Liver & intrahepatic bile ducts
Vascular disorders
Arterial disorders


Topic Completed: 19 February 2021

Minor changes: 25 February 2021

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PubMed Search: Arterial disorders[mh] liver[TI]


Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez RS. Arterial disorders. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/liverarteritis.html. Accessed May 7th, 2021.
Definition / general
  • Pathologic insult to the hepatic artery or its intrahepatic branches
  • Rare and often difficult to diagnose clinically
Essential features
  • Most forms of arterial insult may impact the hepatic artery
  • Depending on type of injury, patients may experience no symptoms, as portal vein compensatorily supplies more blood flow to liver
  • Hepatic artery thrombosis is rare outside of the transplant setting
Etiology
  • Many and varied
  • Vasculitides that can affect the hepatic artery include polyarteritis nodosa, giant cell arteritis, Takayasu arteritis and granulomatosis with polyangiitis
Clinical features
  • Patients with hepatic artery occlusion (due to thrombosis, neoplasia, vasculitis or trauma) present with severe abdominal pain, high transaminases, variable circulatory shock
  • Arterial occlusion may cause infarction, although retrograde arterial flow through accessory vessels and portal supply may sustain liver parenchyma
  • Some forms of hepatic arterial damage (atherosclerosis, cryoglobulinemia, amyloidosis) may occur without any clinical manifestations
Microscopic (histologic) description
  • Ischemia causes centrilobular (zone 3) or localized (infarct type) coagulative necrosis
  • Surviving parenchyma may show acidophil bodies or ballooning degeneration
  • Compromise of arterial flow (e.g. hepatic artery thrombosis) can also lead to ischemic cholangiopathy, with necrosis of large bile ducts
  • Diabetic patients may develop hyaline arteriolosclerosis (Am J Surg Pathol 2015;39:1000)
  • Takayasu arteritis may be associated with hepatic sinusoidal dilatation (Ann Hepatol 2011;10:559)
  • Transplanted livers may experience arterial flow abnormalities, causing increased mitoses, apoptosis and increased Ki67 index (Mod Pathol 2012;25:1594)
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Granulomatosis with polyangiitis

Hepatic artery dissection

Hyaline arteriolosclerosis

Sample pathology report
  • Liver, allograft, orthotopic transplantation:
    • Liver with hepatic artery thrombosis, diffuse zonal necrosis and focal ischemic cholangiopathy
    • Margins of resection unremarkable.
Board review style question #1
Which of the following is most likely to cause necrosis of large intrahepatic bile ducts?

  1. Budd-Chiari syndrome
  2. Hepatic artery thrombosis
  3. Portal vein thrombosis
  4. Primary sclerosing cholangitis
  5. Viral hemorrhagic fever
Board review style answer #1
B. Hepatic artery thrombosis

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Reference: Liver - arterial disorders
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