Anomalous Branch of the Left Hepatic Artery With Pericardial, Diaphragmatic, Splenic and Gastric Supply During Selective Internal Radiotherapy (SIRT)

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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Liver necrosis shortly after pancreaticoduodenectomy with resection of the replaced left hepatic artery

World Journal of Surgical Oncology ◽

10.1186/s12957-017-1151-2 ◽

2017 ◽

Vol 15 (1) ◽

Cited By ~ 8

Author(s):

Michihiro Yamamoto ◽

Masazumi Zaima ◽

Hidekazu Yamamoto ◽

Hideki Harada ◽

Junichiro Kawamura ◽

...

Keyword(s):

Hepatic Artery ◽

Liver Necrosis ◽

Left Hepatic Artery

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Clinical Impact of 99mTc-MAA SPECT/CT-based Personalized Predictive Dosimetry in Selective Internal Radiotherapy: a Retrospective, Single-center Study for Unresectable HCC Patients

10.21203/rs.3.rs-1111102/v1 ◽

2021 ◽

Author(s):

Ana-Maria Bucalau ◽

Benoît Collette ◽

Illario Tancredi ◽

Michael Vouche ◽

Martina Pezzullo ◽

...

Keyword(s):

Response Rate ◽

A Posteriori ◽

Selective Internal Radiotherapy ◽

Internal Radiotherapy ◽

Single Center Study ◽

Group A ◽

Group B ◽

Predictive Dosimetry ◽

Administered Activity ◽

Center Study

Abstract BackgroundRecent data indicates that personalized dosimetry-based selective internal radiotherapy (SIRT) may be associated with better outcome for unresectable hepatocellular carcinoma (HCC).AimWe aim to evaluate the contribution of personalized predictive dosimetry (performed with Simplicity90® software) in HCC patients by comparing them to our historical cohort whose activity was determined by standard dosimetry. MethodsThis is a retrospective, single-center study conducted between February 2016 and December 2020 that included patients with HCC who received SIRT after simulation based on either standard dosimetry (group A) or, as of December 2017, on personalized dosimetry (group B). Primary objectives were best overall response (BOR) and objective response rate (ORR) evaluated by mRECIST at 3 months. Safety and toxicity profiles were evaluated at day 1, 1- and 3-months post-treatment. For group A we studied the dose-response relationship at 3 months and compared the activity to be administered determined a posteriori using Simplicit90Y® and the activity actually administered determined by the standard approach.ResultsBetween February 2016 and December 2020, 66 patients received 69 simulations leading to 40 treatments. The median follow-up time was equal for both groups, 21 months (range 3-55) in group A and 21 months (range 4-39) in group B. The per patient analysis revealed a significant benefit of personalized predictive dosimetry in terms of better overall response at 3 months (80% vs. 33.3%, p= 0.007) and at 6 months (77.8% vs. 22.2%, p= 0.06). This trend was found in the analysis by nodule with a response rate according to mRECIST of 87.5% for personalized dosimetry versus 68.4% for standard dosimetry at 3 months, p= 0.24. Only one grade 3 biological toxicity (hyperbilirubinemia) was noted in group A. The comparison between the administered activity and the recommended activity recalculated a posteriori using Simplicit90Y® showed that the vast majority of patients who progressed (83.33%) received less activity than that recommended by the personalized approach or an inadequate distribution of the administered activity. ConclusionsOur study confirms that the use of personalized dosimetry allows a better selection of HCC patients who can benefit from SIRT, and consequently, improves the effectiveness of this treatment.

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Reconstruction of Aberrant Left Hepatic Artery in Orthotopic Liver Transplantation – Single Center Experience

10.21926/obm.transplant.2101138 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Plamen Mihaylov ◽

◽

Burcin Ekser ◽

Daiki Soma ◽

Andrew Lutz ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatic Artery ◽

Graft Survival ◽

Arterial System ◽

Single Center ◽

Left Hepatic Artery ◽

Entire Cohort ◽

Single Center Experience ◽

Aberrant Left Hepatic Artery ◽

Low Incidence

One of the most feared complications in liver transplantation is hepatic arterial thrombosis (HAT). The incidence of HAT in liver transplantation varies from 1.2% and 8%. One of the risk factors for this complication is anatomical complexity of hepatic arterial system. The focus of this short communication is to show our approach in dealing with aberrant left hepatic artery in settings of liver transplantation. This is a single center experience. Between January 2016 and June 2019, we procured and transplanted 357 adult liver allografts. Of these, there were 34 (9.5%) livers with aberrant left hepatic artery. All of them have been reconstructed on bench table. There was no incidence of HAT in the entire cohort with ALHA. The one-year graft survival for this patient cohort was 93.1%. Our surgical approach resulted in a low incidence of HAT of 1% with excellent graft survival.

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