The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries

Gunji, Hisashi; Cho, Akihiro; Tohma, Takayuki; Okazumi, Shinichi; Makino, Harufumi; Shuto, Kiyohiko; Mochizuki, Ryouyu; Matsubara, Katsuhiko; Hayano, Kouichi; Mori, Chisato; Murakami, Gen; Ochiai, Takenori

doi:10.1016/j.amjsurg.2006.01.046

Cited by 75 publications

(45 citation statements)

References 30 publications

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“…2). 14,15 Our first hypothesis-the use of alternative techniques in pediatric LT contributes to an increased incidence of BCs-was not confirmed by this study because the graft type was not found to be an independent risk factor for the development of BCs. Independently of the type of graft, most of the BCs were anastomotic complications (61%).…”

Section: Discussionmentioning

confidence: 61%

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

et al. 2014

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Biliary complications (BCs) still remain the Achilles heel of liver transplantation (LT) with an overall incidence of 10% to 35% in pediatric series. We hypothesized that (1) the use of alternative techniques (reduced size, split, and living donor grafts) in pediatric LT may contribute to an increased incidence of BCs, and (2) surgery as a first treatment option for anastomotic BCs could allow a definitive cure for the majority of these patients. Four hundred twenty-nine primary pediatric LT procedures, including 88, 91, 47, and 203 whole, reduced size, split, and living donor grafts, respectively, that were performed between July 1993 and November 2010 were retrospectively reviewed. Demographic and surgical variables were analyzed, and their respective impact on BCs was studied with univariate and multivariate analyses. The modalities of BC management were also reviewed. The 1-and 5-year patient survival rates were 94% and 90%, 89% and 85%, 94% and 89%, and 98% and 94% for whole, reduced size, split, and living donor liver grafts, respectively. The overall incidence of BCs was 23% (n 5 98). Sixty were anastomotic complications [47 strictures (78%) and 13 fistulas (22%)]. The graft type was not found to be an independent risk factor for the development of BCs. According to a multivariate analysis, only hepatic artery thrombosis and acute rejection increased the risk of anastomotic BCs (P < 0.001 and P 5 0.003, respectively). Anastomotic BCs were managed primarily with surgical repair in 59 of 60 cases with a primary patency rate of 80% (n 5 47). These results suggest that (1) most of the BCs were anastomotic complications not influenced by the type of graft, and (2) the surgical management of anastomotic BCs may constitute the first and best therapeutic option. Liver Transpl 20:893-903, 2014. V C 2014 AASLD.

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Section: Discussionmentioning

confidence: 61%

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

et al. 2014

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“…18 On the left side the communicating arcade originates from segment IV artery (54%) or left hepatic artery (45%) and on the right side from right anterior sectoral artery (46%) or right hepatic artery (27%) or both (27%). 16,17 Vellar 11 has also reported that segment IV artery was the most important source of blood supply to left hepatic duct.…”

Section: Arterial Supply Of Biliary Tractmentioning

confidence: 96%

“…14 The blood supply of the cystic and hilar hepatic ducts come from cystic artery and right and left hepatic arteries forming a hilar plexus which can provide collateral connections between the right and left livers. 11,15 An extrahepatically located communicating arcade connecting left and right hepatic arteries not only plays an important role in the blood supply of caudate lobe and hilar bile ducts but also in the interlobar arterial collateral system 16,17 [ Figure 5]. The communicating arcade has been named as caudate arcade 15 or transverse hilar marginal artery.…”

Section: Arterial Supply Of Biliary Tractmentioning

confidence: 99%

Biliary Tract Anatomy and its Relationship with Venous Drainage

Babu¹,

Sharma

2014

Journal of Clinical and Experimental Hepatology

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Portal cavernoma develops as a bunch of hepatopetal collaterals in response to portomesenteric venous obstruction and induces morphological changes in the biliary ducts, referred to as portal cavernoma cholangiopathy. This article briefly reviews the available literature on the vascular supply of the biliary tract in the light of biliary changes induced by portal cavernoma. Literature pertaining to venous drainage of the biliary tract is scanty whereas more attention was focused on the arterial supply probably because of its significant surgical implications in liver transplantation and development of ischemic changes and strictures in the bile duct due to vasculobiliary injuries. Since the general pattern of arterial supply and venous drainage of the bile ducts is quite similar, the arterial supply of the biliary tract is also reviewed. Fine branches from the posterior superior pancreaticoduodenal, retroportal, gastroduodenal, hepatic and cystic arteries form two plexuses to supply the bile ducts. The paracholedochal plexus, as right and left marginal arteries, run along the margins of the bile duct and the reticular epicholedochal plexus lie on the surface. The retropancreatic, hilar and intrahepatic parts of biliary tract has copious supply, but the supraduodenal bile duct has the poorest vascularization and hence susceptible to ischemic changes. Two venous plexuses drain the biliary tract. A fine reticular epicholedochal venous plexus on the wall of the bile duct drains into the paracholedochal venous plexus (also called as marginal veins or parabiliary venous system) which in turn is connected to the posterior superior pancreaticoduodenal vein, gastrocolic trunk, right gastric vein, superior mesenteric vein inferiorly and intrahepatic portal vein branches superiorly. These pericholedochal venous plexuses constitute the porto-portal collaterals and dilate in portomesenteric venous obstruction forming the portal cavernoma. ( J CLIN EXP HEPATOL 2014;4:S18-S26) P ortal cavernoma develops as a bunch of dilated and tortuous hepatopetal collateral venous channels in response to portomesenteric venous obstruction and induces morphological changes in the biliary ducts, referred to as portal biliopathy or portal cavernoma cholagiopathy. Available literature suggest that the venous plexuses draining the bile duct and veins around the head of pancreas act as preferential collateral venous pathways and dilate to form the portal cavernoma. It is believed that anatomically distinct collateral venous channels are available in cases of portal venous obstruction involving portal vein alone or superior mesenteric and splenic veins also. This article is an attempt to review the existing literature on the venous drainage of biliary tract to understand the mechanisms of development of portal cavernoma. Arterial supply of the biliary tract is more extensively studied than the venous drainage and since the general pattern of arterial supply and venous drainage is similar, this article includes the review of arterial supply also. A...

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“…The hilar and intrahepatic ducts are nourished by the peribiliary vascular plexus, a network of capillaries arising form the terminal arterial branches. Thereby the hilar region of the bile ducts is supplied mostly via the communicating arcade (7) (Figure 2), although substantial anatomical variability exists (7). It is generally recommended to avoid denudation of the bile duct to preserve the biliary arterial supply.…”

Section: Vascular Supply Of the Biliary Tract And Clinical Implicatiomentioning

confidence: 99%

“…Further preparation of the right and left hepatic arteries increases the risk of injury to biliary arteries, which eventually arise very proximally. The communicating arcade arises at a mean of 2.5 ± 0.8 cm (range 1.0 to 4.0 cm) from the origin of the right hepatic artery and 1.8 ± 0.8 cm (range 0.5 to 4.0 cm) from the origin of the left hepatic artery (7), which has to be respected especially in partial LT.…”

Section: Vascular Supply Of the Biliary Tract And Clinical Implicatiomentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

247

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries

Cited by 75 publications

References 30 publications

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

Biliary Tract Anatomy and its Relationship with Venous Drainage

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

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