Greater Saphenous Vein Graft Revascularization of the Left Hepatic Artery after Resection of Intrahepatic Cholangiocarcinoma with Common Hepatic Artery Resection

Resection of biliary tract malignancies may require resection of the hepatic vasculature. While immediate revascularization of the liver is necessary, reconstruction is difficult when the original vessels are unavailable. We document a case in which a segment of the common hepatic artery was excised during tumor resection and the remaining proximal vessel displayed intima dissection. A greater saphenous vein was placed as a bridge between the remaining left hepatic artery and gastroduodenal artery for successful revascularization.

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Abnormal Persistence of Embryonic Blood Supply of Liver: Anatomist’s Delight, Surgeon’s Nightmare

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2019.106 ◽

2019 ◽

Vol 62 (2) ◽

pp. 72-76

Author(s):

Sabah Yaseen ◽

Surbhi Wadhwa ◽

Kahkashan Jeelani ◽

Anita Mahajan ◽

Sabita Mishra

Keyword(s):

Hepatic Artery ◽

Vascular Anatomy ◽

Left Gastric Artery ◽

Gastroduodenal Artery ◽

Unique Case ◽

Left Hepatic Artery ◽

Hepatic Arteries ◽

Patient Morbidity ◽

High Incidence ◽

The Common

The high incidence of hepato-biliary vascular anatomy variations necessitates its evaluation prior to performing liver transplantation, hepatobiliary, pancreatic, gastric and oesophageal surgeries. We report a unique case of persistence of embryonic arteries of the liver, wherein, the liver was supplied by five vessels. In addition to the usual right and left hepatic arteries from the hepatic artery proper, the liver received two accessory right hepatic arteries, one from the gastroduodenal artery, while another arising from superior mesenteric artery and an accessory left hepatic artery, from the left gastric artery. The origin of gastroduodenal artery was found to be unusually high and its abnormal anterior course over the common bile duct further added complexity to the hepatobiliary anatomy. The presence of these aberrant and accessory arteries predisposes to inadvertent injury leading to patient morbidity and sometimes mortality.

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IX. Experimental Angiographic Investigation of Dilatation of Vessels Peripheral to the Tip of a Catheter in the Common Hepatic Artery

Acta Radiologica ◽

10.3109/05678066609170501 ◽

1966 ◽

Vol 4 ◽

pp. 121-131

Keyword(s):

Hepatic Artery ◽

Common Hepatic Artery ◽

The Common

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Vascular Involvements in Cholangiocarcinoma: Tips and Tricks

Cancers ◽

10.3390/cancers13153735 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3735

Author(s):

Roberta Angelico ◽

Bruno Sensi ◽

Alessandro Parente ◽

Leandro Siragusa ◽

Carlo Gazia ◽

...

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Vena Cava ◽

High Volume ◽

Vascular Reconstruction ◽

Ex Situ ◽

Vascular Involvement ◽

Hepatic Veins ◽

Hepatic Artery Resection ◽

Artery Resection

Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction.

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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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DEVELOPMENT OF COLLATERAL VESSELS IN AN ACUTE OCCLUSION OF THE COMMON HEPATIC ARTERY

American Journal of Roentgenology ◽

10.2214/ajr.97.2.473 ◽

1966 ◽

Vol 97 (2) ◽

pp. 473-476 ◽

Cited By ~ 11

Author(s):

STEWART R. REUTER

Keyword(s):

Hepatic Artery ◽

Common Hepatic Artery ◽

Acute Occlusion ◽

The Common ◽

Collateral Vessels

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Unusual course of the common hepatic artery originating from the celiac trunk

Surgical and Radiologic Anatomy ◽

10.1007/s00276-010-0632-6 ◽

2010 ◽

Vol 32 (9) ◽

pp. 883-885 ◽

Cited By ~ 3

Author(s):

Mo Jin Wang ◽

Zhong Cheng ◽

Rui Wang ◽

Yuan Li ◽

Zong Guang Zhou

Keyword(s):

Hepatic Artery ◽

Celiac Trunk ◽

Common Hepatic Artery ◽

The Common

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Hepatic Artery Embolization prior to En Bloc Resection of an Encased Common Hepatic Artery in Adenocarcinoma of the Head of the Pancreas

Case Reports in Medicine ◽

10.1155/2013/205475 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Gregory Sergeant ◽

Erik Schadde ◽

Geert Maleux ◽

Raymond Aerts

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Balloon Dilation ◽

En Bloc Resection ◽

Common Hepatic Artery ◽

Pathological Examination ◽

Periampullary Cancer ◽

En Bloc ◽

Head Of The Pancreas ◽

The Common

A 64-year-old female patient with adenocarcinoma of the head of the pancreas with encasement of the common hepatic artery and portal vein stenosis was reexplored after six cycles of gemcitabine (1000 mg/m2). Prior to surgery, the patient underwent balloon dilation and stenting of the portal vein in addition to successful coil embolisation of the common hepatic artery, proper hepatic artery, and proximal gastroduodenal artery. After embolisation, a pylorus-preserving pancreaticoduodenectomy was performed with resection of the common hepatic artery and portal vein confluens. Pathological examination showed a moderately differentiated pT3N0 (Stage IIa, TNM 7th edition) tumor with negative section margins. We show with this case that in selected cases of periampullary cancer with encasement of the common hepatic artery, it is technically feasible to perform pancreaticoduodenectomy with hepatic artery resection and negative surgical margins. Nevertheless, the oncological benefit of extended arterial resections remains controversial.

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