the right and left hepatic arteries.

What it does

Brings oxygen-rich blood to the liver (about a quarter of its blood; the portal vein brings the rest). The right hepatic artery gives the cystic artery to the gallbladder, in Calot's triangle.

Key facts

Origin: Common hepatic artery, after the gastroduodenal branch; ascends in the hepatoduodenal ligament, left of the common bile duct and in front of the portal vein
Branches: Right gastric (usually); right and left hepatic arteries; cystic artery from the right hepatic
Supplies: Liver and gallbladder (varies: replaced right hepatic from the SMA, replaced left hepatic from the left gastric)

Relations

Course: From the end of the common hepatic artery it climbs in the hepatoduodenal ligament to the porta hepatis and divides into right and left hepatic arteries below the hilum
Lateral: Common bile duct, to its right
Behind: Portal vein; behind it the epiploic foramen opens into the lesser sac, with the inferior vena cava as its back wall
Below: First part of the duodenum and the gastroduodenal artery, which leaves just before it begins

How to find it

At surgery its pulse is felt in the free edge of the lesser omentum, with a finger passed through the epiploic foramen and the thumb in front: the same grip used for the Pringle maneuver.

On imaging

CT angiography maps the hepatic arteries and their variants before liver resection, transplant or chemoembolization. After liver transplant, Doppler ultrasound checks the hepatic artery waveform; absent or dampened flow suggests thrombosis or stenosis.

Common problems

Pressing the hepatoduodenal ligament (Pringle manoeuvre) stops this artery and the portal vein to control bleeding from the liver.

How it is diagnosed

Ultrasound screening; CT.

Treatment

Monitoring of small aneurysms; repair with a stent-graft through the groin arteries or open surgery for large ones.

Clinical notes

Hepatic artery thrombosis is a feared early complication of liver transplant, causing bile leaks, biliary strictures or graft loss
An injury to the right hepatic artery during cholecystectomy, often together with a bile duct injury, worsens the outcome of the duct repair
A tortuous right hepatic artery can loop right next to the cystic duct (caterpillar or Moynihan hump), giving off a very short cystic artery
Chemoembolization and radioembolization of liver tumours are delivered through its right or left branches

Anatomical variants

Replaced right hepatic artery from the superior mesenteric artery, one of the commonest variants: it runs up behind the pancreatic head and portal vein, to the right and behind in the hepatoduodenal ligament
Replaced or accessory left hepatic artery from the left gastric artery, in the upper lesser omentum
A middle hepatic artery to segment IV, from the right or left hepatic artery
In a minority the right hepatic artery passes in front of the common hepatic duct instead of behind it

Development

The embryonic liver often gets three arteries, from the left gastric, the celiac trunk and the superior mesenteric artery, and usually only the middle one stays. When the others persist they become replaced or accessory left (left gastric) and right (superior mesenteric) hepatic arteries.

Test yourself

Think of the answer, then tap the question to see it.

How are the structures arranged in the free edge of the lesser omentum?

Common bile duct on the right, proper hepatic artery on the left, portal vein behind both; together they form the front wall of the epiploic foramen.

Why does injury to the hepatic artery damage the bile ducts first?

The bile ducts are fed only by hepatic artery branches, so arterial injury or thrombosis causes strictures and leaks before it harms liver tissue.

What is the commonest hepatic artery variant arising from the superior mesenteric artery?

A replaced right hepatic artery, running up behind the pancreatic head and portal vein, to the right and behind in the hepatoduodenal ligament.

What is the Pringle maneuver?

Compressing the hepatoduodenal ligament between finger and thumb, through the epiploic foramen, to stop inflow from the proper hepatic artery and portal vein and control liver bleeding.

What is a feared early arterial complication of liver transplant?

Hepatic artery thrombosis, causing bile leaks, biliary strictures or graft loss; Doppler ultrasound shows absent or dampened arterial flow.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): arteria hepatica propria TA2 4227
Official Spanish (DeCS): Arteria hepática DeCS D006499
English (TA2): Proper hepatic artery
Also called: hepatic artery proper · hepatic artery

Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Abdomen and Pelvis: Celiac Trunk.

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Representative model, for educational purposes only.