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Reconstruction of the Replaced Right Hepatic Artery at the Time of Pancreaticoduodenectomy

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Journal of Gastrointestinal Surgery

Abstract

Background

The arterial anatomy supplying the liver is highly variable. One of the most common variants is a completely replaced right hepatic artery which is seen in about 11% of the population. Interruption of arterial flow to the right hepatic artery at the time of pancreaticoduodenectomy has been associated with biliary fistula and the consequent complications, as well as stenosis of the biliary enteric anastomosis. Malignancies of the posterior aspect of the head of the pancreas can encase a replaced right hepatic artery without involvement of other vascular structures. In this situation, it is possible to resect and reconstruct the replaced right hepatic artery to maintain oxygen delivery to the biliary enteric anastomosis.

Summary

Herein we describe a technique to reconstruct a replaced right hepatic artery following resection of the vessel en bloc with the tumor during a pancreaticoduodenectomy, using inflow from the gastroduodenal artery.

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Acknowledgements

The illustrations were kindly provided by Hyunch Sung and Kuta Brown. Further support was provided by the I.W. Foundation.

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Authors and Affiliations

  1. College of Physicians and Surgeons, Columbia University, 630 West 168th St., New York, NY, 10032, USA

    John D. Allendorf

  2. Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY, 10467-2490, USA

    Sarah Bellemare

  3. 161 Ft. Washington Ave., New York, NY, 10032, USA

    John D. Allendorf

Authors
  1. John D. Allendorf
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  2. Sarah Bellemare
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Correspondence to John D. Allendorf.

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Allendorf, J.D., Bellemare, S. Reconstruction of the Replaced Right Hepatic Artery at the Time of Pancreaticoduodenectomy. J Gastrointest Surg 13, 555–557 (2009). https://doi.org/10.1007/s11605-008-0578-8

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  • DOI: https://doi.org/10.1007/s11605-008-0578-8

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