title: Communicating arcade between the right and left hepatic arteries: evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery.
abstract: OBJECTIVE
  To evaluate prospectively the relationship between the arterial collateral system at the hepatic hilum and the blood supply to the hilar bile duct by using computed tomography (CT) and angiography during temporary balloon occlusion of the right or left hepatic artery.
  
  
  METHODS
  Institutional review board approval and informed consent were obtained. The study included 13 patients with no lesions at the hepatic hilum (eight men and five women; age range, 41-78 years; mean, 65.8 years). After serial angiographic studies were performed for preoperative evaluation or transcatheter arterial chemoembolization, a 5.5-F catheter with an occlusion balloon was positioned in the right or left hepatic artery. Eleven patients underwent angiography of the left hepatic artery with temporary occlusion of the right hepatic artery, and two patients underwent angiography of the right hepatic artery with temporary occlusion of the left hepatic artery. In addition, 11 patients underwent single-level dynamic CT during hepatic arteriography (CTHA) with temporary occlusion of the right or left hepatic artery. The images from angiography and CTHA were interpreted by two authors who assessed the existence of the arterial communication and its branching points, location, and relationship to the hilar bile duct and caudate lobe.
  
  
  RESULTS
  During temporary occlusion of the right or left hepatic artery, the communicating arcade (CA) between the right and left hepatic arteries was immediately evident in all patients. On the left side, the CA originated from the segment IV artery in eight patients (62%) and from the left hepatic artery in five (38%). On the right side, the CA originated from the right anterior hepatic artery in six patients (46%), the right hepatic artery in two (15%), and both arteries in five (38%). The CA was extrahepatically located close to the hilar bile duct and forked into a few branches to the caudate lobe.
  
  
  CONCLUSIONS
  The CA may play an important role not only in the interlobar arterial collateral system but also in the blood supplies to the caudate lobe and hilar bile duct.
authors.affiliation: Department of Academic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan. takatohma@yahoo.co.jp
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tohma
authors.forename: Akihiro
authors.initials: A
authors.lastname: Cho
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okazumi
authors.forename: Harufumi
authors.initials: H
authors.lastname: Makino
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Shuto
authors.forename: Ryoyu
authors.initials: R
authors.lastname: Mochiduki
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Matsubara
authors.forename: Hisashi
authors.initials: H
authors.lastname: Gunji
authors.forename: Takenori
authors.initials: T
authors.lastname: Ochiai
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D021721:Balloon Occlusion; D001653:Bile Ducts, Intrahepatic / Q000098:blood supply; D016461:Chemoembolization, Therapeutic; D003097:Collateral Circulation; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008099:Liver / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed