Dealing with hepatic artery traumas: A clinical literature review

Abstract

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.

Concomitant vascular and bile duct injury in cholecystectomy

“…Оба указанных состояния сопровождаются печеночной недостаточностью различной выраженности, что зависит от объема пораженной паренхимы печени. Риск инфицирования некротизированной печени больше у пациентов после эндоскопических или чрескожных билиарных вмешательств [13,14]. Следует отметить, что неблагоприятное течение заболевания также связано с уровнем повреждения желчных протоков.…”

Importance of Anatomical Variation of the Hepatic Artery for Complicated Liver and Pancreatic Surgeries: A Review Emphasizing Origin and Branching

“…These segmental branches also communicate with each other and form intersegmental arterial communications. Various studies describe the intralobular and intersegmental arterial communicating arcades of liver through anatomical dissection and radiological imaging [ 24 , 25 , 26 ]. At the hilar plate of the liver, the communicating arcade is present between the right and left hepatic artery in the form of the hilar plexus.…”

BILE: A Literature Review Based Novel Clinical Classification and Treatment Algorithm of Iatrogenic Bile Duct Injuries

“…In addition, intrahepatic and prehepatic vascular collaterals try to preserve the blood flow to the affected liver parenchyma and prevent hepatic necrosis in case of an arterial injury [49]. However, factors such as the hemodynamic stability of the patient, the location of the injury, and the presence of comorbidities can influence the ischemic effect on the liver [49][50][51]. The concomitant biliary obstruction, on the background of an IBDI, may further predispose to the development of hepatic necrosis [49][50][51].…”

“…However, factors such as the hemodynamic stability of the patient, the location of the injury, and the presence of comorbidities can influence the ischemic effect on the liver [49][50][51]. The concomitant biliary obstruction, on the background of an IBDI, may further predispose to the development of hepatic necrosis [49][50][51]. As soon as a liver parenchymal necrosis develops, the subsequent bacterial contamination can lead to abscess formation and sepsis [51].…”

“…The concomitant biliary obstruction, on the background of an IBDI, may further predispose to the development of hepatic necrosis [49][50][51]. As soon as a liver parenchymal necrosis develops, the subsequent bacterial contamination can lead to abscess formation and sepsis [51]. Patients submitted to any form of preoperative biliary drainage procedure are at high risk of developing these septic complications [49,52,53].…”