Hepatic Artery Thrombosis

 Results in bile duct ischemia, hepatic parenchymal infarction

– Bile ducts depend on arterial flow and therefore suffer ischemic injury

Clinical Issues

• Relatively well tolerated in native livers
image Anastomosing blood supply with good collateralization protects against ischemic injury

• Transplanted livers much more susceptible, especially early post transplant

• Symptoms related to acuity and ensuing complications

• Cholestatic liver function abnormalities are common


• Zone 3 hemorrhage and hepatocyte dropout in early posttransplant period
• Ischemic bile duct injury

image Denuded, necrotic bile duct epithelium sloughs into lumen, forming eosinophilic bile casts

image Bile leakage into periductal connective tissue

image In time, chronic ischemia can lead to biliary strictures, fibrosis, and duct loss

• Hepatic infarction
image Necrosis of hepatocytes and portal connective tissue

Diagnostic Checklist

• Needle biopsy may not be representative, as ischemic features may be patchy

Hepatic Infarction
This section demonstrates a well-delineated area of hepatic parenchymal infarction image following hepatic artery thrombosis.

Abscess Due to Bile Duct Necrosis and Leak
An explanted allograft liver demonstrates an area of bile duct necrosis and a bile leak image in a patient who developed hepatic artery thrombosis after transplantation.

Bile Duct Necrosis and Leak
This large bile duct has suffered ischemic necrosis image and leakage of bile image. The bile duct ischemia occurred secondary to hepatic artery thrombosis.

Zone 3 Hemorrhage and Hepatocyte Dropout
Cases of hepatic artery thrombosis may feature nonspecific zone 3 hemorrhage, inflammation, and hepatocyte dropout, particularly early in the posttransplant course. These changes can mimic reperfusion injury.



• Hepatic artery thrombosis (HAT)


• Thrombotic occlusion of hepatic artery &/or its branches


Causes of Thrombosis

• Atherosclerosis
• Hypercoagulable state

• Anastomotic complication after liver transplantation

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hepatic Artery Thrombosis

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