Surgery Today

, Volume 44, Issue 10, pp 1912–1919 | Cite as

Preoperative dual-phase 3D CT angiography assessment of the right hepatic artery before gastrectomy

  • Keishi Yamashita
  • Shinichi Sakuramoto
  • Hiroaki Mieno
  • Tomotaka Shibata
  • Masayuki Nemoto
  • Natsuya Katada
  • Shiro Kikuchi
  • Masahiko Watanabe
Original Article
First Online:
Received:
Accepted:

Abstract

Purposes

In the current study, we evaluated the efficacy of dual-phase three-dimensional (3D) CT angiography (CTA) in the assessment of the vascular anatomy, especially the right hepatic artery (RHA), before gastrectomy.

Methods

The study initially included 714 consecutive patients being treated for gastric cancer. A dual-phase contrast-enhanced CT scan using 32-multi detector-row CT was performed for all patients.

Results

Among the 714 patients, 3D CTA clearly identified anomalies with the RHA arising from the superior mesenteric artery (SMA) in 49 cases (6.9 %). In Michels’ classification type IX, the common hepatic artery (CHA) originates only from the SMA. Such cases exhibit defective anatomy for the CHA in conjunction with the celiac–splenic artery system, resulting in direct exposure of the portal vein beneath the #8a lymph node station, which was retrospectively confirmed by video in laparoscopic gastrectomy cases. Fused images of both 3D angiography and venography were obtained, and could have predicted the risk preoperatively, and the surgical finding confirmed its usefulness.

Conclusion

Preoperative evaluations using 3D CTA can provide more accurate information about the vessel anatomy. The fused images from 3D CTA have the potential to reduce the intraoperative risks for injuries to critical vessel, such as the portal vein, during gastrectomy.

Keywords

MDCT Angiography Laparoscopic gastrectomy Hepatic artery Anomaly Portal vein 
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Notes

Conflict of interest

Keishi Yamashita and the co-authors have no conflicts of interest to declare in association with this study.

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Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Keishi Yamashita
    • 1
  • Shinichi Sakuramoto
    • 2
  • Hiroaki Mieno
    • 1
  • Tomotaka Shibata
    • 1
  • Masayuki Nemoto
    • 1
  • Natsuya Katada
    • 1
  • Shiro Kikuchi
    • 1
  • Masahiko Watanabe
    • 1
  1. 1.Department of SurgeryKitasato University School of MedicineSagamiharaJapan
  2. 2.Department of Upper Gastrointestinal Surgery, International Medical CenterSaitama Medical UniversityHidakaJapan

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