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Levels of aspartate aminotransferase (AST), total bilirubin (T-bil), and platelet (PLT) counts in peripheral blood. (A) Level of AST was highest on postoperative day (POD) 1 (4500IU/L), and it then decreased gradually. On POD 14, thrombosis of the portal vein in the remnant liver occurred, and the level of AST again increased (479IU/L), after which the level of AST was stable, and there was no increase after the closure of the arterio-portal shunt (APS); (B) Level of T-bil was highest on POD 20 (15.9mg/dl), after which it decreased gradually, and did not increase after the closure of APS. (C) Platelet count in the peripheral blood was highest on POD 20 (12.2×104/μL), after which it decreased gradually because of portal hypertension and splenomegaly; it was less than 5.0×104/μL by POD 67. After closure of the APS on POD 73, the PLT count increased gradually and by POD 85 it was 8.5×104/μL.
Source publication
Portal vein arterialization (PVA) has been applied as a salvage procedure in hepatopancreatobiliary surgeries, including transplantation and liver resection, with revascularization for malignancies. Here we describe the use PVA as a salvage procedure following accidental injury of the hepatic artery to the remnant liver occurred during left hepatic...
Citations
... There is also a blood supply between the right and left hepatic arteries through the hilar plate plexus. Hilar plate plexus also provides blood supply of the collateral network around the common bile duct confluence and contributes to healing the hepaticojejunostomy anastomosis [64]. In cases where the artery revision is not successful, it should be tried to make the hepaticojejunostomy anastomosis close to the hilar plate, considering that the blood supply may be better [12]. ...
Abstract
BACKGROUND
The hepatic artery (HA) is one of the most threatened vascular structures during
hepatopancreatobiliary (HPB) surgeries and interventional procedures. It can be
affected by many clinical pictures, especially tumors, due to its anatomical
position and neighborhood.
AIM
To reveal the evolution and recent developments in the management of HA
traumas in the light of the literature.
METHODS
In this article, 100 years of MEDLINE (PubMed) literature and articles including
cases and series of HA injuries were reviewed, and the types of injury occurrence,
treatment, and related complications and their management were compiled.
RESULTS
The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies,
among the most common operations. HA anatomy shows anomalies in
approximately 15%-25% of the cases, further increasing this risk. The incidence of
HA injury is not precisely known. Approaches that have evolved in recent years
in managing patients with HA injury (laceration, transection, ligation, resection)
with severe morbidity and mortality risk are reviewed in light of the current
literature.
CONCLUSION
In conclusion, complications and deaths due to HA injury are less common today.
The risk of complications increases in patients with hemodynamic instability,
jaundice, cholangitis, and sepsis. Revealing the variations in the preoperative
radiological evaluation will reduce the risks. In cases where HA injury is detected,
arterial flow continuity should be tried to maintain with primary anastomosis,arterial transpositions, or grafts. In cases where bile duct injury develops, patients
should be directed to HPB surgery centers, considering the possibility of
accompanying HA injury. Large-scale and multicentric studies are needed to
understand better the early and long-term results of HA ligation and determine
preventive procedures.
... After duplicate records were excluded, 20 eligible clinical studies that reported the use of PVA in HPB surgery (not including liver transplantation) were identified. 13,14,[18][19][20][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] These studies, which were published between 1992 and 2016, were included in the systematic review ( Figure 1). The literature review did not identify any prospective studies or randomized controlled trials. ...
... Eleven of the included studies were case reports, and 9 were case series with a median sample size of 3.5 (range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Based on the quality-assessment tool of Murad and colleagues, 22 15 studies were of good quality, 13,14,18-20,23,25-30,33,34,36 4 were of intermediate quality, 31,32,35,37 and 1 was of low quality. 24 A total of 57 patients underwent HPB surgery and PVA. ...
... Hokuto et al., 35 ...
Background:
Portal vein arterialization (PVA) is a possible option when hepatic artery reconstruction is impossible during liver resection. The aim of this study was to review the literature on the clinical application of PVA in hepatopancreatobiliary (HPB) surgery.
Methods:
We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the PubMed, Embase and Web of Science databases until December 2019. Experimental (animal) studies, review articles and letters were excluded.
Results:
Twenty studies involving 57 patients were included. Cholangiocarcinoma was the most common indication for surgery (40 patients [74%]). An end-to-side anastomosis between a celiac trunk branch and the portal vein was the main PVA technique (35 patients [59%]). Portal hypertension was the most common longterm complication (12 patients [21%] after a mean of 4.1 mo). The median followup period was 12 (range 1-87) months. The 1-, 3- and 5-year survival rates were 64%, 27% and 20%, respectively.
Conclusion:
Portal vein arterialization can be considered as a rescue option to improve the outcome in patients with acute liver de-arterialization when arterial reconstruction is not possible. To prevent portal hypertension and liver injuries due to thrombosis or overarterialization, vessel calibre adjustment and timely closure of the anastomosis should be considered. Further prospective experimental and clinical studies are needed to investigate the potential of this procedure in patients whose liver is suddenly de-arterialized during HPB procedures.
