Incidence and management of arterial injuries during pancreatectomy

Kleive, Dyre; Sahakyan, Mushegh А.; Khan, Ammar Hameed; Fosby, Bjarte; Line, Pål–Dag; Labori, Knut Jørgen

doi:10.1007/s00423-018-1666-1

Cited by 13 publications

(30 citation statements)

References 34 publications

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“…Ligation of a hepatic artery may result in hepatic necrosis, liver abscesses, ischemic biliary injury, and/or an anastomotic fistula. These are potential life-threatening complications 13 .…”

Section: Discussionmentioning

confidence: 99%

“…An important finding of the present study is that in all cases of anomalous right hepatic artery, including those that arouse directly from SMA and also those from a hepatic-mesenteric trunk, run posterior to the pancreatic head and portal vein, and laterally to the portal vein before reaching the liver. These anomalous vessels might be accidentally damaged during PD and/or can be involved by tumors of the pancreatic head and cause intra-operative or postoperative bleeding 13 14 …”

Section: Discussionmentioning

confidence: 99%

“…Despite technical advances, PD remains a challenging operation with surgical mortality rates ranging from 1-6% even at experienced centers 17 , 19 ,217, 10 . Major vessels involvement around the pancreas can make the surgery even more challenging 4 , 6 , 23 especially if arterial resection and reconstruction are necessary 1 , 13 , 14 , 16 . Arterial anomalies of the celiac axis, mainly of hepatic arteries, are not uncommon.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Hepatic Arterial Variations With Implications in Pancreatoduodenectomy

Balzan

Gava

Pedrotti

et al. 2019

ABCD, arq. bras. cir. dig.

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Background: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. Aim: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. Methods: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. Results: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. Conclusions: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of Hepatic Arterial Variations With Implications in Pancreatoduodenectomy

Balzan

Gava

Pedrotti

et al. 2019

ABCD, arq. bras. cir. dig.

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“…The fact that HA injury is acute or chronic is another factor affecting the outcome. Many studies have been reported without reconstruction following resections in patients with the HA invasion by the tumor[ 19 , 20 ]. The collateral system, which occurs in cases where arterial occlusion develops slowly, is thought to reduce/prevent liver damage after resection.…”

Section: Discussionmentioning

confidence: 99%

Dealing with hepatic artery traumas: A clinical literature review

Dılek¹,

Atay²

2021

WJCC

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BACKGROUND The hepatic artery (HA) is one of the most threatened vascular structures during hepatopancreatobiliary (HPB) surgeries and interventional procedures. It can be affected by many clinical pictures, especially tumors, due to its anatomical position and neighborhood. AIM To reveal the evolution and recent developments in the management of HA traumas in the light of the literature. METHODS In this article, 100 years of MEDLINE (PubMed) literature and articles including cases and series of HA injuries were reviewed, and the types of injury occurrence, treatment, and related complications and their management were compiled. RESULTS The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies, among the most common operations. HA anatomy shows anomalies in approximately 15%-25% of the cases, further increasing this risk. The incidence of HA injury is not precisely known. Approaches that have evolved in recent years in managing patients with HA injury (laceration, transection, ligation, resection) with severe morbidity and mortality risk are reviewed in light of the current literature. CONCLUSION In conclusion, complications and deaths due to HA injury are less common today. The risk of complications increases in patients with hemodynamic instability, jaundice, cholangitis, and sepsis. Revealing the variations in the preoperative radiological evaluation will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to maintain with primary anastomosis, arterial transpositions, or grafts. In cases where bile duct injury develops, patients should be directed to HPB surgery centers, considering the possibility of accompanying HA injury. Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.

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“…A comprehensive preoperative evaluation of the hepatic artery is important for surgical planning to prevent postoperative problems after liver surgery, such as insufficient functional hepatic volume, liver abscess and ischaemic cholangiopathy. A thorough knowledge of the origin, course and variants of the hepatic artery is essential for target vessel selection.…”

Section: Introductionmentioning

confidence: 99%

Hepatic artery classification based on three-dimensional CT

Yan

Feng

Wang

et al. 2020

British Journal of Surgery

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Background: Precise classification of the hepatic artery is helpful for preoperative surgical planning in hepatobiliary-pancreatic surgery. However, the anatomy of hepatic arteries is variable. This study investigated anatomical variation using three-dimensional visualization and evaluation (3DVE) to develop a nomenclature system. Methods: The origin and course of the hepatic artery were tracked and analysed by using three-dimensional visualization of CT images acquired between 2013 and 2017. The new classification and nomenclature system, named CRL, was developed based on the origins of the common, right and left hepatic arteries. Results: Scans from 770 adults were evaluated. Preoperative 3DVE correlated better with surgical findings than the original CT images alone. Using the CRL classification system, hepatic arteries were divided into nine subtypes. Only 87⋅4-89⋅2 per cent of the hepatic arteries of 610 living-donor liver transplant donors were depicted in Michels', Hiatt's or Varotti's classification, compared with 100 per cent identified by the CRL classification. The CRL classification was validated against external data sets from previous studies, with 99⋅6-100⋅0 per cent of patients classified by the CRL system. Conclusion: The CRL classification covers hepatic artery variants and may be used for planning liver surgery.

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Incidence and management of arterial injuries during pancreatectomy

Abstract: Arterial injury during pancreatectomy is an infrequent and manageable complication. Early recognition and primary repair in order to restore arterial liver perfusion may improve outcome. However, the morbidity is high and comparable to patients undergoing a planned arterial resection.

Cited by 13 publications

References 34 publications

Prevalence of Hepatic Arterial Variations With Implications in Pancreatoduodenectomy

Prevalence of Hepatic Arterial Variations With Implications in Pancreatoduodenectomy

Dealing with hepatic artery traumas: A clinical literature review

Hepatic artery classification based on three-dimensional CT

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