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Toda T, Kanemoto H, Tokuda S, Takagi A, Oba N. Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting: A case report and review of literature. Medicine (Baltimore) 2021; 100:e27788. [PMID: 35049175 PMCID: PMC9191372 DOI: 10.1097/md.0000000000027788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Pancreaticoduodenectomy (PD) is a technically demanding procedure with high rates of morbidity and mortality. Therefore, preoperative evaluation of anatomy is indispensable. Multi-detector row computed tomography (CT) enables us to precisely understand arterial anatomy. It is a well-known fact that anatomical variants are often present in the hepatic artery (HA) but rarely in the gastroduodenal artery (GDA). We present the case of a patient with ampullary cancer with a rare anatomical anomaly, "replaced GDA (rGDA) " arising from the superior mesenteric artery, along with a history of coronary artery bypass grafting (CABG) using right gastroepiploic artery (RGEA). PATIENT CONCERNS A 69-year-old male patient was referred to our department for further investigation of elevated hepatobiliary enzymes. He presented with no symptoms besides intermittent fever of 38°C. He had an operative history of CABG using the RGEA. DIAGNOSIS Abdominal CT and esophagogastroduodenoscopy showed an ampullary tumor and biopsy specimen from the lesion revealed adenocarcinoma. CT angiography revealed the rGDA instead of a normal common HA. INTERVENTION We performed a safe PD, preserving the rGDA and the RGEA to maintain hepatic and cardiac perfusion. OUTCOMES Owing to the presence of a refractory pancreatic fistula, the length-of-hospital stay was extended, and he was discharged on postoperative day 72 without vascular complications. At present, the patient is in good physical condition and does not present with cardiovascular complications as well as tumor recurrence at 6 months after surgery. LESSONS This is possibly the first case of a patient who underwent PD and has a proper HA following a GDA arising from a superior mesenteric artery (rGDA) and has a previous operative history of CABG using the gastroepiploic artery. The coexistence of the history of cardiovascular surgery made PD for this patient considerably more challenging.In the case of a rare anatomical anomaly, a coronary artery bypass via the RGEA should not be considered as an obstacle when R0 resection is achievable.
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Affiliation(s)
- Takeo Toda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Hideyuki Kanemoto
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Satoshi Tokuda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Akihiko Takagi
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Noriyuki Oba
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
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Yan J, Feng H, Wang H, Yuan F, Yang C, Liang X, Chen W, Wang J. Hepatic artery classification based on three-dimensional CT. Br J Surg 2020; 107:906-916. [PMID: 32057096 DOI: 10.1002/bjs.11458] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/22/2019] [Accepted: 11/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Precise classification of the hepatic artery is helpful for preoperative surgical planning in hepatobiliary-pancreatic surgery. However, the anatomy of hepatic arteries is variable. This study investigated anatomical variation using three-dimensional visualization and evaluation (3DVE) to develop a nomenclature system. METHODS The origin and course of the hepatic artery were tracked and analysed by using three-dimensional visualization of CT images acquired between 2013 and 2017. The new classification and nomenclature system, named CRL, was developed based on the origins of the common, right and left hepatic arteries. RESULTS Scans from 770 adults were evaluated. Preoperative 3DVE correlated better with surgical findings than the original CT images alone. Using the CRL classification system, hepatic arteries were divided into nine subtypes. Only 87·4-89·2 per cent of the hepatic arteries of 610 living-donor liver transplant donors were depicted in Michels', Hiatt's or Varotti's classification, compared with 100 per cent identified by the CRL classification. The CRL classification was validated against external data sets from previous studies, with 99·6-100·0 per cent of patients classified by the CRL system. CONCLUSION The CRL classification covers hepatic artery variants and may be used for planning liver surgery.
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Affiliation(s)
- J Yan
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - H Feng
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - H Wang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
- University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - F Yuan
- Graduate School, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - C Yang
- Graduate School, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - X Liang
- University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - W Chen
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - J Wang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
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Soin AS, Chaudhary RJ, Pahari H, Pomfret EA. A Worldwide Survey of Live Liver Donor Selection Policies at 24 Centers With a Combined Experience of 19 009 Adult Living Donor Liver Transplants. Transplantation 2019; 103:e39-e47. [PMID: 30308575 DOI: 10.1097/tp.0000000000002475] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although surgical technique in living donor liver transplantation (LDLT) has evolved with a focus on donor safety and recipient challenges, the donor selection criteria remain considerably disparate. METHODS A questionnaire on donor selection was sent to 41 centers worldwide. 24 centers with a combined experience of 19 009 LDLTs responded. RESULTS Centers were categorized into predominantly LDLT (18) or deceased donor liver transplantation (6), and high- (10) or low-volume (14) centers. At most centers, the minimum acceptable graft-to-recipient weight ratio was 0.7 or less (67%), and remnant was 30% (75%). The median upper limit of donor age was 60 years and body mass index of 33 kg/m. At 63% centers, age influenced the upper limit of body mass index inversely. Majority preferred aspartate transaminase and alanine transaminase less than 50 IU/mL. Most accepted donors with nondebilitating mild mental or physical disability and rejected donors with treated coronary artery disease, cerebrovascular accident and nonbrain, nonskin primary malignancies. Opinions were divided about previous psychiatric illness, substance abuse and abdominal surgery. Most performed selective liver biopsy, commonly for steatosis, raised transaminases and 1 or more features of metabolic syndrome. On biopsy, all considered macrovesicular and 50% considered microvesicular steatosis important. Nearly all (92%) rejected donors for early fibrosis, and minority for nonspecific granuloma or mild inflammation. Most anatomical anomalies except portal vein type D/E were acceptable at high-volume centers. There was no standard policy for preoperative or peroperative cholangiogram. CONCLUSIONS This first large live liver donor survey provides insight into donor selection practices that may aid standardization between centers, with potential expansion of the donor pool without compromising safety.
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Affiliation(s)
| | | | - Hirak Pahari
- Medanta Institute of Liver Transplantation, Haryana, India
| | - Elizabeth A Pomfret
- Division of Transplantation, University of Colorado Anschutz Medical Campus, Aurora, CO
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Su TC, Hung SW, Liu MC, Lin YT, Chen JH, Cheng SB, Chen CCC. Adult-to-adult living donor liver transplantation preoperative survey using MDCT, a single medical center experience in Taiwan. Kaohsiung J Med Sci 2018; 34:95-102. [PMID: 29413233 DOI: 10.1016/j.kjms.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/08/2017] [Accepted: 09/15/2017] [Indexed: 11/15/2022] Open
Abstract
This study evaluated multi-detector computed tomography (MDCT) scans performed on potential living donors for adult-to-adult liver transplantation (LDLT), with the aim of identifying significant findings that could be used to exclude potential transplantation donors. We retrospectively reviewed the medical records of 151 consecutive potential adult donors for LDLT from May 2007 to January 2015. Liver parenchyma steatosis, focal hepatic mass or intraabdominal malignancy, vascular variations, and donor liver volume were evaluated via MDCT. Grounds for excluding potential donors were also recorded and analyzed. Of the 151 potential donors, nine (6.0%) had moderate to severe fatty liver, 37 (24.5%) had hepatic arterial variants, 22 (14.6%) had significant portal venous variants, and more than half were found to have right accessory inferior hepatic vein. No intraabdominal malignancies were found. Eighty-eight potential donors were rejected, with the most common cause being insufficient recipient volume or remnant donor volume (47.7%), moderate to severe parenchymal steatosis (10.2%), and recipient expiration prior to transplantation (8.0%). An additional 16 potential donors were excluded by the surgical team due to the complexity of their portal venous variations. The rate of exclusion by pre-transplant imaging evaluation with MDCT was 33.8%. MDCT can provide accurate quantification of donor liver volume and steatosis severity along with precise demonstration of vascular variants, which are crucial for the preoperative evaluation of LDLT. However, MDCT may be ineffective for evaluating the biliary system without hepatobiliary-excreted contrast agent and has the disadvantage of ionizing radiation.
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Affiliation(s)
- Te-Cheng Su
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Siu-Wan Hung
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan.
| | - Ming-Cheng Liu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yen-Ting Lin
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jeon-Hor Chen
- Department of Radiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; Center for Functional Onco-Imaging, University of California Irvine, CA, USA
| | - Shao-Bin Cheng
- Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Surgery, Chung Shan Medical University, Taichung, Taiwan
| | - Clayton Chi-Chang Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Radiological Technology and Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
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Matsumoto M, Wakiyama S, Shiba H, Ishida Y, Kita Y, Yanaga K. Usefulness of three-dimensional image navigation system for evaluation of hepatic artery before living donor liver transplantation: a case report. Surg Case Rep 2017; 3:87. [PMID: 28755161 PMCID: PMC5533693 DOI: 10.1186/s40792-017-0359-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The evaluation of the hepatic vascular anatomy in living liver donors is increasingly being performed by three-dimensional (3D) computed tomography (CT) angiography. However, details of hepatic artery anatomy obtained by 3D CT angiography are not always superior to those obtained by angiography. Here, we report a case in which the 3D image navigation system helped to detect segment II, III, and IV arteries (A2, A3, and A4, respectively) that individually originated from the proper hepatic artery (PHA); this could not be detected by 3D CT angiography. CASE PRESENTATION A 46-year-old man with end-stage primary biliary cirrhosis was admitted to our hospital for evaluation as a candidate for living donor liver transplantation. The patient's younger sister, aged 43 years, was the only living donor candidate. The predicted left liver graft volume with the middle hepatic vein was found to be 403 mL using the region-growing method with 3D CT software. This volume was sufficiently large for the recipient because the standard liver volume of the recipient was 1095 mL. 3D CT angiography was performed twice but could not reveal the anatomical structure of the left and middle hepatic arteries. However, simulation using the region-growing method demonstrated individual branching off of A2, A3, and A4 from the PHA; conventional angiography demonstrated the same results. Each branch was approximately 1 mm in diameter, which was too small for secure anastomosis. Therefore, we selected the right liver graft for simplicity. The postoperative course of the donor and recipient was uneventful, and they were discharged on postoperative days 10 and 46, respectively. CONCLUSIONS In conclusion, reconstruction of the hepatic vasculature using the 3D software by region-growing method might be a useful adjunct for surgical planning in the evaluation of the hepatic arteries in living liver donors.
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Affiliation(s)
- Michinori Matsumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Shigeki Wakiyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroaki Shiba
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuichi Ishida
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshiaki Kita
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Katsuhiko Yanaga
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Aoki S, Mizuma M, Hayashi H, Nakagawa K, Morikawa T, Motoi F, Naitoh T, Egawa S, Unno M. Surgical anatomy of the right hepatic artery in Rouviere's sulcus evaluated by preoperative multidetector-row CT images. BMC Surg 2016; 16:40. [PMID: 27278629 PMCID: PMC4898399 DOI: 10.1186/s12893-016-0155-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 05/26/2016] [Indexed: 11/10/2022] Open
Abstract
Background Lymph node dissection in Rouviere’s sulcus (RS) is essential during left-sided hepatectomy and caudate lobectomy for hilar cholangiocarcinoma. However, the small segmental or subsegmental arteries (SA/SSA) are often encountered in RS and must be preserved to prevent critical complications, such as liver infarction or liver failure. The aim of this study is to elucidate the anatomy of SA/SSA around RS, which should be understood preoperatively. Methods Between January 2008 and April 2013 from a total of 124 consecutive patients with hilar cholangiocarcinoma, preoperative multidetector-row computed tomography (MDCT) images were obtained at our institution and evaluated. The bifurcation patterns of the SA/SSA, the courses of the posterior SA/SSA and the bifurcation site of the SA/SSA were investigated using MDCT images. Results The typical form, in which right hepatic artery (RHA) bifurcated into the anterior (Aant) and posterior (Apost) hepatic artery and thereafter, Aant/Apost bifurcated into the SA and SSA, was observed in 75 patients (60.5 %). On the other hand, the atypical forms, in which the SA/SSA were independently branched off from RHA before the main bifurcation of the Aant and Apost, were observed in 43 patients (34.7 %). The prior branched arteries supplied the whole or ventral area of segment VI (A6 or A6a) in 11 patients (8.9 %), which was most commonly observed in the atypical form. 15 patients (34.9 %) of the 43 patients with atypical form had partially supraportal posterior branches, that showed early-bifurcated posterior SA/SAA following supraportal course, while the other posterior SA/SSA followed infraportal course. The SA/SSA were extrahepatically bifurcated in 82 patients (66.1 %), comprised of all 43 atypical form and 39 of typical form, while the SA/SSA were intrahepatically bifurcated in remaining 36 patients of typical forms (29.0 %). Conclusion The extrahepatic bifurcation of the SA/SSA from RHA was relatively common. The early-bifurcated SA/SSA was often observed (34.7 % of total cohort) and, in 34.8 % of those atypical forms, posterior SA/SSA from RHA followed a supraportal course. The detailed preoperative knowledge of the anatomy, including SA/SSA, is crucial for left-sided hepatectomy for hilar cholangiocarcinoma.
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Affiliation(s)
- Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan.
| | - Hiroki Hayashi
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan
| | - Shinichi Egawa
- Division of International Cooperation for Disaster Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan
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Technical aspects for live-donor organ procurement for liver, kidney, pancreas, and intestine. Curr Opin Organ Transplant 2015; 20:133-9. [PMID: 25695592 DOI: 10.1097/mot.0000000000000181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW This article reviews current strategies for living-donor organ procurement in liver, kidney, pancreas, and intestinal transplant. RECENT FINDINGS Here we summarize current open and laparoscopic approaches to living donation of abdominal organs. SUMMARY Living donation strategies expand the organ pool in the setting of a significant organ shortage.
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Shimizu H, Hosokawa I, Ohtsuka M, Kato A, Yoshitomi H, Miyazaki M. Clinical significance of anatomical variant of the left hepatic artery for perihilar cholangiocarcinoma applied to right-sided hepatectomy. World J Surg 2015; 38:3210-4. [PMID: 25123176 DOI: 10.1007/s00268-014-2715-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Full understanding of the hilar anatomy is crucial for successful surgical resection of perihilar cholangiocarcinoma (PHC). METHODS The three-dimensional positional relationship between the left hepatic artery (LHA) and the umbilical portion of the left portal vein (UP) was evaluated using multidetector-row computed tomography (CT) in 58 consecutive patients who underwent right-sided hepatectomy for Bismuth-Corlette IIIa or IV tumors. The positional relationship of the LHA related to UP was classified into the following three types: L-UP type, LHA runs into the left lateral section (LLS) from the left caudal side of the UP; R-UP type, LHA runs into the LLS from the right cranial side of the UP; and combined type, one branch of the LHA runs into the LLS from the right cranial side of the UP, and the other from the left caudal side of the UP. RESULTS L-UP-type LHA was observed in 53 cases (91.4 %), R-UP type in three cases (5.2 %), and combined type in two cases (3.4 %). No cancer involvement of the LHA was seen in any cases with L-UP type. In one case with R-UP type (one of three; 33.3 %) and one case with combined type (one of two, 50 %), cancer invasion to the LHA was observed at the right side of the UP, requiring combined resection of the involved LHA. CONCLUSIONS R-UP-type LHA running just along the left hepatic duct may be easily involved by right-side predominant PHC when extending to the left hepatic duct. Hepatobiliary surgeons should recognize this anatomical variant and carefully evaluate the running courses of LHA to successfully perform R0 resection in right-sided hepatectomy for PHC.
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Affiliation(s)
- Hiroaki Shimizu
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan,
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Ghosh SK. Variations in the origin of middle hepatic artery: a cadaveric study and implications for living donor liver transplantation. Anat Cell Biol 2014; 47:188-95. [PMID: 25276478 PMCID: PMC4178194 DOI: 10.5115/acb.2014.47.3.188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/18/2014] [Accepted: 07/10/2014] [Indexed: 11/27/2022] Open
Abstract
Living donor liver transplantation has been associated with severe vascular complications like hepatic artery thrombosis, which commonly involves the hepatic segment 4. Most authors have defined the artery to this segment as the middle hepatic artery. The present study was undertaken to characterize the origin of middle hepatic artery and classify the variations observed in cadaveric livers, and also to analyze the significance (if any) of the findings in relation to living donor liver transplantation. The study was conducted on 125 adult livers, without macroscopic abnormalities, retrieved from human cadavers (age, 55-78 years; male, 77; female, 48) obtained from clinical wards. The hepatic arterial system was exposed, the origin of the middle hepatic artery was identified in each liver specimen and the variations observed in its origin were noted across all the specimen. Six types of hepatic arterial configurations were observed based on variations in the origin of middle hepatic artery, taking into consideration the presence of accessory hepatic arteries. It was noted in 19 (15.2%) livers that in the presence of an accessory left hepatic artery, the middle hepatic artery arose as a sub-branch of the right hepatic artery. Presence of the above hepatic arterial configuration in the donor could possibly be associated with an increased risk of intra-operative injury to the middle hepatic artery during right/left lobe living donor liver transplantation and this may subsequently lead to serious post-operative vascular complications like hepatic artery thrombosis.
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Affiliation(s)
- Sanjib Kumar Ghosh
- Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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Perera MTPR, Isaac JR, Muiesan P. Adult right lobe live donor liver transplant with reconstruction of retro-portal accessory right hepatic artery. Transpl Int 2011; 25:e41-2. [PMID: 22188165 DOI: 10.1111/j.1432-2277.2011.01410.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yoshida A, Okuda K, Sakai H, Kinoshita H, Aoyagi S. 3D anatomical variations of hepatic vasculature and bile duct for right lateral sector of liver with special reference to transplantation. Kurume Med J 2008; 55:43-53. [PMID: 19571492 DOI: 10.2739/kurumemedj.55.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
To achieve a safer living related liver transplantation (LRLT) using the right lateral sector, anatomical variations of the portal vein, hepatic artery and bile duct for the right lateral sector and their three dimentional (3D) relationship were assessed by integrated 3D-CT images. 52 patients who underwent contrast enhanced multi-detector row CT (MD-CT) and MD-CT cholangiography were enrolled. Data from contrast enhanced MD-CT were used to reconstruct the 3D images of the hepatic artery and portal vein. 3D images reconstructed from MD-CT data of the hepatic artery, portal vein and bile duct were integrated into a single image. The dual branching of the right lateral portal vein was observed in 22 (42.3%) patients. Three (5.8%) had dual right lateral ducts and 14 (26.9%) had dual right lateral arteries. Among them, "south-turning" artery and "north-turning" bile duct was observed in 22 (42.3%). "South-turning" artery and "south-turning" bile duct were 3 (5.8%). "North-turning" artery and "north-turning" bile duct were 2 (7.4%). Only 27 (51.9%) had single portal vein, bile duct and artery for the right lateral sector, those were preferable as candidates for right lateral sector graft transplantation. 3D anatomical variations of portal vein, artery and bile duct for the right lateral sector were complexed, and only half of the donor candidates had preferable hepatic structures for right lateral sector graft transplantation. Understanding of the 3D hepatic structures by 3D-CT may contribute to a better definition of anatomical contraindications for LRLT which may further results in more safe and widely applied right lateral sector graft LRLT.
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Affiliation(s)
- Atsushi Yoshida
- Department of Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan
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Heilmaier C, Sutter R, Lutz AM, Seifert B, Weishaupt D, Marincek B, Willmann JK. Mapping of Hepatic Vascular Anatomy: Dynamic Contrast-enhanced Parallel MR Imaging Compared with 64–Detector Row CT. Radiology 2007; 245:872-80. [DOI: 10.1148/radiol.2453062103] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chen JK, Johnson PT, Horton KM, Fishman EK. Unsuspected mesenteric arterial abnormality: comparison of MDCT axial sections to interactive 3D rendering. AJR Am J Roentgenol 2007; 189:807-13. [PMID: 17885049 DOI: 10.2214/ajr.07.2137] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of our study was to determine how frequently significant mesenteric arterial abnormalities that were identified by interactive 3D CT with volume rendering and maximum intensity projection were detected by axial images alone in a series of patients for whom there was no clinical suspicion of mesenteric vascular disease. Axial CT and 3D interpretations were compared for lesions involving the celiac and superior mesenteric arteries or their branches. On a per-patient basis, the axial and 3D interpretations were equivalent in 24% (10/41) of the cases. Axial CT partially agreed with 3D CT in 10% (4/41), and no mesenteric arterial lesion was reported on axial CT in 66% (27/41). The 3D CT findings were supported by other imaging, surgery, clinical findings, or management in 49% (20/41) of the cases. The mesenteric lesions identified resulted in a change in patient management in 15% (6/41) of the subjects. CONCLUSION Unsuspected mesenteric arterial abnormality may elude diagnosis when axial MDCT sections are interpreted without 3D renderings.
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Affiliation(s)
- Jennifer K Chen
- The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Qi YY, Zou LG, Liang P, Zhang D. Establishing models of portal vein occlusion and evaluating value of multi-slice CT in hepatic VX2 tumor in rabbits. World J Gastroenterol 2007; 13:3333-41. [PMID: 17659672 PMCID: PMC4172713 DOI: 10.3748/wjg.v13.i24.3333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish models of portal vein occlusion of hepatic VX2 tumor in rabbits and to evaluate the value of multi-slice CT.
METHODS: Forty New Zealand rabbits were divided into 4 groups according to digital table: Immediate group (group A; transplantation of tumor immediately after the portal vein occlusion), 3-wk group (group B; transplantation of tumor at 3 wk after the portal vein occlusion), negative control group (group C) and positive control group (group D), 10 rabbits in each group. Hepatic VX2 tumor was transplanted with abdominal-embedding innoculation immediately after the portal vein occlusion and at 3 wk after the portal vein occlusion. Meanwhile, they were divided into negative control group (Left external branch of portal vein was occluded by sham-operation, and left exite was embedded and inoculated pseudoly) and positive control group (Transplanted tumor did not suffer from the portal vein occlusion). All rabbits were scanned with multi-slice CT.
RESULTS: All 40 animals were employed in the final analysis without death. Tumor did not grow in both immediate group and 3-wk group. In 3-wk group, left endite was atrophied and growth of tumor was inhibited. The maximal diameter of tumor was significantly smaller than that in positive control group (2.55 ± 0.46 vs 3.59 ± 0.37 cm, t = 5.57, P < 0.001). Incidences of metastasis in the liver and lung were lower in 3-wk group than those in positive control group (10% vs 40%, and 90% vs 100%, respectively). The expression intensities of the vascular endothelium growth factor (VEGF) in groups A, B, C and D were 0.10 ± 0.06, 0.66 ± 0.21, 0.28 ± 0.09 and 1.48 ± 0.32, respectively. VEGF expression level in the test group A was significantly lower than that in the negative control group C (t = 5.07; P < 0.001). In addition, VEGF expression in the test group B was significantly lower than that in the positive control group D (t = 6.38; P < 0.001). Scanning with multi-slice CT showed that displaying rate of hepatic artery branches was obviously lower in grade III (40%) than that in gradeI(70%) and II (100%) (P < 0.05); but there was no significant difference in displaying rate of the portal vein at various grades. Values of blood flow (BF) of the liver, blood volume (BV), mean transit time (MTT) and permeability of vascular surface (PS) were lower in the immediate group and 3-wk group than those in control groups, but values of hepatic arterial fraction (HAF) were increased. Significant positive correlations were existed between BF and BV (r = 0.905, P < 0.01), and between BF and PS (r = 0.967, P < 0.01), between BV and PS (r = 0.889, P < 0.01). A significant negative correlation existed between PV and HAF (r = -0.768, P < 0.01), between PS and HAF (r = -0.557, P < 0.01). The values of BF, BV and PS had a positive correlation with VEGF (rBF = 0.842, rBV = 0.579, rPS = 0.811, P < 0.01) . However, there was no significant correlation between the values of MTT and HAF and the VEGF expression (rMTT = 0.066, rHAF = -0.027).
CONCLUSION: Ligating the left external branch of portal vein is an ideal way to establish models of portal vein occlusion in rabbits with hepatic VX2 tumor. Multi-slice CT plays a key role in evaluating effect of portal vein occlusion.
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Affiliation(s)
- Yue-Yong Qi
- Department of Radiology, Xinqiao Hospital, Third Military Medical University of Chinese PLA, Chongqing 400037, China.
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15
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Abstract
Improvements in surgical technique, advances in the field of immunosuppresion and the early diagnosis and treatment of complications related to liver transplantation have all led to prolonged survival after liver transplantation. In particular, advances in diagnostic and interventional radiology have allowed the Interventional Radiologist, as part of the transplant team, to intervene early in patients presenting with complications related to organ transplant with resultant increase in graft and patient survival. Such interventions are often achieved using minimally invasive percutaneous endovascular techniques. Herein we present an overview of some of these diagnostic and therapeutic approaches in the treatment and management of patients before and after liver transplantation.
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Affiliation(s)
- Nikhil B Amesur
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Lee MW, Lee JM, Lee JY, Kim SH, Park EA, Han JK, Kim YJ, Shin KS, Suh KS, Choi BI. Preoperative evaluation of the hepatic vascular anatomy in living liver donors: Comparison of CT angiography and MR angiography. J Magn Reson Imaging 2006; 24:1081-7. [PMID: 17024662 DOI: 10.1002/jmri.20726] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To compare the diagnostic performance of CT angiography (CTA) and MR angiography (MRA) for preoperative hepatic vascular evaluation in living liver donors. MATERIALS AND METHODS Twenty-eight living donor candidates underwent preoperative CTA and MRA. Two blinded radiologists evaluated the anatomic types of the hepatic artery (HA) and portal vein (PV), and the number of aberrant hepatic veins (HVs) on both CTA and MRA, independently. Four grades of confidence levels were used to indicate the clarity of depiction of the HA and PV. Surgical findings were used as a standard of reference. RESULTS For determining the anatomic types of the HA and PV, and the number of aberrant HVs, CTA and MRA did not significantly differ in terms of accuracy ([89%, 96%, and 68% on CTA] vs. [86%, 93%, and 68% on MRA] for reader 1, P>0.05; and [93%, 100%, and 86% on CTA] vs. [89%, 93%, and 79% on MRA] for reader 2, P>0.05). Confidence for the depiction of major branches of HA and PV did not differ between CTA and MRA, except for a better depiction of the left HA (LHA) on CTA (P<0.05) CONCLUSION In living donor candidates, both CTA and MRA can provide a complete evaluation of the hepatic vascular anatomy.
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Affiliation(s)
- Min Woo Lee
- Department of Radiology, Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
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