Angiographic classification of hepatic arterial collaterals.

Charnsangavej, C.; Chuang, V P; Wallace, Sidney; Soo, C S; Bowers, Thomas A.

doi:10.1148/radiology.144.3.6285413

Cited by 173 publications

(85 citation statements)

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“…Michels has described the details of extrahepatic arterial collaterals to the liver after ligation of the hepatic artery in a series of 200 cases of hepatic resection, in which at least 26 possible routes of collateral arterial blood supply to the liver from the common hepatic trunk were noted [19] . Among them, the following are clinically important: (1) the subphrenic branch of the phrenic artery or internal mammary artery, (2) the aberrant hepatic artery, (3) the periductal arterial plexus, (4) other collaterals into the hepatic hilum from the superior mesenteric artery, and (5) the intrahepatic branches [19,20] . Although the significance of extrahepatic collateral pathways in association with liver damage after hepatic TAE has been reported [2,[21][22][23] , the relationship between the primary surgical procedure and the development of extrahepatic collaterals following hepatobiliary pancreatic surgery has not been described in detail.…”

Section: Discussionmentioning

confidence: 99%

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Tajima

Kuroki²,

Tsutsumi³

et al. 2007

WJG

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AIM:To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery. METHODS:We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepatobiliary pancreatic surgery between June 1992 and April 2006. We paid special attention to the extrahepatic arterial collaterals to the liver which may affect post-TAE liver damage and patient outcome. RESULTS:The underlying diseases were all malignancies, and the surgical procedures included hepatopancreatoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenectomy in 2. A total of 11 pseudoaneurysm developed: 4 in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful hemostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery, were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection, the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arterial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic artery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE. CONCLUSION:When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral pathways to the liver created by the primary surgical procedure and a short postoperative interval may lead to an unfavorable outcome.

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Section: Discussionmentioning

confidence: 99%

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Tajima

Kuroki²,

Tsutsumi³

et al. 2007

WJG

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“…Furthermore, because some studies have shown that major bile ducts are also supplied by collaterals between the left and right hepatic arteries, the loss of a small arterial branch might not play an important role in the vitality of the biliary tree. [17][18][19] Analyzing early postoperative events, we found a significant increase in HAT in patients with complex arterial reconstruction (10.5% versus 2.0%). Some published reports support this result, 20,21 whereas other state opposite findings.…”

Section: Discussionmentioning

confidence: 99%

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Soliman

Bodingbauer

Langer

et al. 2003

Liver Transplantation

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The goal of this study was to analyze the influence of multiple anastomosis on outcome in orthotopic liver transplantation (OLT) and its implications for split-liver and living related liver transplantation programs. In a retrospective study, 683 first OLTs in adults were analyzed. Complex hepatic artery reconstruction was defined as revascularization of the graft requiring additional anastomosis between donor hepatic arteries. OLT was performed in a standard manner. All patients had daily ultrasound examination. In this series we found 72 grafts (10.5%) with anatomic arterial variations that required complex hepatic artery reconstruction. There was no difference in primary organ function and demographic data compared with patients with simple arterial reconstruction. However, hepatic artery thrombosis (HAT) occurred in 9.7% of patients (7 of 72) with complex reconstruction in contrast to 2.0% in the control group (12 of 638; P < .001). Statistical analysis identified multiple anastomoses (P < .002) and primary nonfunction (P < .02) as significant risk factors for HAT. Three patients underwent successful thrombectomy for HAT, all others had to undergo retransplantation. Although in the group with complex arterial reconstruction increased graft loss caused by HAT was found early postoperatively, the overall 5-year patient and graft survival was not different for both groups. Although complex reconstruction is a risk factor for HAT, early diagnosis of HAT by daily ultrasound and early repeat OLT can provide similar 5-year survival as for patients with simple reconstruction. We conclude that complex hepatic artery reconstruction challenges conventional OLT as well as split-liver and living related liver transplantation, but does not necessarily affect its longterm outcome. O rthotopic liver transplantation (OLT) is one of the outstanding innovations in the treatment of end-stage liver diseases in recent decades. The enormous success of this new surgical procedure resulted in an increasing organ shortage, which is the main challenge for OLT nowadays. Great efforts have been made to enlarge the donor pool, and especially split-liver transplantation and living related liver transplantation were to contribute to the solution of this problem. However, because these new surgical techniques are determined by their technical feasibility and limits, concepts that have been considered controversial since the early period of OLT have become of particular interest. [1][2][3][4] In this context, the vascular reconstruction of the hepatic artery and factors related to hepatic artery thrombosis (HAT), one of the most life-threatening complication in liver transplantation, are still being discussed. Many reports on the incidence of anatomic variations of the hepatic artery have been published and risk factors for HAT have been identified, 5-8 but an actual systematic analysis assessing exclusively the role of graft revascularization on outcome is rare. Therefore, the goal of this study is to analyze the results of complex hepatic ...

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“…The development of collateral blood flow with one of the hepatic arteries being occluded was shown to be a possibility and to depend heavily on the site of vascular obstruction [26,27] . Hepatic interlobar arterial collaterals were exhaustively analyzed in autopsied specimens and corrosion casts [26][27][28][29][30] , as well as with radiological studies [31][32][33][34][35][36][37] called into being by the evolution of hepatic surgery, transplantation, interventional radiology, endovascular chemotherapy and embolization. Angiography demonstrated the interlobar branch-relayed collateral blood flow between the hepatic arteries [31][32][33][34][35][36][37] to be readily noted at the occlusion of either of the hepatic arteries [32,33,37] , which was demonstrated by computerized tomographic angiography in our Case 2 ( Figure 11).…”

Section: Discussionmentioning

confidence: 99%

“…The majority of investigators are in agreement that the interlobar collateral is extraparenchymal, passes cranial to the bifurcation of the PVs in the hepatic hilum in close proximity to the bile ducts [32,33,[37][38][39][40] and makes the crucial contribution of the blood supply to the biliary tract, as well as one of the hepatic lobes in the event of liver major route interruption [29,36,37,41] . So far it has not been clear whether there are transparenchymal branches to connect the hepatic lobes [31,33,36,42] . Case 2 demonstrates that LHA excision at a distal pancreatectomy with resection of CA and its branches is permissible by virtue of the fact that an arterial blood supply keeps coming to the left hepatic lobe thanks to the availability of the interlobar collateral.…”

Section: Discussionmentioning

confidence: 99%

Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy

Егоров

Petrov²,

Lozhkin³

et al. 2013

WJGS

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Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type Ⅷb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.

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Angiographic classification of hepatic arterial collaterals.

Cited by 173 publications

References 0 publications

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy

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