A New Method to Measure Portal Venous and Hepatic Arterial Blood Flow Patients Intraoperatively

The intraoperative measurement of the afferent circulation of the liver, namely the hepatic artery flow and portal venous flow was carried out upon 14 anesthetized patients having carcinoma in the splanchnic area, mainly in the head of the pancreas by means of transit time ultrasonic volume flowmeter. The hepatic artery flow, portal venous flow and total hepatic flow were 0.377±0.10; 0.614±0.21; 0.992±0.276 l/min respectively.The ratio of hepatic arterical flow to portal venous flow was 0.66±0.259 There was a sharp, significant increase in hepatic arterial flow (29.8±6.1%, p<0,01) after the temporary occlusion of the portal vein, while the temporary occlusion of hepatic artery did not have any significant effect on portal venous circulation. The interaction between hepatic arterial flow and portal venous flow is a much disputed question, but according to the presented data here, it is unquestionable, that the decrease of portal venous flow immediately results a significant increase in hepatic artery circulation.

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Hepatic blood flow distribution: consideration of gravity, liver surface, and norepinephrine on regional heterogeneity

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y93-018 ◽

1993 ◽

Vol 71 (2) ◽

pp. 128-135 ◽

Cited By ~ 21

Author(s):

W. Wayne Lautt ◽

Joshua Schafer ◽

Dallas J. Legare

Keyword(s):

Blood Flow ◽

Portal Vein ◽

Hepatic Artery ◽

Arterial Occlusion ◽

Flow Distribution ◽

Arterial Flow ◽

Blood Flow Distribution ◽

Hepatic Arterial Flow ◽

Venous Flow ◽

Core Samples

Blood flow distribution within the livers of cats and dogs was assessed using 15-μm microspheres injected into the hepatic artery and portal vein. Representative vertical core samples (n = 11–18) were taken from the thickest part of each liver. Heterogeneity was assessed in several ways. The difference in total flow to different lobes was greater in dogs than in cats, and in dogs, those lobes with highest portal venous flow had lowest hepatic arterial flow. Overall flow variance was very high in both species, with adjacent surface samples in a single lobe showing variance of 15–22% for both vessels. The ratio of highest to lowest flow within core samples averaged 2.1–3.4 for both vessels in both species. The hepatic arterial flow was highest to the surface 2 mm of the liver. Portal flow most often (31% of all samples) showed a pattern of highest flow to the top, graduating down to lowest flow to the bottom (dorsal side) of the vertical cores. However, this pattern appeared much more frequently in the most ventral liver lobes and very seldom in the lobes lying beneath the liver mass. Norepinephrine reduced heterogeneity. Hepatic arterial occlusion for 10 min produced minor and inconsistent reduction of heterogeneity. Rotating cats from back to front and again to back disrupted patterns of distribution but not in a way that could be interpreted as due to effects of gravity. Flow patterns changed with time. The heterogeneity of perfusion appears to be under dynamic and multiple interacting forces.Key words: blood flow distribution, blood flow heterogeneity, hepatic artery, portal vein, liver.

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Factors influencing control of arterial circulation in the liver of the dog

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1963.205.6.1260 ◽

1963 ◽

Vol 205 (6) ◽

pp. 1260-1264 ◽

Cited By ~ 40

Author(s):

Roy Cohn ◽

Samuel Kountz

Keyword(s):

Blood Flow ◽

Hepatic Artery ◽

Artery Blood Flow ◽

Portal Venous Flow ◽

Hepatic Arterial Flow ◽

Experimental Conditions ◽

Venous Flow ◽

Arterial Circulation ◽

Factors Influencing ◽

Intrinsic Regulation

Measurements were made of the hepatic arterial flow in thirty-one mongrel dogs by the use of the electromagnetic square wave flowmeter under the following experimental conditions: hepatic arterial neurectomy, portal venous flow reductions, portal venous flow elimination and diversion, and systemic acidosis and alkalosis. The findings suggest that the periarterial nerves about the hepatic artery influence the intrinsic regulation of hepatic artery blood flow only in the presence of severely reduced portal venous flow.

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The Relationship between Portal Venous and Hepatic Arterial Blood Flow. I. Experimental Liver Transplantation

HPB Surgery ◽

10.1155/1996/90536 ◽

1996 ◽

Vol 10 (1) ◽

pp. 21-26 ◽

Cited By ~ 18

Author(s):

F. Jakab ◽

I. Sugár ◽

Z. Ráth ◽

P. Nágy ◽

J. Faller

Keyword(s):

Liver Transplantation ◽

Portal Vein ◽

Hepatic Artery ◽

Portal Pressure ◽

Arterial Blood Flow ◽

Portal Flow ◽

Continuous Increase ◽

Arterial Blood ◽

Artery Flow ◽

The Relationship

The relationship between the changes in portal venous and hepatic arterial blood flows, in the liver is a much disputed question, it has tremendous significance in the practice of transplantation, and an explanation has been available since 1981, when Lautt published the so-caled “adenosine washout theory”. According to our earlier observations the decrease of portal pressure or flow consistently led to an increase in hepatic artery flow. At the same time changes in hepatic artery flow or pressure seemed to produce only inconsistent effects on the portal circulation. In the present experiments liver transplantation (OLTX) was carried out on mongrel dogs by Starzl's method. Electromagnetic flow probes were placed on the hepatic artery and the portal vein before removal of recipient’s liver, and after completion of all vascular anastomoses to the newly inserted liver, during the recirculatory phase of OLTX. The flow probes were connected to a Hellige electromagnetic flowmeter, portal venous and systemic arterial pressures were also recorded.The control HAF was 241±23 ml/min, the average PVF was 517±47 ml/min before removal of the recipients's liver. In the recirculatory phase the HAF increased, by 71±12% (p < 0.001). The PVF decreased in most animals after OLTX. The decrease was in average –40.2±3.5% (p < 0.001). The THBF calculated by adding the HAF and PVF showed a small, but not significant decrease during recirculation.The systemic arterial pressure decreased slightly and portal vein pressure rose in most animals after OLTX. There was a substantial increase in portal inflow resistance and prehepatic arteriolar resistance and a decrease in hepatic artery resistance. The decrease of PVF after OLTX can be explained by progressive fluid accumulation in the liver parenchyma and increased sinusoidal and portal inflow resistance. The prolonged and continuous increase in hepatic artery flow during the recirculatory phase of OLTX may be due to the decrease of portal flow. The exact mechanism, by which a change in portal flow leads to arteriolar dilatation, can be most probably explained by the “adenosine washout theory” of Lautt.

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A rare anastomosis between the root of common hepatic artery and proper hepatic artery: implications for pancreaticoduodenectomy

Surgical Case Reports ◽

10.1186/s40792-019-0746-y ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 1

Author(s):

Takeshi Morinaga ◽

Katsunori Imai ◽

Keisuke Morita ◽

Kenichiro Yamamoto ◽

Satoshi Ikeshima ◽

...

Keyword(s):

Pancreatic Cancer ◽

Hepatic Artery ◽

Pancreatic Head ◽

Common Hepatic Artery ◽

Arterial Flow ◽

Anastomotic Site ◽

Proper Hepatic Artery ◽

Arterial Reconstruction ◽

Hepatic Arterial Flow ◽

The Common

Abstract Background Hepatic artery anomalies are often observed, and the variations are wide-ranging. We herein report a case of pancreatic cancer involving the common hepatic artery (CHA) that was successfully treated with pancreaticoduodenectomy (PD) without arterial reconstruction, thanks to anastomosis between the root of CHA and proper hepatic artery (PHA), which is a very rare anastomotic site. Case presentation A 78-year-old woman was referred to our department for the examination of a tumor in the pancreatic head. Contrast-enhanced computed tomography (CT) revealed a low-density tumor of 40 mm in diameter located in the pancreatic head. The involvement of the common hepatic artery (CHA), the root of the gastroduodenal artery (GDA), and portal vein was noted. Although such cases would usually require PD with arterial reconstruction of the CHA, it was thought that the hepatic arterial flow would be preserved by the anastomotic site between the root of the CHA and the PHA, even if the CHA was dissected without arterial reconstruction. PD with dissection of the CHA and PHA was safely completed without arterial reconstruction, and sufficient hepatic arterial flow was preserved through the anastomotic site between the CHA and PHA. Conclusion We presented an extremely rare case of an anastomosis between the CHA and PHA in a patient with pancreatic cancer involving the CHA. Thanks to this anastomosis, surgical resection was successfully performed with sufficient hepatic arterial flow without arterial reconstruction.

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Combined resection of the hepatic artery without reconstruction in pancreaticoduodenectomy: a case report of pancreatic cancer with an aberrant hepatic artery

Surgical Case Reports ◽

10.1186/s40792-020-00997-5 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Tadao Kuribara ◽

Tatsuo Ichikawa ◽

Kiyoshi Osa ◽

Takeshi Inoue ◽

Satoshi Ono ◽

...

Keyword(s):

Pancreatic Cancer ◽

Hepatic Artery ◽

Locally Advanced ◽

Pancreatic Head ◽

Arterial Embolization ◽

Arterial Blood Flow ◽

Temporary Increase ◽

Combined Resection ◽

Arterial Blood ◽

Arterial Resection

Abstract Background Pancreaticoduodenectomy (PD) is rarely performed for pancreatic cancer with hepatic arterial invasion owing to its poor prognosis and high surgical risks. Although there has been a recent increase in the reports of PD combined with hepatic arterial resection due to improvements in disease prognosis and operative safety, PD with major arterial resection and reconstruction is still considered a challenging treatment. Case presentation A 61-year-old man with back pain was diagnosed with pancreatic head and body cancer. Although distant metastasis was not confirmed, the tumor had extensively invaded the hepatic artery; therefore, we diagnosed the patient with locally advanced unresectable pancreatic cancer. After gemcitabine plus nab-paclitaxel (GnP) therapy, the tumor considerably decreased in size from 35 to 20 mm. Magnetic resonance imaging revealed a gap between the tumor and the hepatic artery. Tumor marker levels returned to their normal range, and we decided to perform conversion surgery. In this case, an artery of liver segment 2 (A2) had branched from the left gastric artery; therefore, we decided to preserve A2 and perform PD combined with hepatic arterial resection without reconstruction. After four cycles of GnP therapy, we performed hepatic arterial embolization to prevent postoperative ischemic complications prior to surgery. Immediately after embolization, collateral arterial blood flow to the liver was observed. Operation was performed 19 days after embolization. Although there was a temporary increase in liver enzyme levels and an ischemic region was found near the surface of segment 8 of the liver after surgery, no liver abscess developed. The postoperative course was uneventful, and S-1 was administered for a year as adjuvant chemotherapy. The patient is currently alive without any ischemic liver events and cholangitis and has not experienced recurrence in the past 4 years since the surgery. Conclusions In PD for pancreatic cancer with hepatic arterial invasion, if a part of the hepatic artery is aberrant and can be preserved, combined resection of the common and proper hepatic artery without reconstruction might be feasible for both curability and safety.

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Changes in Hepatic Hemodynamics due to Primary Liver Tumours

HPB Surgery ◽

10.1155/1996/62057 ◽

1996 ◽

Vol 9 (4) ◽

pp. 245-248 ◽

Cited By ~ 9

Author(s):

F. Jakab ◽

Z. Ráth ◽

F. Schmal ◽

P. Nagy ◽

J. Faller

Keyword(s):

Hepatocellular Carcinoma ◽

Blood Flow ◽

Hepatic Artery ◽

Hepatic Blood Flow ◽

Primary Hepatocellular Carcinoma ◽

Portal Venous Flow ◽

Venous Flow ◽

Control Value ◽

Early Results ◽

Total Hepatic Blood Flow

Data regarding the afferent circulation of the liver in patients with primary hepatocellular carcinoma are controversial, we have carried out measurement of hepatic arterial and portal venous flow intraoperatively by transit time ultrasonic volume flowmetry. In patients with primary hepatocellular carcinoma the hepatic artery flow increased to 0.55±0.211 compared with the control value of 0.37±0.102 1/min. (p<0.01). The portal venous flow decreased from 0.61±0.212 l/min, to 0.47±l/min. p<0.01). Due to the opposite changes in the afferent circulation the total hepatic blood flow did not change significantly, compared with controls.The ratio of hepatic arterial flow to portal vein flow increased to 1.239±0.246 in patients with hepatocellular carcinoma, which is double of the control value (0.66±0.259 l/min). After resection this ratio did not change.The resection did not alter hepatic artery or portal venous flow significantly, although the total hepatic blood flow decreased significantly (p<0.01).On the basis of our early results it is possible that the ratio of the two circulations may be to deel measured with doppler ultrasound and provide diagnostic information.

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Systemic and hepatic hemodynamic changes in acute liver injury

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1997.272.3.g617 ◽

1997 ◽

Vol 272 (3) ◽

pp. G617-G625 ◽

Cited By ~ 5

Author(s):

A. J. Makin ◽

R. D. Hughes ◽

R. Williams

Keyword(s):

Blood Flow ◽

Liver Injury ◽

Hepatic Injury ◽

Acute Liver Injury ◽

Venous Blood ◽

Marked Change ◽

Arterial Blood Flow ◽

Venous Flow ◽

Subsequent Increase ◽

Arterial Blood

Systemic and hepatic circulatory changes were studied in rats over the course of acute liver injury. Hepatic injury was induced by intraperitoneal injection of D-galactosamine (1.1 g/kg), and systemic and hepatic hemodynamics were measured over a 72-h period using a radioactive microsphere technique with direct measurement of arterial, portal venous, and hepatic venous blood oxygen content. Cardiac output increased to a maximum at 48 h, producing a marked increase (450%) in hepatic arterial blood flow so that it became the dominant supply of oxygen at the time of maximal hepatic injury. A subsequent increase in portal venous flow resulted in an overall increase in total hepatic blood flow of 500%. At this point the oxygen delivery by the hepatic arterial and portal venous systems was equal. These circulatory changes returned to control values by 72 h with recovery of liver function. These results demonstrate the development of a hyperdynamic circulation and a marked change in the normal relationship between portal venous and hepatic arterial blood flows that occur during hepatic injury.

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Cessation of arterial and venous flow at a finite driving pressure in porcine coronary circulation

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1984.246.4.h525 ◽

1984 ◽

Vol 246 (4) ◽

pp. H525-H531 ◽

Cited By ~ 1

Author(s):

R. F. Bellamy ◽

J. D. O'Benar

Keyword(s):

Coronary Artery ◽

Arterial Pressure ◽

Coronary Sinus ◽

Time Course ◽

Coronary Circulation ◽

Venous Pressure ◽

Pressure Change ◽

Arterial Flow ◽

Venous Flow ◽

Artery Flow

We investigated the hypothesis that coronary capacitance is responsible for epicardial coronary artery flow stopping at arterial pressures greater than the coronary venous pressure. Using an in situ blood-perfused swine heart preparation, we compared the arterial pressures at which coronary artery inflow and coronary sinus outflow ceased. A pressure change was used that had the time course of aortic pressure during diastole. Data were obtained in hypocalcemic-arrested, adenosine-vasodilated preparations before and after pharmacologic interventions simulating the coronary circulation of the intact beating heart. The effect of extravascular compression was studied with barium contracture, while acetylcholine was infused to increase coronary vasomotor tone. The arterial pressure when arterial flow ceased was 13 +/- 5 mmHg in the arrested-vasodilated preparations, 37 +/- 10 mmHg after acetylcholine, and from 18 to 150 mmHg during barium contracture. Coronary sinus outflow ceased when arterial pressure was slightly less than the arterial pressure at which arterial flow had stopped. The differences between the arterial and venous zero flow arterial pressures were as follows: arrested-vasodilated 4 +/- 3 mmHg, acetylcholine 9 +/- 4, and barium contracture 0 +/- 3. The arteriovenous pressure gradients across the coronary bed at the instant venous flow ceased were as follows: arrested-vasodilated 5 +/- 6 mmHg, acetylcholine 23 +/- 6, and from 12 to 128 during barium contracture. These data do not support the suggestion that cessation of epicardial artery flow is solely a capacitance phenomenon.

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Determination of the Arterial Flow Fraction in Normal and Diseased Livers Using Constrained Deconvolution

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/pime_proc_1992_206_272_02 ◽

1992 ◽

Vol 206 (2) ◽

pp. 93-98 ◽

Cited By ~ 2

Author(s):

D C Barber ◽

W B Tindale

Keyword(s):

Hepatic Artery ◽

Arterial Flow ◽

Simulation Studies ◽

Tracer Concentration ◽

Hepatic Arterial Flow ◽

Model Driven ◽

Clinical Series ◽

True Measure

There is some evidence that the ratio of the blood flow to the liver through the hepatic artery to the total flow to the liver through the hepatic artery and portal vein (the hepatic arterial flow fraction, AFF) is altered in the presence of cirrhosis. Several methods have been published that seek to provide an index of this ratio. These indices are dependent on factors other than the AFF and cannot provide a true measure of it. The impulse retention function of the liver has two components and these may be derived using a model-driven deconvolution of the arterial tracer concentration curve and the curve of tracer concentration in the liver. The AFF may then be obtained from the relative heights of these two components. Simulation studies show that the AFF calculated using this method is reasonably accurate and a small clinical series shows that it is capable of appropriate clinical classification of patients into cirrhotic and non-cirrhotic groups.

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