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

Abstract

Portal vein arterialization results in acceptable rates of survival in relation to spontaneous outcomes in patients with completely de-arterialized livers. The management of complications (especially PHT) after the procedure is challenging. Portal vein arterialization may represent a salvage option or a bridge to liver retransplantation and thus may make curative resection in locally advanced HPB cancers with vascular involvement feasible.

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“…First introduced in 1992 like a method to replace a damaged hepatic artery during major hepatobiliary surgery [3], PVA is becoming now a method to rescue the grafts in the field of liver transplantation, when an arterial thrombosis occur and there are no alternative ways to restore the arterial flow [2]. During these experiences it appeared evident that the Arterialization is not just useful to replace the hepatic artery flow, but also to reverse the necrosis that very often is linked to the thrombosis.…”

Impact of Age on Survival after Partial Portal Vein Arterialization for the Treatment of Post-Hepatectomy Liver Failure in a Rat Model

“…Moreover, it acknowledged that with increasing age, the liver tissue becomes more sensitive to ischemia-reperfusion injury and its regenerative capacity is reduced [2]. There is experimental [3][4][5][6] and clinical [7][8][9][10][11][12][13] evidence that the liver hyper-oxygenation through the partial portal vein arterialization (PPVA) enhances the regenerative capacity of the resected liver. This event is probably due to the improvement of the microcirculation flow and the tissue oxygen supply.…”

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

“…Some researchers propose that PV arterialization should be applied with caution due to its negative effects [14, 15]; therefore it is now mainly used in acute hepatic failure, HA, or PV thrombosis after liver transplantation and extensive hepatobiliary surgery [14, 16]. Considering the salutary effect of partial portal vein arterialization (PPVA) on hepatocytes [17, 18], it was hypothesized that PPVA could also protect cholangiocytes from acute ischemic injury.…”