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

Jiang, Jun; Wei, Jishu; Wu, Junli; Gao, Wentao; Li, Qiang; Jiang, Kuirong

doi:10.1155/2016/7427246

Cited by 4 publications

(3 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PVA was historically used in portal hypertension surgery in association with portocaval shunting. It seemed to attenuate the ischemic effect on cholangiocytes caused by a HA disruption, reducing cholestasis and proinflammatory cytokine production, ductular reaction, and fibrosis [4] in animal models.…”

Section: Discussionmentioning

confidence: 99%

Portal vein arterialization following a radical left extended hepatectomy for Klatskin tumor: A case report

Basso

Meniconi

Usai

et al. 2021

Ann Hepatobiliary Pancreat Surg

View full text Add to dashboard Cite

Portal vein arterialization (PVA) has been attracting attention for its role as a salvage inflow technique in various clinical applications. Initially performed in shunt surgery for portal hypertension, with the aim of preventing a decreased hepatic inflow, it is largely used in case of hepatic artery thrombosis in the transplantation domain or in the enlarged radical operations in case of hilar cancer invading the hepatic artery. A 62-year-old man underwent a left extended hepatectomy with hepatic bile duct resection and right Roux-en-Y hepaticojejunostomy for hilar cholangiocarcinoma. Computed tomography scan on postoperative day (POD) 5 revealed right hepatic artery pseudo-aneurysm, which was confirmed by an angiography. Stent placement was infeasible. Coiling of the pseudoaneurysm was associated with a risk of complete occlusion inducing critical liver failure. Since his general conditions were deteriorated, the patient underwent an emergency laparotomy. Hepatic artery reconstruction was impossible. Thus, a PVA was performed by anastomosing the ileocecal artery and vein. The intraoperative ultrasound showed satisfactory patency of the PVA with good portal flow in the absence of arterial flow. Doppler ultrasound on POD 15 showed that the cross-sectional area and blood flow of the portal vein were increased. The patient was discharged on POD 54 in good general condition. Hepatic artery disruption represents potentially lethal complications of hepatic, biliary, and pancreatic surgery. PVA may be a feasible therapeutic strategy to guarantee arterial inflow to the remnant liver. Although PVA is a salvage surgical procedure, increased portal flow should be controlled to avoid portal hypertension and liver fibrosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Portal vein arterialization following a radical left extended hepatectomy for Klatskin tumor: A case report

Basso

Meniconi

Usai

et al. 2021

Ann Hepatobiliary Pancreat Surg

View full text Add to dashboard Cite

show abstract

“…An important finding of our study is the degenerative changes in the later stages of the experiment of the muscular membrane of the wall of the common bile duct. Experiments have shown that damage to the muscular layer of the bile duct leads to the development of liver cirrhosis [16,19,28,33] and even hepatocellular carcinoma [1,30]. Significant collagen deposition, portal fibrosis, periductal edema, lymphocytic inflammation, dilatation of all bile ducts, blind end of small bile ducts, cholestasis (bile corks), increased systemic oxidative stress, and fibrosis were observed in rats after ligature was applied to the common bile duct, which eventually leads to liver cirrhosis [15,32].…”

Section: Discussionmentioning

confidence: 99%

Morphological features of the wall of common bile duct under the conditions of experimental opioid exposure

2020

View full text Add to dashboard Cite

The morphological condition of the bile ducts remains one of the most important problems of modern medical science. In order to obtain an analgesic effect in patients with acute cholangitis, opioids are often used. However, information on the effectiveness of opioids in the treatment of pathological conditions of the bile ducts is contradictory. The rapidly progressive destruction of the intrahepatic bile ducts associated with the use of narcotic agents has been described. Further study of the effect of opioids on the structural organization of the common bile duct is relevant. In order to establish the morphological state of the common bile duct under conditions of long-term opioid exposure, a study was performed on 24 sexually mature white male rats, aged 3.5-5.0 months and weighing 180-200 g, which were injected intramuscularly with Nalbuphine for 6 weeks. The study material is represented by histological specimens of the common bile duct of white rats. The “Aver Media” computer system was used to photograph microspecimens. The “ImageJ” computer program was used to measure the diameter of the lumen and the wall thickness of the common bile duct. After 2 weeks of Nalbuphine administration to white rats, plethora of wall microvessels and a significant increase in the longitudinal diameter of the lumen of the common bile duct were observed. After 4 weeks of the experiment, the common bile duct was dilated, the transverse and longitudinal diameters of its lumen almost doubled, pathological changes in its wall had all the signs of inflammation. In the later stages of the experiment (introduction of Nalbuphine for 6 weeks), the pathological changes increased and manifested by destructuring the wall of the common bile duct, disorganization of cholangiocytes, thinning of the cell layer due to detachment of cholangiocytes, polymorphism of their nuclei, destruction of intercellular junctions, stratification of its own plate, vacuolar dystrophy of the muscular membrane “varicose” expansion of venules, significant smooth muscle hyperplasia of arterioles, the presence of perivascular lymphocytic infiltrates in the duct wall.

show abstract

“…[45][46][47][48][49] Moreover, cholestasis, bile duct injury, inflammation, energy state due to elevation in ATP content, hypoxia and hypoxia-associated gene changes were reported to be decreased with PVA compared to liver de-arterialization without reconstruction. 50,51 The hepatic artery provides the main oxygen supply to the biliary tract. 10 The liver parenchyma and hepatocytes are supplied with oxygen from both the hepatic artery and the portal vein.…”

Section: Pathophysiologic Changes After Portal Vein Arterializationmentioning

confidence: 99%

Portal vein arterialization as a salvage procedure in hepatopancreatobiliary surgery: a systematic review

Majlesara

Ghamarnejad

Khajeh

et al. 2021

cjs

View full text Add to dashboard Cite

Background: Portal vein arterialization (PVA) is a possible option when hepatic artery reconstruction is impossible during liver resection. The aim of this study was to review the literature on the clinical application of PVA in hepatopancreatobiliary (HPB) surgery. Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the PubMed, Embase and Web of Science databases until December 2019. Experimental (animal) studies, review articles and letters were excluded. Results: Twenty studies involving 57 patients were included. Cholangiocarcinoma was the most common indication for surgery (40 patients [74%]). An end-to-side anastomosis between a celiac trunk branch and the portal vein was the main PVA technique (35 patients [59%]). Portal hypertension was the most common longterm complication (12 patients [21%] after a mean of 4.1 mo). The median followup period was 12 (range 1–87) months. The 1-, 3- and 5-year survival rates were 64%, 27% and 20%, respectively. Conclusion: Portal vein arterialization can be considered as a rescue option to improve the outcome in patients with acute liver de-arterialization when arterial reconstruction is not possible. To prevent portal hypertension and liver injuries due to thrombosis or overarterialization, vessel calibre adjustment and timely closure of the anastomosis should be considered. Further prospective experimental and clinical studies are needed to investigate the potential of this procedure in patients whose liver is suddenly de-arterialized during HPB procedures.

show abstract

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

Cited by 4 publications

References 44 publications

Portal vein arterialization following a radical left extended hepatectomy for Klatskin tumor: A case report

Portal vein arterialization following a radical left extended hepatectomy for Klatskin tumor: A case report

Morphological features of the wall of common bile duct under the conditions of experimental opioid exposure

Portal vein arterialization as a salvage procedure in hepatopancreatobiliary surgery: a systematic review

Contact Info

Product

Resources

About