J Korean Soc Radiol.  2018 May;78(5):353-357. 10.3348/jksr.2018.78.5.353.

Entirely Replaced Left Gastric Artery from the Left Hepatic Artery: A Case Report

• Kim S
• Seo JW
• Shin W

• KMID: 2410726
• DOI: http://doi.org/10.3348/jksr.2018.78.5.353

Abstract

Arteries originating from the celiac axis have numerous anatomical variations. When performing interventional and surgical procedures, it is important to be aware of these variations to have better outcomes and to prevent iatrogenic complications. We report on a case of a 62-year-old man who came to our institution to receive transarterial chemoembolization for hepatocellular carcinoma. The computed tomography and angiography revealed a rare anatomic variation: the entire left gastric artery originated from the left hepatic artery with no other accessory feature of the left gastric artery from celiac axis or aorta was seen. To our knowledge, this is the first report on the entirely replaced left gastric artery from the left hepatic artery that was confirmed by utilizing both computed tomographic and angiographic images.

MeSH Terms

Anatomic Variation
Angiography
Aorta
Arteries*
Carcinoma, Hepatocellular
Celiac Artery
Hepatic Artery*
Humans
Middle Aged
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 A 62-year-old male patient with entirely replaced LGA from the LHA, confirmed on liver CT and conventional angiography. A. In a volume-rendering CT angiographic image, the celiac axis (*) bifurcates into the CHA and the splenic artery, and no other feature of the LGA from celiac axis or aorta is seen. After branching of the GDA (white curved arrow) and the RGA (empty curved arrow), the proper hepatic artery (white short arrow) bifurcates into the RHA (empty arrowhead) and LHA (empty short arrow). The LGA (white long arrow) is directly branching from the LHA, and the LHA is continuing its passage (empty long arrow). Note the unusual communication (white arrowhead) between the RGA and the GDA. B. In an initial volume-rendering CT image, the celiac axis (arrow) bifurcates into the CHA and the splenic artery, and no other feature of the LGA from the proximal portion of celiac axis or aorta is visible. C. During the initial TACE, a celiac angiogram shows the CHA (arrow) and splenic artery (curved arrow) are derived from the celiac axis (arrowhead), with no evidence of LGA. D. A subsequent CHA angiogram shows the LGA (arrow) branching from the LHA. A HCC, in segment 6/7 (arrowhead), is noted. CHA = common hepatic artery, CT = computed tomography, GDA = gastroduodenal artery, HCC = hepatocellular carcinoma, LGA = left gastric artery, LHA = left hepatic arter, RGA = right gastric artery, RHA = right hepatic artery, TACE = transarterial chemoembolization

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