Liver and intrahepatic bile ducts - nontumor
Vascular disorders
Arterial disorders

Author: Raul S. Gonzalez, M.D. (see Authors page)

Revised: 11 December 2017, last major update November 2017

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

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

Cite this page: Gonzalez, R.S. Arterial disorders. PathologyOutlines.com website. http://pathologyoutlines.com/topic/liverarteritis.html. Accessed December 14th, 2017.
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

Images hosted on PathOut server:

Images contributed by Dr. Raul S. Gonzalez:

Granulomatosis with polyangiitis

Hepatic artery dissection

Hyaline arteriolosclerosis

Board review 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 answer #1
B. Hepatic artery thrombosis