Ischemic Cholangiopathy

Abstract

Bile ducts are supplied with blood exclusively via hepatic arteries. Obstruction of large arteries is rapidly compensated for by the opening of preexisting intrahepatic or transcapsular collateral arteries, which prevents ischemic damage. Ischemic bile duct injury may occur when small hepatic arteries or the peribiliary vascular plexus are injured, or when all possible arterial blood supplies are interrupted, as is the case in transplanted liver with hepatic artery thrombosis. Most causes of bile duct ischemia are iatrogenic. Systemic diseases involving small hepatic arteries may also be implicated. Depending on the extent and velocity of the arterial obstructive process, ischemic cholangiopathy may present as acute formation of biliary casts, bile duct necrosis, or chronic disease resembling primary sclerosing cholangitis. In many patients, correction of arterial obstruction is not possible. When biliary drainage or reconstruction is not possible or has failed, liver transplantation is the only means of providing potential cure.

Partial Portal Vein Arterialization Attenuates Acute Bile Duct Injury Induced by Hepatic Dearterialization in a Rat Model

“…The mechanisms of the hepatobiliary damage induced by complete hepatic deprivation in the present study are complex and multifactorial. First, cholangiocytes were the primary target of the initial insult, hepatic arterial ischemia [2]. Evidence of BDI and injury has been presented in this current study and a previous study [13].…”

“…Hepatic artery (HA) thrombosis causes serious biliary complications such as nonanastomotic biliary strictures and bile leakage in liver transplant recipients [1, 2]. However, outside the liver transplantation setting, the HA is believed to be expendable since the liver receives an abundant blood supply from the proper HA, the portal vein (PV), and extensive collateral pathways in the native liver [3].…”

“…In addition, cholangiocytes are more susceptible to arterial ischemia than hepatocytes [2, 13]. It is possible that ischemic bile injury plays a role in liver abscess but the mechanisms are as yet not elucidated.…”

Implication of the presence of a variant hepatic artery during the Whipple procedure

“…In the context of PD, the iatrogenic injury of a RHA may pose a risk that leads to a biliary fistula secondary to an ischemic hepato-jejunal anastomoses ischemia, despite the existence of a hiliar vascularization. Some authors refer bile duct ischemia after ligation of the common hepatic artery (19). The revascularization is essential if there is a commitment aberrant right hepatic artery, aberrant common hepatic artery or an accessory RHA with a high flow to the right lobe.…”

Does Aberrant Hepatic Arterial Anatomy Affect Resection Margin Status In Pancreaticoduodenectomy For Pancreatic Adenocarcinoma?

“…Secondly, once the gastroduodenal artery (GDA) is ligated the arterial supply to the bile duct is heavily reliant on branches of the right hepatic artery which, if sacrificed, renders the proximal common bile duct and therefore bilioenteric anastomosis vulnerable to ischaemia with subsequent breakdown or structuring [14,15]. Finally, attempts to preserve the vessel while ensuring oncological clearance may damage the adventitia increasing the risk of pseudoaneurysm formation and postoperative haemorrhage especially in the setting of a pancreatic fistula or intra-abdominal collections [10,16].…”