Occlusion of Proximal Common Hepatic Artery: A New Etiology for Chronic Intestinal Ischemia

Abstract

Chronic intestinal ischemia is a relatively uncommon vascular entity as compared with all other forms of symptomatic arterial occlusive disease. Severe stenosis or occlusion of one or more of three major vessels supplying the intestine may result in chronic visceral ischemia. However, review of the literature failed to document common hepatic artery occlusion as a cause of chronic intestinal ischemia. A case of a seventy-two-year-old man with a six-month history of postprandial abdominal pain is presented. A selective angiogram was taken, which revealed occlusion of the proximal common hepatic artery with collaterals from the superior mesenteric artery (SMA) reconstituting the hepatic arterial system while resulting in a low-flow state through the SMA. A supraceliac aorto-hepatic artery bypass was performed, using an 8 mm polytetrafluoroethylene graft. Color flow ultrasonography of the aorta, performed prior to discharge, revealed a patent graft. At one year follow-up, the patient is asymptomatic with good flow through the graft as documented by an arteriogram. The authors report the first documented case of common hepatic artery occlusion as a cause of chronic intestinal ischemia.