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Clinical significance of variant hepatic artery in pancreatic resection:A comprehensive review

World Journal of Gastroenterology 2022年第19期28卷 2057-2075页

作者： Ye-Cheng Xu Feng Yang De-Liang Fu Department of Pancreatic Surgery Huashan HospitalShanghai 200040China Department of Pancreatic Surgery Pancreatic Disease InstituteHuashan HospitalShanghai 200040China

The anatomical structure of the pancreaticoduodenal region is complex and closely related to the surrounding vessels.A variant of the hepatic artery,which is not a rare finding during pancreatic surgery,is prone to intraoperative injury.Inadvertent injury to the hepatic artery may affect liver perfusion,resulting in necrosis,liver abscess,and even liver failure.The preoperative identification of hepatic artery variations,detailed planning of the surgical approach,careful intraoperative dissection,and proper management of the damaged artery are important for preventing hepatic hypoperfusion.Nevertheless,despite the potential risks,planned artery resection has become acceptable in carefully selected patients.arterial reconstruction is sometimes essential to prevent postoperative ischemic complications and can be performed using various methods.The complexity of procedures such as pancreatectomy with en bloc celiac axis resection may be mitigated by the presence of an aberrant right hepatic artery or a common hepatic artery originating from the superior mesenteric artery.Here,we comprehensively reviewed the anatomical basis of hepatic artery variation,its incidence,and its effect on the surgical and oncological outcomes after pancreatic resection.In addition,we provide recommendations for the prevention and management of hepatic artery injury and liver hypoperfusion.Overall,the hepatic artery variant may not worsen surgical and oncological outcomes if it is accurately identified pre-operatively and appropriately managed intraoperatively.

关键词： Hepatic artery Pancreatectomy Pancreaticoduodenectomy arterial reconstruction Celiac axis resection Outcome Prognosis

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Visceral debranching followed by chemotherapy and resection for locally advanced pancreatic cancer with arterial invasion: case report

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胰腺病学杂志(英文) 2022年第3期05卷 134-136页

作者： Ronellenfitsch Ulrich Rebelo Artur Kleeff Jorg Department of Visceral Vascular and Endocrine Surgery 3. University Hospital Halle (Saale) 4. Martin-Luther-University Halle-Wittenberg 5. Halle (Saale) 6. Germany

The oncological outcome of patients with locally advanced pancreatic cancer continues to be dismal. Abutment or invasion of visceral arteries, which constitutes irresectability according to the consensus of the International Association of Pancreatology and can be found in a considerable proportion of patients upon initial diagnosis, usually precludes complete resection in curative intent. Simultaneous tumor resection and arterial reconstruction are associated with relevant morbidity and mortality. Here, we present a case in which a therapeutic split was done so that isolated arterial reconstruction (visceral debranching with an iliacohepatic bypass graft) preceded neoadjuvant FOLFIRINOX chemotherapy and subsequent multivisceral tumor resection. Despite several perioperative vascular complications, which were addressed by surgical and endovascular techniques, the patient had a favorable outcome of the operations and is tumor-free after 8 months of follow-up. The feasibility and safety of this novel therapeutic strategy of a therapeutic split with isolated visceral debranching as the first treatment step is currently evaluated in a clinical trial (PREVADER, NCT04136769).

关键词： arterial reconstruction Pancreatic cancer Preoperative chemotherapy Therapeutic split

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A liver donor with double hepatic artery aneurysm: a saved graft

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Hepatobiliary & Pancreatic Diseases International 2015年第4期14卷 443-445页

作者： Vincenzo Tondolo Alberto Manzoni Fausto Zamboni Division of General Surgery and Transplantation Department of Surgery Brotzu Hospital

The shortage of organs and the increasing median age of deceased donors for orthotropic liver transplantation stimulate transplant centres to accept grafts that otherwise would have been discarded due to severe vascular abnormali- ties. We encountered a donor with two arterial aneurysms and a left accessory hepatic artery： an arterial aneurysm of the common hepatic artery and a left accessory hepatic artery arising from a second aneurysm of the left gastric artery （Mi- chels type V）. A complex reconstruction was created to trans- plant the liver. Multiple arterial anastomosis was made and the hepatic inflow of the transplanted liver restored. Although the procedure increased the risk of hepatic artery thrombosis, one more organ supposed to be discarded was saved.

关键词： liver transplantation anastomosis anatomy hepatic aneurysm arterial reconstruction

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Back-table surgery pancreas allograft for transplantation:Implications in complications

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World Journal of Transplantation 2021年第1期11卷 1-6页

作者： Javier Briceño Juan Manuel Sánchez-Hidalgo Alvaro Arjona-Sanchez Department of General and Digestive Surgery Reina Sofia University HospitalCordoba 14004Spain

To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique.Back-table surgery for pancreatic graft is a complex,meticulous and laborious technique on which the success of implant surgery and perioperative results depends.The technique can be described in the following steps:Preparation of the sterile table,ex-situ inspection of the pancreasspleen block,management of the duodenum,identification of the bile duct,preparation of the portal vein,preparation of the own graft arteries and anastomosis to the arterial graft,spleen management and graft preservation prior to implantation in the recipient.A careful inspection of the pancreas-spleen block should be performed.It is important to identify the stump of the main bile duct,the portal vein cuff,and the arrangement of the superior mesenteric artery and splenic artery.The redundant duodenum must be removed.The availability of a good venous cuff facilitates the portal vein anastomosis and the positioning of the graft,two key points to prevent thrombosis.The section line of the arteries must be clean,without atherosclerosis,to prevent arterial thrombosis.The superior and splenic mesenteric arteries are generally separated by dense fibrolymphatic tissue.The artery can be reconstructed by interposing a"Y"graft from the donor iliac artery;or with an end-to-end anastomosis between the splenic artery and the superior mesenteric artery.An exquisite technique of bench work helps to prevent the most feared complications of pancreas transplantation:Thrombosis and graft pancreatitis.

关键词： Pancreas transplantation Back-bench work Pancreas thrombosis Graft pancreatitis arterial reconstruction Pancreas allograft

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