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How to deal with right hepatic artery coming from the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review

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Hepatobiliary & Pancreatic Diseases International 2023年第2期22卷 121-127页

作者： Andrea Chierici Antonio Castaldi Mohamed El Zibawi Edoardo Rosso Antonio Iannelli Service de Chirurgie Digestive Centre Hospitalier d’Antibes Juan-les-PinsAntibesFrance Department of Digestive Surgery and Liver Transplantation University Hospital Center of NiceNiceFrance Department of Radiology University Hospital Center of NiceNiceFrance Department of Surgery Centre Hospitalier de LuxembourgLuxembourgLuxembourg Faculty of Medicine UniversitéCôte d’AzurNiceFrance Inserm U1065Team 8’Hepatic Complications of Obesity and Alcohol’NiceFrance

Background: Anatomical variations in the liver arterial supply are quite common and can affect the surgical strategy when performing a minimally invasive pancreaticoduodenectomy(MIPD). Their presence must be preemptively detected to avoid postoperative liver and biliary complications. Data sources: Following the PRISMA guidelines and the Cochrane protocol we conducted a systematic review on the management of an accessory or replaced right hepatic artery(RHA) arising from the superior mesenteric artery when performing an MIPD. Results: Five studies involving 118 patients were included. The most common reported management of the aberrant RHA was conservative(97.0%);however, patients undergoing aberrant RHA division without reconstruction did not develop liver or biliary complications. No differences in postoperative morbidity or long-term oncological related overall survival were reported in all the included studies when comparing MIPD in patients with standard anatomy to those with aberrant RHA. Conclusions: MIPD in patients with aberrant RHA is feasible without increase in morbidity and mortality. As preoperative strategy is crucial, we suggested planning an MIPD with an anomalous RHA focusing on preoperative vascular aberrancy assessment and different strategies to reduce the risk of liver ischemia.

关键词： Pancreatic cancer Pancreaticoduodenectomy hepatic artery Superior mesenteric artery

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Angiographic Findings of Extrahepatic Branches Originating from hepatic artery and Its Clinical Significance

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Chinese Journal of Cancer Research 2009年第1期21卷 61-67页

作者： Xiao-dong Wang Ren-jie Yang Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education） Department of Interventional Therapy Peking University School of Oncology Beijing Cancer Hospital ＆ Institute Beijing 100036 China

Objective： To observe the presentation and variation of extrahepatic branches originating from hepatic artery by hepatic arteriography. Methods： hepatic arteriogram of 200 cases with unresectable hepatic primary or metastatic tumors before interventional therapy were retrospectively analyzed. Two interventional radiologists independently reviewed the type, originating artery, distribution and variation of extrahepatic artery. Results： Five types of extrahepatic artery were found, with the most common type of the right gastric artery （n=156, 78%）, followed by the cystic artery （n=126, 63%）, accessory left gastric artery （n=19, 9.5%）, hepatic falciform artery （n=5, 2.5%）, and accessory left inferior phrenic artery （n=4, 2%）. In 188 cases, there were extrahepatic arteries derived from hepatic proper artery or its branches, and the most frequent originating site was the right hepatic artery （130 extrahepatic branches）, followed by the proper hepatic artery （103 branches）, left hepatic artery （56 branches） and middle hepatic artery （3 branches）. The left hepatic artery was the arising site with the multiple types of extrahepatic branches including all above branches except the cystic artery. Conclusion： Many types of extrahepatic branches usually derive from the hepatic artery or its distal branches, and its originating sites are not constant. It is important to avoid damage of extrahepatic tissue during interventional therapy for liver tumors.

关键词： hepatic artery Angiography, accessory left gastric artery hepatic falciform artery Interventional therapy

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Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting

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World Journal of Gastroenterology 2006年第35期12卷 5733-5734页

作者： Cynthia Sudar Singh Kamini Giri Renuka Gupta Mohammed Aladdin Harinder Sawhney Department of Medicine WyckoffHeights Medical Center Brooklyn New York United States

A 41-year old alchoholic male with a history of chronic pancreatitis was admitted for nausea, vomiting and weight loss. Angiogram was performed and demonstrated an aneurysmal sac with a narrow neck originating from the inferior aspect of the distal portion of the proper hepatic artery. The origin of the pseudoaneurysm was covered with a 5 mm × 2.5 cm Viabahn cover stent （Gore）. A repeat angiogram showed some leak and a second stent （6 mm × 2.3 cm） was deployed and overlapped with the first stent by 3 mm. Contrast was injected and a repeat angiogram demonstrated complete exclusion of the aneurysm. A repeat computerized axial tomography （CAT） scan of the abdomen after 24 h showed successful stenting. The patient had an uneventful post-operative course.

关键词： hepatic artery Aneurysm Stents

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Stent-grafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy

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World Journal of Gastroenterology 2010年第29期16卷 3716-3722页

作者： Mao-Qiang Wang Feng-Yong Liu Feng Duan Zhi-Jun Wang Peng Song Qing-Sheng Fan Department of Interventional Radiology Chinese PLA General HospitalBeijing 100853China

AIM:To present a series of cases with life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm after pancreaticoduodenectomy(PD) treated with placement of ***:Massive hemorrhage from ruptured hepatic artery pseudoaneurysm after PD in 9 patients(6 men,3 women) at the age of 23-75 years(mean 48 years),were treated with placement of percutaneous endovascular balloon-expandable coronary *** patients were not suitable for embolization because of a non-patent portal *** or more stent-grafts,ranging 3-6 mm in diameter and 16-55 mm in length,were placed to exclude ruptured *** data,including clinical condition,liver function tests,and Doppler ultrasound examination,were recorded at the outpatient ***:Immediate technical success was achieved in all the 9 *** stent-grafts were deployed in the intended position for immediate cessation of bleeding and preservation of satisfactory hepatic arterial blood *** significant procedure-related complications *** bleeding occurred in 2 patients at 16 and 24 h,respectively,after placement of stent-grafts and treated with surgical *** patient died of sepsis 12 d after the interventional *** remaining 6 patients were survived when they were *** mean follow-up time was 10.5 mo(range 4-16 mo).No patient had recurrent bleeding after *** ultrasound examination verified the patency of hepatic artery and stent-grafts during the ***:Placement of stent-grafts is an effective and safe procedure for acute life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm.

关键词： Pancreaticoduodenectomy Hemorrhage hepatic artery Pseudoaneurysm Stent-graft

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Mesenteric Ischemia:An unusual presentation of fistula between superior mesenteric artery and common hepatic artery

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World Journal of Gastroenterology 2004年第17期10卷 2605-2606页

作者： Ertugrul Kayacetin Serdar Karakse Aydin Karabacakoglu Dilek Emlik Department of Gastroenterology Meram Medical FacultySelcuk UniversityKonya-Turkey Department of Radiology Meram Medical FacultySelcuk UniversityKonya-Turkey

Chronic mesenteric ischemia is an uncommon condition associated with a high morbidity and *** reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistula betwee... 详细信息

关键词： Adult Angiography Arterio-Arterial Fistula Female hepatic artery Humans Ischemia Mesenteric artery, Superior

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Delayed hemorrhage from hepatic artery after ultrasound-guided percutaneous liver biopsy: A case report

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World Journal of Gastroenterology 2006年第26期12卷 4273-4275页

作者： Fen-Yu Ren Xi-Xu Piao Ai-lian Jin Department of Gastroenterology and Hepatology Yanbian University Hospital Yanji 133000 Jilin Province China

Percutaneous liver biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. Pseudoaneurysm of hepatic artery is an unusual complication after ultrasound-guided percutaneous liver biopsy. Delayed hemorrhage occurs much less frequently. We report a case of pseudoaneurysm of the hepatic artery of a 46-year-old man who was admitted for abdominal pain after 4 d of liver biopsy. The bleeding was controlled initially by angiographic embolization. However, recurrent bleeding could not be controlled by repeat angiography, and the patient died 4 d after admission from multiorgan failure. The admittedly rare possibility of delayed hemorrhage should be considered whenever a liver biopsy is performed.

关键词： Hemorrhage hepatic artery Percutaneous liver biopsy

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Dealing with hepatic artery traumas:A clinical literature review

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World Journal of Clinical Cases 2021年第28期9卷 8425-8440页

作者： Osman Nuri Dilek Arif Atay Department of General Surgery Division of Hepatopancreatobiliary Surgeryİzmir Katip Celebi University School of Medicineİzmir 35150Turkey Department of Surgery İzmir Katip Celebi University School of Medicineİzmir 35150Turkey

BACKGROUND The hepatic artery(HA)is one of the most threatened vascular structures during hepatopancreatobiliary(HPB)surgeries and interventional *** can be affected by many clinical pictures,especially tumors,due to its anatomical position and *** To reveal the evolution and recent developments in the management of HA traumas in the light of the *** In this article,100 years of MEDLINE(PubMed)literature and articles including cases and series of HA injuries were reviewed,and the types of injury occurrence,treatment,and related complications and their management were *** The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies,among the most common *** anatomy shows anomalies in approximately 15%-25%of the cases,further increasing this *** incidence of HA injury is not precisely *** that have evolved in recent years in managing patients with HA injury(laceration,transection,ligation,resection)with severe morbidity and mortality risk are reviewed in light of the current *** In conclusion,complications and deaths due to HA injury are less common *** risk of complications increases in patients with hemodynamic instability,jaundice,cholangitis,and *** the variations in the preoperative radiological evaluation will reduce the *** cases where HA injury is detected,arterial flow continuity should be tried to maintain with primary anastomosis,arterial transpositions,or *** cases where bile duct injury develops,patients should be directed to HPB surgery centers,considering the possibility of accompanying HA ***-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.

关键词： hepatic artery Injury Anomaly Ligation Resection Reconstruction

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

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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 to the hepatic artery may affect liver perfusion,resulting in necrosis,liver abscess,and even liver *** 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 ***,despite the potential risks,planned artery resection has become acceptable in carefully selected *** reconstruction is sometimes essential to prevent postoperative ischemic complications and can be performed using various *** 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 ***,we comprehensively reviewed the anatomical basis of hepatic artery variation,its incidence,and its effect on the surgical and oncological outcomes after pancreatic *** addition,we provide recommendations for the prevention and management of hepatic artery injury and liver ***,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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Effect of hepatic artery embolization on liver hypertrophy response in a rabbit liver VX2tumor model

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Hepatobiliary & Pancreatic Diseases International 2013年第6期12卷 622-629页

作者： Krijn P van Lienden Lisette T Hoekstra Jessica D van Trigt Joris J Roelofs Otto M van Delden Thomas M van Gulik Department of RadiologyAcademic Medical Center University of Amsterdam Department of Surgery (Surgical Laboratory)Academic Medical Center University of Amsterdam Department of PathologyAcademic Medical Center University of Amsterdam

BACKGROUND:Portal vein embolization not only induces hypertrophy of the non-embolized liver,but also enhances tumor *** latter could be prevented by embolizing the hepatic arteries supplying the tumor-bearing liver *** study aimed to determine the effects of transcatheter arterial embolization(TAE)on tumor volume and liver regeneration in a rabbit VX2 tumor ***:Twenty-three rabbits underwent subcapsular tumor implantation with a VX2 *** weeks after implantation,18 rabbits were used for TAE experiments,5were for sham *** response and liver regeneration response of the embolized cranial and non-embolized caudal liver lobes were assessed by CT volumetry,liver to body weight index,and the amount of proliferating ***:All super-selective arterial tumor embolization procedures were performed *** embolization,the tumor volume increased after an initial steady *** tumor volume after embolization was smaller than that of the sham group,but this difference was not *** necrosis of the tumor,however,was seen after embolization,without damage of the surrounding liver *** was a significant atrophy response of the tumor bearing cranial lobe after super-selective arterial embolization of the tumor with a concomitant hypertrophy response of the non-embolized,caudal *** regeneration response was confirmed histologically by a significantly higher number of proliferating hepatocytes on the Ki-67 stained ***:Super-selective,bland arterial coil embolization causes massive necrosis of the tumor,despite increase of volume on CT *** of the tumor bearing liver lobe is seen after arterial embolization of the tumor with a concomitant hypertrophy response of the non-embolized lobe,despite absence of histological damage of the tumor-surrounding liver parenchyma.

关键词： hypertrophy liver regeneration animal model transarterial embolization hepatic artery

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Single organ hepatic artery vasculitis as an unusual cause of epigastric pain:A case report

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World Journal of Clinical Cases 2022年第26期10卷 9384-9389页

作者： Rojin Kaviani Jessica Farrell Natasha Dehghan Sarvee Moosavi Internal Medicine University of British ColumbiaVancouver V5Z 1M9British ColumbiaCanada Division of Radiology Providence Health CareVancouver V5T 3N4British ColumbiaCanada Division of Rheumatology Providence Health CareVancouver V5T 3N4British ColumbiaCanada Division of Gastroenterology University of British ColumbiaVancouver V6Z 2K5British ColumbiaCanada

BACKGROUND Single-organ vasculitis(SOV)is characterized by inflammation of a blood vessel,affecting one organ,such as the skin,genitourinary system,or the aorta without systemic *** SOV is rare,with hepatic artery involvement reported only in two prior published ***,we presented a case of isolated hepatic artery vasculitis presenting after Pfizer-BioNTech mRNA corona virus disease 2019(COVID-19)*** SUMMARY A 50-year-old woman with hypertension presented to our Emergency Department with recurrent diffuse abdominal pain that localized to the epigastrium and emesis without diarrhea that began eight days after the second dose of the PfizerBioNTech COVID-19 *** work revealed an elevated C-reactive protein(CRP)of 19 mg/L(normalhepatic artery vasculitis.A detailed review of her history and examination did not reveal infectious or systemic autoimmune causes of her *** extensive autoimmune panel was ***-19polymerase chain reaction nasopharyngeal swab,human immunodeficiency virus,viral hepatitis and Heliobacter pylori serology were *** six months,the patient’s symptoms,and blood work spontaneously *** High clinical suspicion of SOV is required for diagnosis in patients with acute abdominal pain and dyspepsia.

关键词： Single organ vasculitis hepatic artery gastrointestinal vasculitis COVID-19 vaccine hepatic artery vasculitis Case report

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