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Description
Supraduodenal artery (SDA) supplies the proximal duodenum, which originates most commonly from gastroduodenal artery (GDA), followed by common and proper hepatic artery.1 2 Origination from left hepatic artery (LHA) is relatively rare and only few articles have addressed this anatomic variation.3 Recognition of such an aberrant artery and proper coiling before liver-directed therapy are essential to prevent non-target organ injury. Herein, we report two rare cases of SDA that originated from the LHA.
Case 1
A 56-year-old man had a massive type hepatocellular carcinoma (HCC) in right hepatic lobe with right portal vein tumour thrombosis (figure 1). He had one episode of massive upper gastrointestinal bleeding at 2nd hepatic arterial infusion chemotherapy (HAIC) and panendoscope revealed haemorrhagic duodenitis with duodenal bulb ulcer. In our hospital, a SDA that originated from the LHA was found at angiography, which was successfully embolised with a minicoil (figure 2) with the assistance of a ‘Swan-neck configuration’ microcatheter (Maestro, Merit) and proceeded with transarterial chemoembolization (TACE) and subsequent HAIC without identical complication.
Case 2
A 59-year-old man with recurrent HCCs in both hepatic lobes underwent 6th TACE followed by temporary HAIC. He had intractable epigastralgia after HAIC. Panendoscope revealed haemorrhagic duodenitis and shallow ulcers from gastric antrum to 1st portion of duodenum (figure 3). A SDA, that originated from the LHA, was identified (figure 4) and proven to supply the proximal duodenum by cone-beam CT (figure 5). It also acted as a parasitic vessel supplying the right lobe tumour. We successfully embolised the SDA with minicoils (figure 6) to prepare for next HAIC/TACE if clinically indicated.
Learning points
Recognition of supraduodenal artery (SDA) variation to avoid iatrogenic duodenitis and peptic ulcer in liver-directed therapy.
SDA may act as a parasitic vessel supplying the liver tumour.
Cone-Beam CT/Angio-CT can be very effective to confirm origin of SDA from left hepatic artery.
Footnotes
Contributors T-HO: main author. D-KW: main director. PM-CS: second director. M-FC: surgery assistant.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Next of kin consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.