In Reply to: Case 0498_01 -- Unexplained lethal vasculitis posted by Editor on March 31, 1998 at 14:47:30:
Case 1: Commentary
This case raises an interesting question about the likelihood of hepatic infarction as a result of hepatic artery occlusion in the presence of a patent portal vein. Since the majority of the blood supply to the normal liver is derived from the portal vein, it is generally assumed that hepatic artery embolization in patients with a patent portal vein is safe and that the risk of hepatic infarction and consequent liver failure or abscess formation is low. However, hepatic artery embolization is not always a benign intervention when the portal vein is patent.
We have a growing experience with hepatic artery embolizatiion for acute GI bleeding in patients who have undergone a Whipple procedure and develop bleeding at the stump of the GDA which requies embolization of the common hepatic artery. In this setting we have seen one of four patients develop an infarct and liver abscesses despite a patent portal vein.