Hepatic Arteries
The hepatic arteries provide the principal arterial blood supply to the liver and biliary system. The common hepatic artery usually arises from the celiac trunk and gives rise to the proper hepatic artery, which typically divides into right and left hepatic arteries near the porta hepatis.
The hepatic arteries provide oxygenated arterial blood to the liver and contribute importantly to the blood supply of the intrahepatic and extrahepatic biliary system. In the most common arrangement, arterial blood reaches the liver through the common hepatic artery, a branch of the celiac trunk, and then through the proper hepatic artery.
The proper hepatic artery ascends toward the liver within the hepatoduodenal ligament and usually divides near the porta hepatis into the right hepatic artery and left hepatic artery. These vessels subsequently divide into progressively smaller branches that accompany portal venous and biliary branches within the hepatic parenchyma.
Although the liver receives a greater proportion of its total blood flow through the portal vein, the hepatic arterial system is essential because it supplies oxygenated blood to hepatic tissue and provides the predominant arterial supply to the biliary tree. Hepatic arterial anatomy also shows considerable variation, making detailed knowledge of its branching patterns important in liver surgery, cholecystectomy, transplantation, and interventional radiology.
Overview of the Hepatic Arterial Pathway
The typical arterial pathway to the liver is:
- Abdominal aorta
- Celiac trunk
- Common hepatic artery
- Proper hepatic artery
- Right and left hepatic arteries
- Sectoral and segmental hepatic arterial branches
Celiac Trunk
The celiac trunk is a major unpaired branch of the abdominal aorta supplying structures derived predominantly from the embryological foregut.
It usually arises from the anterior aspect of the abdominal aorta shortly below the aortic hiatus of the diaphragm.
Branches of the Celiac Trunk
The celiac trunk classically divides into three major branches:
- Left gastric artery
- Splenic artery
- Common hepatic artery
The common hepatic artery provides the principal conventional arterial route toward the liver.
Common Hepatic Artery
The common hepatic artery typically arises from the celiac trunk and passes toward the right along the superior border of the proximal pancreas.
It gives rise to branches supplying the stomach, duodenum, pancreas, and liver.
Course of the Common Hepatic Artery
From the celiac trunk, the common hepatic artery passes anteriorly and toward the right in the upper abdomen.
It approaches the first part of the duodenum, where its branching pattern gives rise to vessels supplying both the hepatobiliary system and neighboring gastrointestinal structures.
Gastroduodenal Artery
The gastroduodenal artery is a major branch of the common hepatic artery.
After the gastroduodenal artery arises, the continuation of the hepatic arterial trunk is generally referred to as the proper hepatic artery.
Course of the Gastroduodenal Artery
The gastroduodenal artery descends posterior to the superior part of the duodenum.
Its branches contribute to the arterial supply of the stomach, duodenum, and pancreas.
Right Gastric Artery
The right gastric artery commonly arises from the proper hepatic artery, although its origin is variable.
It passes along the lesser curvature of the stomach and anastomoses with the left gastric artery.
Proper Hepatic Artery
The proper hepatic artery is the continuation of the hepatic arterial pathway beyond the origin of the gastroduodenal artery.
It ascends toward the liver within the free edge of the lesser omentum, specifically the hepatoduodenal ligament.
Hepatoduodenal Ligament
The hepatoduodenal ligament forms the thickened free right margin of the lesser omentum and connects the liver with the proximal duodenum.
It contains the major components of the portal triad together with lymphatics and autonomic nerves.
Portal Triad
The major structures within the hepatoduodenal ligament are the:
- Proper hepatic artery
- Portal vein
- Bile duct
These structures have a characteristic general arrangement before they divide near the hepatic hilum.
Arrangement Within the Hepatoduodenal Ligament
The proper hepatic artery generally lies anterior to the portal vein and to the left of the bile duct.
The bile duct lies anteriorly and toward the right, while the portal vein occupies a more posterior position.
| Structure | Typical Position |
|---|---|
| Proper hepatic artery | Anterior and left |
| Bile duct | Anterior and right |
| Portal vein | Posterior |
Division of the Proper Hepatic Artery
Near the porta hepatis, the proper hepatic artery usually divides into right and left hepatic arteries.
These vessels distribute arterial blood to the functional right and left portions of the liver.
Right Hepatic Artery
The right hepatic artery is the principal arterial supply to the functional right liver in the conventional arrangement.
It typically passes toward the right near the hepatic ductal system before dividing into branches supplying individual right-sided hepatic territories.
Relationship to the Common Hepatic Duct
The right hepatic artery commonly passes posterior to the common hepatic duct as it travels toward the right liver.
This relationship is clinically important because the artery and bile ducts lie in close proximity within the hepatic hilum.
Right Anterior Arterial Branches
Branches of the right hepatic artery supply the right anterior hepatic sector, which includes principally segments V and VIII.
These arterial branches generally accompany corresponding portal venous and biliary branches.
Right Posterior Arterial Branches
The right posterior sector, consisting principally of segments VI and VII, receives arterial branches that accompany the right posterior portal pedicle.
Cystic Artery
The cystic artery most commonly arises from the right hepatic artery.
It provides the principal arterial supply to the gallbladder and is one of the most important branches encountered during cholecystectomy.
Course of the Cystic Artery
The cystic artery typically approaches the gallbladder within the hepatocystic triangle.
Near the gallbladder, it commonly divides into superficial and deep branches supplying different aspects of the organ.
Superficial Cystic Branch
The superficial branch generally supplies the free or peritoneal surface of the gallbladder.
Deep Cystic Branch
The deep branch travels between the gallbladder and its hepatic bed and supplies the attached surface.
Hepatocystic Triangle
The hepatocystic triangle is bounded by the cystic duct, common hepatic duct, and inferior surface of the liver.
The cystic artery is commonly found within this region, although both its origin and course may vary.
Left Hepatic Artery
The left hepatic artery supplies most of the functional left liver in the conventional arterial arrangement.
It passes toward the left at the hepatic hilum and divides into branches accompanying the portal pedicles of the left hepatic territories.
Arterial Supply to Segments II and III
Segments II and III form the left lateral hepatic territory and receive arterial branches from the left hepatic arterial system.
These branches generally accompany the corresponding left portal venous branches.
Arterial Supply to Segment IV
Segment IV belongs functionally to the left liver and usually receives arterial branches associated with the left hepatic artery.
Its arterial supply can vary and may include contributions from other hepatic arterial branches.
Arterial Supply to Segment I
The caudate lobe, corresponding to segment I, has a variable arterial supply.
It may receive branches from both the right and left hepatic arteries, contributing to its relatively independent vascular anatomy.
Functional Distribution
| Arterial Territory | Principal Segments |
|---|---|
| Left lateral territory | II and III |
| Left medial territory | IV |
| Right anterior territory | V and VIII |
| Right posterior territory | VI and VII |
| Caudate territory | I, often receives variable bilateral contributions |
Segmental Hepatic Arteries
Within the liver, the right and left hepatic arteries divide into progressively smaller branches corresponding to functional hepatic territories.
Segmental arterial branches generally travel with branches of the portal vein and bile ducts.
Glissonian Pedicles
Branches of the hepatic artery, portal vein, and bile ducts travel together within connective tissue extensions commonly described surgically as Glissonian pedicles.
This organization permits vascular and biliary control of selected hepatic territories during anatomical liver resection.
Intrasegmental Course
Hepatic arterial branches are generally intrasegmental, meaning that they travel within the functional hepatic territories they supply.
This differs from the major hepatic veins, which generally occupy intersegmental planes.
Hepatic Arteries and Portal Vein
The liver has a dual blood supply from the hepatic artery and portal vein.
The portal vein carries nutrient-rich venous blood from the gastrointestinal tract and related organs, while the hepatic artery delivers oxygenated systemic arterial blood.
Dual Blood Supply of the Liver
| Feature | Hepatic Artery | Portal Vein |
|---|---|---|
| Blood type | Oxygenated systemic arterial blood | Portal venous blood |
| Origin | Ultimately from celiac arterial system in typical anatomy | Portal venous system |
| Entry | Porta hepatis | Porta hepatis |
| Intrahepatic course | Accompanies portal pedicles | Forms major basis of portal territories |
| Termination | Hepatic sinusoids and arterial microcirculation | Hepatic sinusoids |
Hepatic Sinusoids
Terminal branches of the hepatic arterial and portal venous systems ultimately deliver blood into the hepatic sinusoids.
Within these specialized vascular channels, arterial and portal venous blood mix before passing toward central veins.
Central Veins
Blood from hepatic sinusoids drains into central veins within classical hepatic lobules.
These vessels ultimately contribute to larger hepatic venous channels.
Hepatic Veins
The hepatic veins provide the principal venous outflow from the liver and drain into the inferior vena cava.
Unlike hepatic arterial and portal venous branches, the major hepatic veins do not pass through the porta hepatis.
Hepatic Arteries Versus Hepatic Veins
| Feature | Hepatic Arteries | Hepatic Veins |
|---|---|---|
| Function | Arterial inflow | Venous outflow |
| Relationship to porta hepatis | Enter through hepatic hilar region | Do not pass through porta hepatis |
| Segmental relationship | Generally intrasegmental | Generally intersegmental |
| Major termination | Hepatic microcirculation | Inferior vena cava |
Arterial Supply of the Biliary Tree
The hepatic arterial system is particularly important for the blood supply of the biliary tree.
Unlike hepatocytes, which receive blood from both portal venous and arterial sources through the sinusoids, the bile ducts depend predominantly on arterial blood supplied through networks surrounding the ducts.
Peribiliary Vascular Plexus
The peribiliary vascular plexus is a network of small blood vessels surrounding the bile ducts.
It receives arterial blood from hepatic arterial branches and supplies the biliary epithelium and supporting tissues.
Clinical Importance of Biliary Arterial Supply
Interruption of arterial flow can produce ischemic injury to the bile ducts even when portal venous blood flow to the liver remains present.
This relationship is especially important following liver transplantation and complex hepatobiliary procedures.
Extrahepatic Bile Duct Blood Supply
The extrahepatic bile ducts receive small arterial branches that form longitudinal vascular networks along the duct wall.
These vessels arise from hepatic arterial branches superiorly and vessels associated with the gastroduodenal region inferiorly.
Anatomical Variations
The hepatic arterial system demonstrates substantial anatomical variation.
The conventional arrangement of a common hepatic artery from the celiac trunk followed by a proper hepatic artery dividing into right and left hepatic arteries is common, but alternative origins and courses occur frequently enough to have major clinical importance.
Replaced Hepatic Artery
A replaced hepatic artery is an artery that arises from an alternative source instead of the expected conventional vessel and provides the principal arterial supply to its hepatic territory.
Accessory Hepatic Artery
An accessory hepatic artery provides additional arterial supply to a hepatic territory that also receives a conventional hepatic artery.
The distinction between replaced and accessory vessels is important when describing hepatic arterial anatomy.
Replaced Right Hepatic Artery
A common arterial variation is a replaced right hepatic artery arising from the superior mesenteric artery.
Its course toward the liver may bring it into close relationship with the portal vein, bile ducts, pancreatic head, and other structures of the hepatoduodenal region.
Replaced Left Hepatic Artery
A replaced left hepatic artery may arise from the left gastric artery.
Such a vessel can travel within the lesser omentum toward the left hepatic territory.
Accessory Right Hepatic Artery
An accessory right hepatic artery may arise from the superior mesenteric artery while a conventional right hepatic artery remains present.
Both vessels may contribute significantly to the arterial supply of the right liver.
Accessory Left Hepatic Artery
An accessory left hepatic artery may arise from the left gastric artery in addition to the conventional left hepatic arterial supply.
Common Hepatic Artery Variations
The common hepatic artery itself may occasionally arise from a source other than the celiac trunk.
Its course may also vary in relation to the portal vein, pancreas, and hepatoduodenal ligament.
Clinical Importance of Arterial Variations
Variant hepatic arteries can be injured if their presence is not recognized during surgery.
Preoperative identification is particularly important during hepatic resection, pancreatic surgery, gastric surgery, biliary procedures, and liver transplantation.
Cystic Artery Variations
The cystic artery also demonstrates considerable variation in origin, number, and course.
Although it most commonly arises from the right hepatic artery, it may originate from other hepatic or nearby arterial branches.
Double Cystic Arteries
More than one cystic artery may supply the gallbladder.
Failure to recognize an additional arterial branch can contribute to bleeding during cholecystectomy.
Moynihan's Hump
A tortuous right hepatic artery may form a prominent loop close to the gallbladder and cystic duct, sometimes described as Moynihan's hump or a caterpillar hump.
The cystic artery may arise from this loop and be very short, creating a potential risk of right hepatic arterial injury during gallbladder surgery.
Cholecystectomy
During cholecystectomy, the relationship between the cystic artery, cystic duct, common hepatic duct, and right hepatic artery must be identified carefully.
Variation in arterial anatomy is one reason precise surgical identification of structures is necessary before division.
Critical View of Safety
The critical view of safety is a surgical method used to establish the anatomy of the cystic structures before they are divided during cholecystectomy.
Its purpose includes reducing the risk of injury to the bile ducts and nearby hepatic arterial branches.
Pringle Maneuver
The Pringle maneuver involves temporary compression or clamping of the hepatoduodenal ligament.
This interrupts inflow through both the proper hepatic arterial system and portal vein and can help control hepatic bleeding during selected operations or trauma.
Persistent Bleeding During Portal Triad Occlusion
If significant bleeding continues despite effective portal triad occlusion, the source may involve the hepatic veins, inferior vena cava, or another vessel not controlled by compression of the hepatoduodenal ligament.
Liver Transplantation
The hepatic artery is critically important in liver transplantation because arterial inflow must be reconstructed between donor and recipient.
Small vessel caliber and anatomical variation make the arterial anastomosis technically important.
Hepatic Artery Thrombosis
Hepatic artery thrombosis is a particularly important vascular complication after liver transplantation.
Loss of arterial flow can compromise the graft and may produce ischemic injury of the biliary system because of its dependence on hepatic arterial perfusion.
Hepatic Artery Stenosis
Narrowing of the hepatic artery can reduce arterial perfusion to the liver and biliary tree.
Doppler ultrasound and cross-sectional vascular imaging may be used to evaluate suspected stenosis.
Hepatic Artery Aneurysm
An aneurysm may develop within the hepatic arterial system.
Its clinical significance depends on its location, size, surrounding relationships, and risk of rupture or other complications.
Hepatic Artery Pseudoaneurysm
A pseudoaneurysm may occur after trauma, surgery, inflammation, or instrumentation involving the hepatobiliary region.
Because rupture can cause significant hemorrhage, identification of the involved arterial branch is clinically important.
Hemobilia
Hemobilia refers to bleeding into the biliary system caused by communication between a blood vessel and bile duct.
Hepatic arterial injury, trauma, tumors, and interventional procedures are among the possible causes.
Hepatic Trauma
In liver trauma, arterial branches may be damaged together with portal and hepatic venous structures.
Active arterial bleeding can sometimes be localized and treated through endovascular techniques.
Transarterial Embolization
Transarterial embolization involves catheter-based delivery of embolic material into selected arterial branches.
It may be used to control hepatic arterial bleeding or as part of treatment strategies for selected hepatic tumors.
Transarterial Chemoembolization
Transarterial chemoembolization uses the hepatic arterial route to deliver therapy to selected hepatic tumors while reducing arterial blood flow to the targeted tissue.
Knowledge of segmental arterial anatomy and variant vessels is essential for accurate catheter placement.
Tumor Arterial Supply
Many hepatic tumors receive substantial blood supply from branches of the hepatic arterial system.
This arterial dependence provides an anatomical basis for several catheter-directed treatments.
Hepatic Resection
During anatomical liver resection, arterial branches supplying the hepatic territory being removed can be controlled together with corresponding portal venous and biliary branches.
Preservation of arterial flow to the remaining liver is essential.
Segmentectomy
Segmental liver resection requires identification of the portal pedicle supplying the selected hepatic segment.
The hepatic arterial branch within this pedicle contributes to the segment's arterial inflow.
Right Hepatectomy
A functional right hepatectomy requires management of arterial branches supplying segments V, VI, VII, and VIII while preserving arterial inflow to the remaining left liver.
Left Hepatectomy
A functional left hepatectomy involves arterial control of the functional left hepatic territory, principally segments II, III, and IV.
Variant arterial anatomy must be identified because arterial branches may not follow the conventional pattern.
Pancreatic Surgery
Variant hepatic arteries may pass near or through tissues encountered during pancreatic surgery.
A replaced right hepatic artery arising from the superior mesenteric artery is particularly important because of its potential relationship to the pancreatic head and hepatoduodenal structures.
Gastric Surgery
A replaced or accessory left hepatic artery arising from the left gastric artery can be encountered during operations involving the lesser curvature and upper stomach.
Its significance depends on how much hepatic tissue depends on that vessel for arterial perfusion.
Angiography
Catheter angiography can demonstrate the hepatic arterial system in detail and allows simultaneous therapeutic intervention when required.
Selective catheterization can identify individual hepatic arterial branches and variant vessels.
CT Angiography
Contrast-enhanced CT angiography can map the origin, course, and branching of the hepatic arteries.
It is particularly useful in preoperative and preprocedural planning.
MR Angiography
MR angiographic techniques can also demonstrate hepatic vascular anatomy.
The choice of imaging method depends on the clinical context and the level of vascular detail required.
Doppler Ultrasound
Doppler ultrasound can evaluate blood flow within the hepatic arterial system.
It is particularly useful for vascular surveillance after liver transplantation and for assessing hepatic arterial patency and flow characteristics.
Hepatic Arterial Anatomy on Imaging
Cross-sectional imaging can identify the common hepatic artery, proper hepatic artery, right and left hepatic arteries, and many of their major branches.
Imaging also allows assessment of their relationships to the portal vein, biliary tree, pancreas, and hepatic lesions.
Common Hepatic Versus Proper Hepatic Artery
| Feature | Common Hepatic Artery | Proper Hepatic Artery |
|---|---|---|
| Typical origin | Celiac trunk | Continuation after gastroduodenal artery arises |
| Major territory | Hepatobiliary and adjacent upper gastrointestinal structures through branches | Principal arterial route toward liver |
| Major branch relationship | Gives rise to gastroduodenal artery | Usually divides into right and left hepatic arteries |
| Hepatoduodenal ligament | Approaches region | Ascends within ligament |
Right Versus Left Hepatic Artery
| Feature | Right Hepatic Artery | Left Hepatic Artery |
|---|---|---|
| Main territory | Functional right liver | Functional left liver |
| Principal segments | V, VI, VII and VIII | II, III and IV |
| Common important branch | Cystic artery | Branches to left hepatic territories |
| Common variant source | Superior mesenteric artery | Left gastric artery |
Conventional Hepatic Arterial Pattern
| Artery | Typical Origin | Major Role |
|---|---|---|
| Common hepatic artery | Celiac trunk | Provides major arterial pathway toward liver and adjacent organs |
| Proper hepatic artery | Continuation of common hepatic artery after gastroduodenal branch | Principal arterial trunk entering hepatic hilum |
| Right hepatic artery | Proper hepatic artery | Supplies functional right liver |
| Left hepatic artery | Proper hepatic artery | Supplies functional left liver |
| Cystic artery | Usually right hepatic artery | Supplies gallbladder |
Important Hepatic Arterial Variations
| Variation | Common Alternative Origin |
|---|---|
| Replaced right hepatic artery | Superior mesenteric artery |
| Replaced left hepatic artery | Left gastric artery |
| Accessory right hepatic artery | Superior mesenteric artery |
| Accessory left hepatic artery | Left gastric artery |
| Variant cystic artery | May arise from several hepatic or nearby arterial branches |
Key Features of the Hepatic Arteries
| Feature | Key Point |
|---|---|
| Principal conventional source | Celiac trunk through common hepatic artery |
| Main hepatic arterial trunk | Proper hepatic artery |
| Major terminal branches | Right and left hepatic arteries |
| Location of proper hepatic artery | Hepatoduodenal ligament |
| Relationship to portal vein | Usually anterior |
| Relationship to bile duct | Proper hepatic artery generally lies to its left |
| Common source of cystic artery | Right hepatic artery |
| Major biliary role | Provides predominant arterial supply to bile ducts |
| Major anatomical characteristic | Frequent branching and origin variations |
Anatomical and Clinical Importance
The hepatic arterial system provides the oxygenated component of the liver's dual blood supply and is the principal arterial supply of the biliary tree. In the conventional arrangement, the common hepatic artery arises from the celiac trunk, gives rise to the gastroduodenal artery, and continues as the proper hepatic artery. The proper hepatic artery then divides near the porta hepatis into right and left hepatic arteries.
Within the liver, hepatic arterial branches accompany portal venous and biliary branches within portal pedicles. This arrangement follows the functional segmentation of the liver and allows individual hepatic territories to receive distinct arterial branches. The right hepatic artery supplies most of segments V through VIII, while the left hepatic artery supplies most of segments II through IV. Segment I frequently receives variable contributions from both sides.
Hepatic arterial anatomy is clinically important because substantial variation occurs in arterial origin and course. Replaced or accessory right hepatic arteries may arise from the superior mesenteric artery, while replaced or accessory left hepatic arteries may arise from the left gastric artery. Recognition of these patterns is essential during cholecystectomy, liver resection, transplantation, pancreatic and gastric surgery, and catheter-based hepatic interventions.
Last updated on September 30, 2026