The Blood Supply of the Biliary Ductal System and Its Relevance to Vasculobiliary Injuries Following Cholecystectomy

Vellar, Ivo D.

doi:10.1046/j.1440-1622.1999.01702.x

Cited by 87 publications

(72 citation statements)

References 6 publications

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“…10 The supraduodenal CBD including CHD is primarily supplied by 6-8 small arteries of about 0.30 mm in diameter having a longitudinal ascending or descending course and anastomosing with each other. The most prominent axial vessels run along the lateral borders and named as 3 o'clock and 9 o'clock arteries, 7,11 right and left arch arteries, 12 right and left marginal arteries 8 [ Figure 2]. Ascending branches arise from the posterior superior pancreaticoduodenal artery (PSPDA -frequently mentioned as retroduodenal artery in earlier literature), supraduodenal artery, gastroduodenal artery (GDA) and retroportal artery, while descending branches come from right hepatic artery (RHA), cystic artery.…”

Section: Arterial Supply Of Biliary Tractmentioning

confidence: 99%

“…A marginal artery on the posterior surface of CBD, probably similar to the retroportal artery, was also reported in few cases. 11 Rath et al 12 described three patterns of arterial vascularization named as axial pattern with right and left arches, ladder pattern with horizontally directed branches and mixed pattern [ Figure 3]. The left marginal artery (3 o'clock artery) is present in 95% cases 8 and arises inferiorly from PSPDA or GDA and joins the RHA superiorly.…”

Section: Arterial Supply Of Biliary Tractmentioning

confidence: 99%

“…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%

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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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Section: Arterial Supply Of Biliary Tractmentioning

confidence: 99%

Section: Arterial Supply Of Biliary Tractmentioning

confidence: 99%

Section: Arterial Supply Of Biliary Tractmentioning

confidence: 99%

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Biliary Tract Anatomy and its Relationship with Venous Drainage

Babu¹,

Sharma

2014

Journal of Clinical and Experimental Hepatology

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“…In contrast, the arterial supply of hilar bile duct is a collateral system, where the right and left hepatic arteries communicate freely via the hilar plate arterial plexus. 12 Hence, ischemia seldom happens. The proximal bile duct stump should be dissected at the level of hepatic duct convergence, especially in the case of injury of the right hepatic artery.…”

Section: Discussionmentioning

confidence: 99%

A Promising Method for Repairing Low-Level Biliary Strictures After Cholecystectomy

Cheng

Huang

Dong

2015

International Surgery

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The purpose of this study is to introduce and evaluate a new technique of repairing bile ducts by the tubular gastric wall with a vascularized pedicle. Both the end-to-end bile duct repair and Roux-en-Y hepatoenterostomy have limitations in the treatment of benign bile duct strictures after cholecystectomy. There are no other good choices to manage these cases, especially the bile duct transection injuries or partly missing common bile duct or hepatic duct. Eleven patients with partly missing common bile ducts in the Chinese People's Liberation Army General Hospital between January 2007 and December 2012 were retrospectively analyzed. The study comprised 8 females and 3 males, whose age ranged from 29 to 56 years. All patients underwent successful bile duct repair. The time of operations ranged from 210 minutes to 240 minutes. The maximal blood loss was less than 220 ml. There was no perioperative mortality and no case of gastric fistula. Postoperative complications occurred in 3 patients, including wound infection, bile leakage, and erosive gastritis. All complications were cured by conservative treatment. The mean follow-up time was 42 months. One patient was classified as Terblanche's grade II and 10 patients were classified as Terblanche's grade I. The observations indicate that this technique is a feasible and effective choice to manage low level biliary stricture after cholecystectomy, especially suitable to repair bile duct transection injuries or partly missing common bile duct or hepatic duct.

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“…However, these arteries do not continue cranially into the right and left HDs. Vellar (4) showed that the 9 o'clock artery joins the right hepatic artery or one of its branches proximal to the right HD in most cases, whereas the 3 o'clock and the transverse hilar arteries terminate in the peribiliary plexus of the left/both HDs. Besides, the orientation and number of HDs in the graft are variable in more than half the cases, making 3 and 9 o'clock positions irrelevant.…”

mentioning

confidence: 99%

Targeting the Achilles' heel of adult living donor liver transplant: Corner‐sparing sutures with mucosal eversion technique of biliary anastomosis

et al. 2016

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Having performed over 2200 living donor liver transplantations (LDLTs), we read with interest the article by Vij et al. (1) Essentially, they have modified the hilar plate and Glissonian sheath approach we previously described, (2) by using corner-sparing sutures with mucosal eversion. They ascribe their low rate of biliary complications to the latter 2 steps. We wish to share our anatomic and practical reservations with their concept.Although mucosal eversion of the recipient duct is usually possible, it is less feasible in the donor hepatic ducts (HDs) which are often small and thin-walled.The more intriguing question is of the cornersparing sutures. The duct is supplied by the peribiliary plexus (2,3) between the hepatic duct wall and the hilar plate layers fed by pancreaticoduodenal, gastroduodenal, hepatic, and cystic arteries. The 3 and 9 o'clock arteries are in the wall of the extrahepatic bile duct. However, these arteries do not continue cranially into the right and left HDs. Vellar (4) showed that the 9 o'clock artery joins the right hepatic artery or one of its branches proximal to the right HD in most cases, whereas the 3 o'clock and the transverse hilar arteries terminate in the peribiliary plexus of the left/both HDs. Besides, the orientation and number of HDs in the graft are variable in more than half the cases, making 3 and 9 o'clock positions irrelevant.On the recipient side, in our last 445 LDLTs with at least 1-year follow-up, right and/or left HDs were used for anastomoses in 21%, cystic ducts in 6%, and common hepatic duct (CHD) or Roux loop in the rest. Even when the CHD is used, the bleeding 3 and 9 o'clock arteries either need suture ligation or get plugged with a clot. Hence, whether or not a suture is placed at the 3/9 o'clock positions, the marginal arteries are blocked during anastomosis. In our opinion, the major arterial supply comes from the peribiliary plexuses on both the donor and recipient sides, preserved by preserving the entire hilar plate.In this context, the rationale of the authors' cornersparing sutures is unclear. Their low complication rate could be due to increasing surgical experience and stricter selection of donors based on biliary anatomy (not specified).With our technique, (2) the current early (<3 months) and overall biliary complication rates are 6.1% and 8.9% (445 LDLTs, no donor excluded based on biliary anatomy; single/multiple ducts, 242/203), respectively.

show abstract

The Blood Supply of the Biliary Ductal System and Its Relevance to Vasculobiliary Injuries Following Cholecystectomy

Cited by 87 publications

References 6 publications

Biliary Tract Anatomy and its Relationship with Venous Drainage

Biliary Tract Anatomy and its Relationship with Venous Drainage

A Promising Method for Repairing Low-Level Biliary Strictures After Cholecystectomy

Targeting the Achilles' heel of adult living donor liver transplant: Corner‐sparing sutures with mucosal eversion technique of biliary anastomosis

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