Partial portal arterialization for dearterialized liver after hepatectomy

Abstract

Following a portacaval shunt, portal arterialization has been used to avoid a decrease in hepatic blood flow',*. In 1992 Iseki and colleagues3 described partial portal arterialization to raise the portal oxygen pressure for the prevention of liver necrosis due to obstruction of the hepatic artery after extended pancreatobiliary surgery. The authors carried out partial portal arterialization using the ileocolic artery and vein to prevent postoperative hepatic failure resulting from obstruction of the hepatic artery after hepatectomy. The technique of and indications for partial portal arterialization following hepatectomy are reported. Surgical techniqueAfter major hepatectomy, the ileocaecal region is mobilized. The ileocolic artery and vein are exposed at the proximal portion of the marginal vessels and are anastomosed with a side-to-side continuous suture using 7/0 polypropylene under a loupe. This technique is simple and easy.This method was applied for three major hepatectomies. The reasons for poor blood flow of the hepatic artery to the remnant liver were failure of the arterial reconstruction, insufficient collateral formation after obstruction of the proper hepatic artery, and inability to reconstruct the hepatic artery.The postoperative course was uneventful in the first and the third cases; the second patient died from pulmonary oedema and the effect of the method was not evaluated. In the first patient, postoperative angiography on day 43 after operation demonstrated obstruction of the anastomosis. In the third patient, postoperative angiography on the 29th postoperative day showed a patent anastomosis and no reflux to the splenic vein (Fig. 1). Upper gastrointestinal endoscopy indicated no oesophageal varices at 6 months after surgery. Haemolysis and ascites due to portal hypertension did not occur in patients 1 and 3.

Prediction, prevention and management of postresection liver failure

“…Portal vein thrombosis has also been implicated in the development of PLF. In these rare cases of inflow and outflow thrombosis with PLF, a decision must be made regarding the benefit of surgical or radiological thrombectomy or dissolution versus anticoagulation129–131.…”

Portal vein arterialization: a salvage procedure for a totally de-arterialized liver. The Paul Brousse Hospital experience

“…Subsequently, the references in the articles identified in the search were examined to identify any further series of patients submitted to PVA. The use of PVA in LT and HPB surgery was reported in 61 patients in 26 relevant studies (excluding the present series of 16 patients) between 1993 and mid‐2012, each of which referred to one to six patients . Studies that referred to those patients submitted to PVA and to arterial reconstruction, in whom physiological arterial inflow was thus maintained (25 patients in the LT setting and none in the HPB setting) were excluded .…”

Studying Liver Regeneration by Means of Molecular Biology: How Far We Are in Interpreting the Findings?

“…In such a large scale hepatectomies additional measures are employed to increase the survival rate. These include high energy diets or portal vein arterialization in experimental and clinical settings (9,40,42).…”