What are the branches of the common hepatic artery (CHA)?

Branches of the Common Hepatic Artery

The common hepatic artery (CHA) typically divides into the gastroduodenal artery (GDA) and the proper hepatic artery (PHA), with the PHA further dividing into the right and left hepatic arteries. 1

Normal Anatomy of Common Hepatic Artery Branches

• The common hepatic artery originates from the celiac trunk (the first major branch of the abdominal aorta) 2
• The common hepatic artery bifurcates into:
  • Gastroduodenal artery - travels inferiorly behind the duodenal bulb 2
  • Proper hepatic artery - continues laterally toward the liver within the hepatoduodenal ligament 2
• The proper hepatic artery provides the right gastric artery before dividing into the left and right hepatic arteries 2
• Non-hepatic arteries such as the accessory left gastric artery, cystic artery, and falciform artery can arise from the hepatic artery 3

Common Anatomical Variations

• Anatomical variations in the common hepatic artery and its subdivisions are common, occurring in 25-75% of cases 1
• The most common variations include:
  • Type 1 (75.7%): Normal anatomy as described above 1
  • Type 2 (9.7%): Replaced or accessory left hepatic artery arising from the left gastric artery 1
  • Type 3 (10.6%): Replaced or accessory right hepatic artery originating from the superior mesenteric artery 1
  • Type 4 (2.3%): Both right and left hepatic arteries arising from the superior mesenteric and left gastric arteries, respectively 1
  • Type 5 (1.5%): The entire common hepatic artery arising as a branch of the superior mesenteric artery 1
  • Type 6 (0.2%): The common hepatic artery originating directly from the aorta 1

Rare Anatomical Variants

• Absence of proper hepatic artery - where the common hepatic artery gives rise directly to the left hepatic artery, then continues until it bifurcates into the gastroduodenal artery and right hepatic artery 2
• Replaced proper hepatic artery - originating from the superior mesenteric artery rather than the common hepatic artery 4
• Coexistence of both replaced proper hepatic and gastroduodenal arteries due to common hepatic artery absence 4
• Common hepatic artery originating from superior mesenteric artery with replaced right hepatic artery 5

Clinical Significance

• Knowledge of hepatic arterial anatomy is crucial for:
  • Hepatobiliary surgical procedures 6
  • Liver transplantation 1
  • Transarterial chemoembolization (TACE) for hepatocellular carcinoma 3
  • Cholecystectomy and management of traumatic injuries 2
• Identification of non-hepatic arteries arising from the hepatic artery is essential during procedures to prevent serious adverse events such as gastric ulcer, cholecystitis, and skin rash 3
• Accurate depiction and definition of the hepatic arterial anatomy are crucial to avoid iatrogenic injury with potentially devastating ischemic and necrotic results 6

Imaging Considerations

• Angiography should include visualization of the celiac trunk and superior mesenteric artery to identify anatomical variations of the hepatic artery 3
• Cone-beam CT during procedures can provide better spatial resolution and more precisely depict hepatic arterial anatomy 3
• Preoperative imaging is essential when evaluating the resectability of tumors in the hepatobiliary and pancreatic area, taking into account possible vascular variations 4

Understanding these anatomical patterns and variations is essential for safe and effective surgical and radiological procedures involving the liver and surrounding structures.