The gastroduodenal artery (GDA) is a terminal branch of the common hepatic artery that mainly supplies the pylorus of the stomach, proximal duodenum, and the head of the pancreas. Due to its proximity to the posterior wall of the first part of the duodenum, the gastroduodenal artery is one of the most important sources of upper gastrointestinal bleeding - mostly secondary to peptic ulcer disease or erosive malignant ulcers.
Gross anatomy
The gastroduodenal artery arises as one of two terminal branches of the common hepatic artery. The gastroduodenal artery passes inferiorly towards the pylorus, duodenum and head of the pancreas whereas the other terminal branch, the proper hepatic artery, passes superiorly towards the liver.
In the majority of cases, the origin of the gastroduodenal artery is to the left of common bile duct and drifts further away from duct as it descends behind the first part of the duodenum, lying 3 to 5 mm from the common bile duct 4,5. However, this relationship is variable (see below) and of surgical importance.
It passes inferiorly behind the first part of the duodenum to the left of the common bile duct, where it gives off the supraduodenal artery. Inferiorly, the gastroduodenal artery relates to the head of the pancreas 4. More inferiorly, it bifurcates into two arteries at the upper border of the pancreas:
-
runs forward between the pancreas and first part of the duodenum, and passes left into the greater omentum at the head of the pancreas, and runs along the greater curvature of the stomach to anastomose with the left gastroepiploic artery (from the splenic artery)
-
superior pancreaticoduodenal artery
divides into anterior and posterior branches which encircle the pancreatic head and anastomoses with similar branches of the inferior pancreaticoduodenal artery from the superior mesenteric artery
Variant anatomy
The relationship of the gastroduodenal artery to the first part of the duodenum and common bile duct is variable, and has been divided into four types 4,5:
-
type 1 (63%): normal anatomy
origin is to the left of the common bile duct
drifts further leftwards (away from duct) as it descends behind the first part of the duodenum (D1)
-
type 2 (20%)
origin is to the left of the common bile duct
drifts progressively closer to the bile duct without crossing it as it descends behind the first part of the duodenum (D1)
-
type 3 (14%)
origin is to the left of the common bile duct
crosses the common bile duct anteriorly to lie on its right side behind the first part of the duodenum (D1)
-
type 4 (3%)
origin is to the right of the common bile duct
remains to the right of common bile duct as it descends behind the first part of the duodenum (D1)
Additional variants include:
a large number of alternative origins of the GDA have been described (e.g. right and left hepatic arteries, aorta, celiac trunk, superior mesenteric artery) 5
transverse pancreatic artery may arise from the GDA rather than the splenic artery
cystic artery (single or double) may arise from the GDA