scholarly journals Vascular Involvements in Cholangiocarcinoma: Tips and Tricks

Cancers ◽  
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.

scholarly journals Results of portal vein and hepatic artery resection for surgical treatment of Klatskin tumor

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S639
Author(s):  
O. Kotenko ◽  
A. Popov ◽  
A. Korshak ◽  
D. Fedorov ◽  
A. Grinenko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Klatskin Tumor ◽  
Hepatic Artery Resection ◽  
Artery Resection

scholarly journals Results of portal vein and hepatic artery resection for surgical treatment of Klatskin tumor

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S892
Author(s):  
O. Kotenko ◽  
A. Popov ◽  
A. Korshak ◽  
D. Fedorov ◽  
A. Grinenko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Klatskin Tumor ◽  
Hepatic Artery Resection ◽  
Artery Resection

scholarly journals Eight-Year Survival Following Left Hepatic Trisectionectomy With Combined Hepatic Artery And Portal Vein Resection For Advanced Perihilar Cholangiocarcinoma

2021 ◽  
Author(s):  
Haitham Triki ◽  
Heithem Jeddou ◽  
Stylianos Tzedakis ◽  
Dihia Belabbas ◽  
Solène Florence Kammerer-Jacquet ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Perihilar Cholangiocarcinoma ◽  
Portal Vein Resection ◽  
Extended Hepatectomy ◽  
Hepatic Artery Resection ◽  
Left Hepatic Trisectionectomy ◽  
Vein Resection ◽  
Left Trisectionectomy ◽  
Artery Resection

Abstract We report the case of a patient with exceptional survival over 8 years after left trisectionectomy combined with portal vein and hepatic artery resection and reconstruction for advanced perihilar cholangiocarcinoma. Such extended hepatectomy with vascular resection is the only way to obtain free tumor margin. It can be performed with acceptable morbidity and mortality and it is the only hope to prolong survival.

scholarly journals DISTRIBUTION OF THE HEPATIC BLOOD VESSELS OF THE GROUND SQUIRREL (SPERMOPHILUS CITELLUS)

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Miloš BLAGOJEVIĆ ◽  
Ivana NEŠIĆ ◽  
Milena ĐORĐEVIĆ ◽  
Drago NEDIĆ ◽  
Marija ZDRAVKOVIĆ ◽  
...  
Keyword(s):  
Portal Vein ◽  
Blood Vessels ◽  
Hepatic Artery ◽  
Ground Squirrel ◽  
Vena Cava ◽  
Celiac Artery ◽  
Ground Squirrels ◽  
Hepatic Veins ◽  
Arterial Blood ◽  
Spermophilus Citellus

The aim of this paper was to study distribution of the hepatic artery and portal vein of theportal system of the liver in ground squirrels (Spermophilus citellus) and compare these data withthose concerning the rats, rabbits, guinea pigs and nutrias. The liver of the ground squirrel receivesthe oxygen and nutrients through blood from two large blood vessels: portal vein and hepatic artery(a. hepatica propria). The portal vein is formed by the confluence of three main venous bloodvessels: v. gastropancreaticoduodenalis, v. gastrolienalis and v. mesenterica cranialis. It collectsvenous blood from the stomach, pancreas, spleen and all of intestines except the rectum. The portalvein enters the porta hepatis on the liver together with the hepatic artery. Five venous branches ofdifferent size separate from the portal vein and ramify into the respective liver lobes.Blood leaves the liver through the hepatic veins that start with the central veins. Three large hepaticveins and two venous trunks drain lobes of the liver and enter the caudal vena cava as it passesthrough the liver.A. hepatica propria supplies the liver and gallbladder with oxygenated blood. It raises from thehepatic artery (a. hepatica) wich is the third branch of the celiac artery. A. hepatica propria in theportal fissure is divided into two branches, of which the left branch brings arterial blood to the lefthepatic lobe, and the right branch brings it into other liver lobes.

Localization of intrahepatic portal vascular resistance

1986 ◽  
Vol 251 (3) ◽  
pp. G375-G381 ◽  
Author(s):  
W. W. Lautt ◽  
C. V. Greenway ◽  
D. J. Legare ◽  
H. Weisman
Keyword(s):  
Pressure Drop ◽  
Portal Vein ◽  
Vascular Resistance ◽  
Venous Pressure ◽  
Vena Cava ◽  
Sympathetic Nerves ◽  
Hepatic Veins ◽  
Pressure Changes ◽  
Stimulation Of ◽  
Anesthetized Cat

The pressure drop from the portal vein to the vena cava occurs primarily across a postsinusoidal site localized to a narrow segment (less than 0.5 cm) of hepatic veins (roughly 1.5 mm diam) in the anesthetized cat. Portal venous pressure (PVP = 8.9 +/- 0.3 mmHg) and lobar hepatic venous pressure (LVP = 8.7 +/- 0.4 mmHg) are insignificantly different, and pressure changes imposed from the presinusoidal or postsinusoidal side are equally transmitted to both pressure sites. Several types of experiments were done to validate the LVP measurement. The portal vein, hepatic sinusoids, and hepatic veins proximal to the resistance site are all under a similar pressure. Previously reported calculations of hepatic vascular resistance are in error because of incorrect assumptions of sinusoidal pressure and localization of the portal resistance site as presinusoidal. Stimulation of hepatic sympathetic nerves for 3 min caused LVP and PVP to increase equally, showing that the increased "portal" resistance is postsinusoidal across the same region of the hepatic veins that was previously localized as the site of resistance in the basal state.

scholarly journals Irreversible Electroporation as a Bridge to Liver Transplantation

2019 ◽  
Vol 85 (1) ◽  
pp. 103-110 ◽  
Author(s):  
Robert M. Cannon ◽  
David N. Bolus ◽  
Jared A. White
Keyword(s):  
Liver Transplantation ◽  
High Risk ◽  
Length Of Stay ◽  
Portal Vein ◽  
Irreversible Electroporation ◽  
Vena Cava ◽  
Hepatic Veins ◽  
Bridge To Transplantation ◽  
Adjacent Structures ◽  
Hepatic Vasculature

Hepatocellular carcinoma (HCC) in proximity to major hepatic vasculature poses a risk for invasion, which would contraindicate liver transplantation, yet, is difficult to treat with thermal ablation. This study was undertaken to evaluate the feasibility of irreversible electroporation (IRE) as a bridge to transplantation for high-risk tumors. All patients with HCC in proximity to major hepatic vasculature treated with laparoscopic IRE as bridge to transplantation were studied. Patient and tumor characteristics, length of stay, and treatment-related complications were recorded. Tumor response was assessed with CT and explant pathology. Five patients with a median Model for End Stage Liver Disease (MELD) of 13 (7–21) underwent IRE. The median tumor size was 2.7 cm (1.5–3.7 cm). Adjacent structures included the right portal vein, hepatic veins/inferior vena cava (IVC) and left portal vein. Length of stay was one day for all patients. One patient suffered portal vein thrombosis. The transplant occurred at a median of 142 days (47–264) after IRE. Pathologic necrosis ranged from 30 to 100 per cent, without any vascular invasion. Four patients remain alive with no evidence of disease with median follow-up of 403 (227–623) days. The remaining patients died because of transplant-related complications onpost IRE day 297. IRE shows promise as a bridge to liver transplant for high risk HCC in a preliminary series, justifying further prospective evaluation.

Deployment of Direct Intrahepatic Portocaval Shunt (DIPS) from a Femoral Access

2018 ◽  
Author(s):  
Abdulrahman Masrani ◽  
Bulent Arslan
Keyword(s):  
Portal Vein ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Hepatic Veins ◽  
Portocaval Shunt ◽  
Femoral Access ◽  
Direct Puncture ◽  
The Right ◽  
Brachiocephalic Veins

The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be effective in management of esophageal varices bleeding in patients with liver cirrhosis when endoscopic manuvers fail to control it. Ascites refractory to optimal medical therapy is another indication for TIPS procedure. Occasionally, TIPS cannot be performed due to vascular anatomical difficulties such as occluded central venous access, small hepatic veins, or portal vein occlusion. Direct intrahepatic portocaval shunt (DIPS) can be considered as an alternative option in such circumstances. DIPS is typically performed utilizing jugular access with direct puncture from the inferior vena cava (IVC) to the right portal vein. However, the interventionalist may be challenged by jugular or brachiocephalic veins occlusion. This chapter discusses perfroming DIPS procedure utilizing femoral access in a patient with bilateral occluded brachiocephalic veins and thrombosed right portal vein.

scholarly journals Novel surgical technique and efficacy analysis of donor pancreas preparation without vascular reconstruction in pancreas transplantation

2019 ◽  
Vol 47 (12) ◽  
pp. 6182-6191
Author(s):  
Wen-wei Liao ◽  
Xiang-chao Ling ◽  
Cheng Zhang ◽  
Fu-rong Liu ◽  
Xiao-feng Zhu ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Pancreas Transplantation ◽  
Vascular Complications ◽  
Celiac Trunk ◽  
Vascular Reconstruction ◽  
Gastroduodenal Artery ◽  
Common Hepatic Artery ◽  
Efficacy Analysis ◽  
Outflow Channel

Objective Because of the complicated blood supply and vascular structure of the pancreas, blood vessel reconstruction and reshaping are generally required during pancreas transplantation. We modified the vascular preparation procedure for the donor pancreas (i.e., no vascular reconstruction was performed) based on experiences in our department and in other domestic and international transplantation centers. Methods Twelve donor pancreas preparations without vascular reconstruction were performed. The patch (Carrel patch), celiac trunk, and superior mesenteric artery were preserved as arterial inflow channels for the donor pancreas. The common hepatic artery and the gastroduodenal artery were transected at a site 0.5 cm away from the bifurcation. The bifurcated portion was preserved for the donor liver. The stumps of the gastroduodenal artery and common hepatic artery were then ligated. The portal vein was transected in the middle of the hepatoduodenal ligament during separation of the liver and pancreas. The partial portal vein preserved with the pancreas was used as the outflow channel of the donor pancreas. Results The transplanted pancreas functioned well in the recipients, and no vascular complications were reported. Conclusion The overall efficacy of pancreas transplantation without vascular reconstruction has been improved.

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