Comparative Results of the Ligation of the Hepatic Artery in Animals

Abstract

In a preliminary report1 the reason for this study was pointed out to be an injury of the hepatic artery sustained by a boy, aged 12 years, who was run over by a wagon, the wheels passing over the epigastric region. He had all the symptoms of an internal hemorrhage. At operation, the hepatic artery was found to be severed. Both ends of the artery were tied. The boy did well until the tenth day, when he developed a slight jaundice, accompanied by vomiting. He died on the fourteenth day, of symptoms resembling acute yellow atrophy of the liver. A postmortem examination was refused. Our desire to duplicate this injury in animals has developed these experiments.In our preliminary studies, rabbits were used exclusively; but in our later experiments, dogs, cats, guinea-pigs and rabbits were employed.These animals may be divided into the carnivorous and herbivorous types. We found the former particularly resistant to the effects of the ligation of the hepatic artery, while the latter succumbed in every instance. This difference in their susceptibility to the ligation may be due to changes in the metabolism in these two types of animals. This problem is occupying our attention at the present time and the results will be reported in the near future.However, the anatomic variations may be a sufficient reason alone to cause such a tremendous difference in the mortality rate of the different animals. To arrive at a definite conclusion concerning the difference in the ability of these animals to resist the ligation performed in a similar manner, a study of the comparative anatomy of the four animals used was deemed essential (Figs. 1, 2, 3 and 4).

Accidental hepatic artery ligation in humans

“…In 1905 Haberer reported, in a well controlled study, that ligation of the hepatic artery distal to the right gastric branch was usually fatal in dogs [8]. This early work was confirmed and extended to other animals by Behrend [9,10] and Cameron [11].…”

“…An additional patient who apparently died of hemorrhage eight hours after ligation of the common hepatic artery was included, although autopsy was not performed [53]. In another case in which autopsy was not performed jaundice preceded death [10]. A final group of five patients was included in whom a lobar artery was ligated in the course of partial hepatectomy [8,42,46,54,55].…”

Collateral arterial pathways to the liver after ligation of the hepatic artery and removal of the celiac axis

“…When the hepatic trunk is cut, the arc may still route blood into the liver i€ the gastroduodenal takes origin from the left hepatic (11 per cent), right hepatic (7 per cent), middle hepatic (1 per cent), replaced hepatic trunk (3. 5 per cent) or directly from the celiac or superior mesenteric (2.5 per cent). T h e right limb of Rarkow's arc may join the transverse pancreatic artery running along the inferior surface of the pancreas and, through the latter's right branch, become joined with the gastroduodenal via which it may unite with a severed hepatic.…”

“…After injection of a red-lead dye into the aorta of dogs, Jefferson, Proffitt and Necheles noted a direct communication between the extrahepatic liver arteries and the right superior phrenic but never with the left superior phrenic. 5. Through the falciform ligament and ligamentum teres.…”

Αι Θεραπευτικαι Εφαρμογαι Της Απολινωσεως Της Ηπατικης Αρτηριας

“…Δύο χρόνια μετά τον Haberer (1905), οί Brainbridge καί Leathees (1907) διαπιστώνουν τήν αύτόλυσιν του ήπατος σαν αποτέλεσμα τής άπολινώσεως τής ηπατικής αρτηρίας καί πρώτοι διατυπώνουν τήν θεωρίαν, συμφώνως προς τήν οποίαν ή αύτόλυσις οφείλεται είς ύποξυγοναιμίαν του ήπατος. Είς τά αυ τά συμεπράσματα οδηγούνται καί οί Narath (1916) καί Behrend (1922), οί όποιοι έχρησιμοποίησαν δια τά πειράματα των διάφορα είδη ζώων.…”