PMC6319521_01
a Celiac axis angiogram demonstrating right and left hepatic arteries (arrows) arising from a proper hepatic artery (PHA) with no branching GDA. No blood flow is seen towards site of bleeding as identified by endoscopic clips (arrowhead). b PHA angiographic subselection demonstrating right and left hepatic arteries (white arrows), with LHA distribution opacified (arrowheads)
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Fig1
However, upon catheterization of the celiac axis and subselection of the presumed CHA, angiography demonstrated no native GDA (Fig. 1a). Proper right and left hepatic arteries were identified (Fig. 1b).
SMA angiogram demonstrating a replaced GDA (rGDA), which then continued towards the liver (arrow)
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Fig2
Superior mesenteric artery (SMA) angiogram demonstrated opacification of a replaced GDA (Fig. 2), which then supplied a large portion of the left lobe of the liver, with no opacification of the right hepatic artery (Fig. 3a). The replaced GDA was successfully coil embolized, with post-coil embolization angiography demonstrating occlusion of the replaced GDA and patency of the gastroepiploic artery, which also arose from the GDA (seen in Fig. 2).
a GDA angiographic subselection demonstrating blood supply to the left lobe of the liver (dotted area), with no opacification of the RHA. b Active extravasation of contrast into the duodenal lumen in the region of the endoscopic clips was seen (arrowheads). There is decreased distal flow after initial coil placement (arrow). Additional coils were subsequently deployed
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Fig3
Active extravasation of contrast into the duodenal lumen in the region of the endoscopic clips was seen (Fig. 3b).