Portal vein arterialization using an accessory right hepatic artery in liver transplantation

Abstract Background Hepatic artery thrombosis can lead to graft loss associated with severe hepatic infarction or bile duct ischemia. When anatomical hepatic artery reconstruction is impossible in liver transplantation or hepato-pancreatic biliary surgery, portal vein arterialization (PVA) is proposed as a salvage technique. Herein, we report our experience with a case that showed favorable clinical outcomes after partial PVA during living-donor liver transplantation (LDLT) because of difficulties in arterial reconstruction. Case presentation A 62-year-old woman with non-B, non-C liver cirrhosis complicated with hepatocellular carcinoma was being prepared for LDLT using an extended left lobe graft. The graft presented with two arteries (left hepatic artery, 2 mm; middle hepatic artery, 2 mm). The first anastomosis was performed using the recipient hepatic artery stumps, but no flow was detected on Doppler control because of thrombus formation. The next attempt was executed using the middle colic artery with a radial artery jump graft and the right gastroepiploic artery, but it led to the same result. Thus, the graft oxygen support by the standard arterial procurement was abandoned, and a shunt was created between the ileocecal artery and the vein to obtain PVA. Arteriography of the superior mesenteric artery showed that the shunt was relatively patent, and the portal vein was apparent. No biliary complication or liver abscess occurred postoperatively, and the patient presented with good liver function and no complications related to portal vein hypertension, nor liver fibrosis 18 months after the LDLT. Conclusion Partial PVA with a shunt created between the ileocecal artery and the vein is useful when arterial reconstruction is difficult during LDLT for preventing graft loss caused by severe hepatic infarction or bile duct ischemia.

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Replaced Right Hepatic Artery Originated from the Proximal Segment of the Common Hepatic Artery and Crossing behind the Portal Vein: A Dangerous Anomaly in Hepatic Resection and Liver Transplantation

The American Surgeon ◽

10.1177/000313481207801202 ◽

2012 ◽

Vol 78 (12) ◽

pp. 501-503 ◽

Cited By ~ 1

Author(s):

Marcio F. Chedid ◽

Luiz Henrique B. Capaverde ◽

Guilherme G. Pretto ◽

Douglas F. L. Nemos ◽

Vilson F. Oliveira ◽

...

Keyword(s):

Liver Transplantation ◽

Portal Vein ◽

Hepatic Resection ◽

Hepatic Artery ◽

Common Hepatic Artery ◽

Proximal Segment ◽

Right Hepatic Artery ◽

Replaced Right Hepatic Artery ◽

The Common

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Portal Vein Thrombosis Associated With Right Hepatic Artery Injury During Cholecystectomy: An Uncommon Indication for Urgent Liver Transplantation

Cirugía Española (English Edition) ◽

10.1016/j.cireng.2014.01.040 ◽

2015 ◽

Vol 93 (1) ◽

pp. 45-46

Author(s):

Joana Ferrer-Fábrega ◽

Marta Barrufet ◽

Verónica Prado ◽

Jose Fuster ◽

Juan Carlos García-Valdecasas

Keyword(s):

Liver Transplantation ◽

Portal Vein ◽

Hepatic Artery ◽

Portal Vein Thrombosis ◽

Vein Thrombosis ◽

Right Hepatic Artery ◽

Artery Injury ◽

Hepatic Artery Injury

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Portal vein arterialization for iatrogenic embolization of the hepatic artery. An old but still useful technique?

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2020.04.022 ◽

2020 ◽

Vol 71 ◽

pp. 91-94

Author(s):

Tim Reese ◽

York von Rittberg ◽

Karl J. Oldhafer

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Portal Vein Arterialization

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Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft

Liver Transplantation ◽

10.1002/lt.20794 ◽

2006 ◽

Vol 12 (11) ◽

pp. 1607-1614 ◽

Cited By ~ 40

Author(s):

Carlos Moreno ◽

Antoni Sabaté ◽

Joan Figueras ◽

Imma Camprubí ◽

Antonia Dalmau ◽

...

Keyword(s):

Liver Transplantation ◽

Portal Vein ◽

Hepatic Artery ◽

Orthotopic Liver Transplantation ◽

Hemodynamic Profile

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Multidisciplinary treatment of left hepatic artery pseudoaneurysm after hepatobiliary resection for gallbladder cancer: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0757-8 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Ryusei Yamamoto ◽

Teiichi Sugiura ◽

Yukiyasu Okamura ◽

Takaaki Ito ◽

Yusuke Yamamoto ◽

...

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Liver Failure ◽

Hepatic Artery ◽

Remnant Liver ◽

Left Hepatic Artery ◽

Artery Pseudoaneurysm ◽

Hepatobiliary Resection ◽

Portal Vein Arterialization ◽

Arterial Inflow

Abstract Background When a postoperative hepatic artery pseudoaneurysm develops after massive hepatectomy, both an intervention for the pseudoaneurysm and patency of hepatic artery should be considered because occlusion of the residual hepatic artery results in critical liver failure. However, the treatment strategy for a pseudoaneurysm of the hepatic artery after hepatobiliary resection is not well established. Case presentation A 65-year-old woman underwent right hepatectomy, extrahepatic duct resection, and portal vein resection, for gallbladder cancer. Although the patient had an uneventful postoperative course, computed tomography on postoperative day 6 showed a 6-mm pseudoaneurysm of the hepatic artery. Angiography revealed the pseudoaneurysm located on the bifurcation of the left hepatic artery to the segment 2 artery plus the segment 3 artery and 4 artery. Stent placement in the left hepatic artery was not feasible because the artery was too narrow, and coiling of the pseudoaneurysm was associated with a risk of occluding the left hepatic artery and inducing critical liver failure. Therefore, portal vein arterialization constructed by anastomosing the ileocecal artery and vein was performed prior to embolization of the pseudoaneurysm to maintain the oxygen level of the remnant liver, even if the left hepatic artery was accidentally occluded. The pseudoaneurysm was selectively embolized without occlusion of the left hepatic artery, and the postoperative laboratory data were within normal limits. Although uncontrollable ascites due to portal hypertension occurred, embolization of the ileocolic shunt rapidly resolved it. The patient was discharged on postoperative day 45. Conclusion Portal vein arterialization prior to embolization of the aneurysm may be a feasible therapeutic strategy for a pseudoaneurysm that develops after hepatectomy for hepatobiliary malignancy to guarantee arterial inflow to the remnant liver. Early embolization of arterioportal shunting after confirmation of arterial inflow to the liver should be performed to prevent morbidity induced by portal hypertension.

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