Left Hepatic Artery

arteria hepatica sinistra

The left hepatic artery arises from the proper hepatic artery or the common hepatic artery and supplies the left hepatic lobe (segments II, III, and IV). In approximately 20-25% of individuals a replaced or accessory left hepatic artery arises from the left gastric artery and runs in the lesser omentum to reach the left lobe, creating a surgically important variant that affects both hepatic resection and gastrectomy planning.

Region: Abdomen

Clinical Relevance

Clinical Notes

The replaced or accessory left hepatic artery from the left gastric artery is the most clinically important hepatic arterial variant, encountered during upper GI surgery. In total gastrectomy, ligation of the left gastric artery sacrifices this replaced vessel, potentially devascularising the left hepatic lobe. In laparoscopic gastrectomy for cancer, the vessel is identified in the lesser omentum before left gastric artery division. In liver transplantation, the left hepatic artery is reconstructed at the back-table if it arises from the left gastric artery. In left hepatectomy, the left hepatic artery is ligated first to delineate the ischaemic left lobe.

Pathology

Common Injuries & Conditions

Replaced Left Hepatic Artery in Gastrectomy

An accessory or replaced left hepatic artery running in the gastrohepatic ligament from the left gastric artery must be identified and preserved or reconstructed before left gastric artery ligation during gastrectomy; inadvertent division causes left hepatic lobe ischaemia visible as intraoperative colour change of the left lobe.