Intraoperative Injury to Hepatic Arterial Structures

Chapter

Abstract

The hepatic artery and its branches provide arterial blood to the liver, biliary tract, pancreatic head, and duodenum. Its proximity to vital structures in the porta hepatis, compounded with frequent anatomic variations, make it susceptible to injury during hepatopancreatobiliary surgery. Consequences of loss of hepatic arterial flow range from transient insignificant transaminitis to hepatic necrosis, anastomotic leak, and death. Knowledge of the spectrum of anatomic aberrations, clinical scenarios that determine morbidity, and tools to anticipate, avoid, and manage intraoperative injury can equip surgeons to effectively steer potentially catastrophic situations toward more favorable outcomes.

Keywords

Hepatic artery Arterial injury Arterial ligation Celiac artery stenosis Pancreaticoduodenectomy 

References

  1. 1.
    Shukla PJ, Barreto SG, Kulkarni A, Nagarajan G, Fingerhut A. Vascular anomalies encountered during pancreatoduodenectomy: do they influence outcomes? Ann Surg Oncol. 2009;17(1):186–93.CrossRefPubMedGoogle Scholar
  2. 2.
    Chamberlain RS, El-Sedfy A, Rajkumar D. Aberrant hepatic arterial anatomy and the whipple procedure: lessons learned. Am Surg. [Review]. 2011;77(5):517–26.PubMedGoogle Scholar
  3. 3.
    Hann LE, Blumgart LH. Surgical and ragiologic anatomy of the liver, biliary tract, and pancreas. In: Jarnagin WR, editor. Blumgart’s surgery of the liver, pancreas and biliary tract. 5th ed. Philadelphia: Elsevier Saunders; 2012.Google Scholar
  4. 4.
    Rocha FG. Liver blood flow: physiology, measurement, and clinical relevance. In: Jarnagin WR, editor. Blumgart’s surgery of the liver, pancreas, and biliary tract. 5th ed. Philadelphia: Elsevier Saunders; 2012.Google Scholar
  5. 5.
    Northover JM, Terblanche J. A new look at the arterial supply of the bile duct in man and its surgical implications. Br J Surg. 1979;66(6):379–84.CrossRefPubMedGoogle Scholar
  6. 6.
    Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966;112(3):337–47.CrossRefPubMedGoogle Scholar
  7. 7.
    Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. [Review]. 1994;220(1):50–2.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology. 2002;224(2):542–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat. 2004;26(3):239–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Abdullah SS, Mabrut J-Y, Garbit V, Roche E, Olagne E, Rode A, et al. Anatomical variations of the hepatic artery: study of 932 cases in liver transplantation. Surg Radiol Anat. 2006;28(5):468–73.CrossRefPubMedGoogle Scholar
  11. 11.
    López-Andújar R, Moya A, Montalvá E, Berenguer M, De Juan M, San Juan F, et al. Lessons learned from anatomic variants of the hepatic artery in 1081 transplanted livers. Liver Transplant. 2007;13(10):1401–4.CrossRefGoogle Scholar
  12. 12.
    Suzuki T, Nakayasu A, Kawabe K, Takeda H, Honjo I. Surgical significance of anatomic variations of the hepatic artery. Am J Surg. 1971;122(4):505–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Daly JM, Kemeny N, Oderman P, Botet J. Long-term hepatic arterial infusion chemotherapy. Anatomic considerations, operative technique, and treatment morbidity. Arch Surg. 1984;119(8):936–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Rygaard H, Forrest M, Mygind T, Baden H. Anatomic variants of the hepatic arteries. Acta Radiol Diagn (Stockh). 1986;27(4):425–7.Google Scholar
  15. 15.
    Chen CY, Lee RC, Tseng HS, Chiang JH, Hwang JI, Teng MM. Normal and variant anatomy of hepatic arteries: angiographic experience. Zhonghua Yi Xue Za Zhi (Taipei). 1998;61(1):17–23.Google Scholar
  16. 16.
    De Santis M, Ariosi P, Calo GF, Romagnoli R. Hepatic arterial vascular anatomy and its variants. Radiol Med. 2000;100(3):145–51.PubMedGoogle Scholar
  17. 17.
    Song S-Y, Chung JW, Yin YH, Jae HJ, Kim H-C, Jeon UB, et al. Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology. 2010;255(1):278–88.CrossRefPubMedGoogle Scholar
  18. 18.
    Woods MS, Traverso LW. Sparing a replaced common hepatic artery during pancreaticoduodenectomy. Am Surg. 1993;59(11):719–21.PubMedGoogle Scholar
  19. 19.
    Volpe CM, Peterson S, Hoover EL, Doerr RJ. Justification for visceral angiography prior to pancreaticoduodenectomy. Am Surg. 1998;64(8):758–61.PubMedGoogle Scholar
  20. 20.
    Furukawa H, Shimada K, Iwata R, Moriyama N. A replaced common hepatic artery running through the pancreatic parenchyma. Surgery. 2000;127(6):711–2.CrossRefPubMedGoogle Scholar
  21. 21.
    Sakorafas GH, Sarr MG, Peros G. Celiac Artery Stenosis: an underappreciated and unpleasant surprise in patients undergoing pancreaticoduodenectomy. J Am Coll Surg. 2008;206(2):349–56.CrossRefPubMedGoogle Scholar
  22. 22.
    Park CM, Chung JW, Kim HB, Shin SJ, Park JH. Celiac axis stenosis: incidence and etiologies in asymptomatic individuals. Korean J Radiol. 2001;2(1):8–13.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Berney T, Pretre R, Chassot G, Morel P. The role of revascularization in celiac occlusion and pancreatoduodenectomy. Am J Surg. 1998;176(4):352–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Corinne Winston JT. Computer tomography of the liver, biliary tract, and pancreas. In: Jarnagin WR, editor. Blumgart’s surgery of the liver, pancreas, and biliary tract. 5th ed. Philadelphia: Elsevier Saunders; 2012.Google Scholar
  25. 25.
    Sahani D, Saini S, Pena C, Nichols S, Prasad SR, Hahn PF, et al. Using multidetector CT for preoperative vascular evaluation of liver neoplasms: technique and results. AJR Am J Roentgenol. 2002;179(1):53–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Takahashi S, Murakami T, Takamura M, Kim T, Hori M, Narumi Y, et al. Multi-detector row helical CT angiography of hepatic vessels: depiction with dual-arterial phase acquisition during single breath hold. Radiology. 2002;222(1):81–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Winston CB, Lee NA, Jarnagin WR, Teitcher J, DeMatteo RP, Fong Y, et al. CT angiography for delineation of celiac and superior mesenteric artery variants in patients undergoing hepatobiliary and pancreatic surgery. AJR Am J Roentgenol. 2007;189(1):W13–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Tamm EP, Balachandran A, Bhosale PR, Katz MH, Fleming JB, Lee JH, et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin North Am. 2012;50(3):407–28.CrossRefPubMedGoogle Scholar
  29. 29.
    Schwartz LH. Magnetic resonance imaging of the liver, biliary tract, and pancreas. In: Jarnagin WR, editor. Blumgart’s surgery of the liver, pancreas and biliary tract. 5th ed. Philadelphia: Elsevier Saunders; 2012.Google Scholar
  30. 30.
    Varadarajulu S, Eloubeidi MA. The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. Surg Clin North Am. 2010;90(2):251–63.CrossRefPubMedGoogle Scholar
  31. 31.
    Winston CB, Lee NA, Jarnagin WR, Teitcher J, DeMatteo RP, Fong Y, et al. CT angiography for delineation of celiac and superior mesenteric artery variants in patients undergoing hepatobiliary and pancreatic surgery. AJR Am J Roentgenol. 2007;189(1):W13–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Graham RR, Cannell CD. Accidental ligation of the hepatic artery. Br J Surg. 1933;20:566.CrossRefGoogle Scholar
  33. 33.
    Brittain RS, Marchioro TL, Hermann G, Waddell WR, Starzl TE. Accidental hepatic artery ligation in humans. Am J Surg. 1964;107:822–32.Google Scholar
  34. 34.
    Plengvanit U, Chearanai O, Sindhvananda K, Dambrongsak D, Tuchinda S, Viranuvatti V. Collateral arterial blood supply of the liver after hepatic artery ligation, angiographic study of twenty patients. Ann Surg. 1972;175(1):105–10.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Mays ET, Wheeler CS. Demonstration of collateral arterial flow after interruption of hepatic arteries in man. N Engl J Med. 1974;290(18):993–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Lewis FR, Lim RC Jr, Blaisdell FW. Hepatic artery ligation: adjunct in the management of massive hemorrhage from the liver. J Trauma. 1974;14(9):743–55.CrossRefPubMedGoogle Scholar
  37. 37.
    Flint LM, Mays ET, Aaron WS, Fulton RL, Polk HC. Selectivity in the management of hepatic trauma. Ann Surg. 1977;185(6):613–8.CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    McDermott WV Jr, Hensle TW. Metastatic carcinoid to the liver treated by hepatic dearterialization. Ann Surg. 1974;180(3):305–8.CrossRefPubMedCentralPubMedGoogle Scholar
  39. 39.
    Lee YT. Liver function tests after ligation of hepatic artery. J Surg Oncol. 1978;10(4):305–20.CrossRefPubMedGoogle Scholar
  40. 40.
    Allen PJ, Stojadinovic A, Ben-Porat L, Gonen M, Kooby D, Blumgart L, et al. The management of variant arterial anatomy during hepatic arterial infusion pump placement. Ann Surg Oncol. 2002;9(9):875–80.CrossRefPubMedGoogle Scholar
  41. 41.
    Nancy E. Kemeny ASE. Regional chemotherapy for liver tumors. In: Jarnagin WR, editor. Blumgart’s surgery of the liver, pancreas and biliary tract. 5th ed. Philadelphia: Elsevier-Saunders; 2012.Google Scholar
  42. 42.
    Makary MA, Fishman EK, Cameron JL. Resection of the celiac axis for invasive pancreatic cancer. J Gastrointest Surg. 2005;9(4):503–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Smoot RL, Donohue JH. Modified Appleby procedure for resection of tumors of the pancreatic body and tail with celiac axis involvement. J Gastrointest Surg. 2012;16(11):2167–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Doppman JL, Girton M, Vermess M. The risk of hepatic artery embolization in the presence of obstructive jaundice. Radiology. 1982;143(1):37–43.CrossRefPubMedGoogle Scholar
  45. 45.
    Soares AF, Castro e Silva Junior O, Ceneviva R, Roselino JE, Zucoloto S. Biochemical and morphological changes in the liver after hepatic artery ligation in the presence or absence of extrahepatic cholestasis. Int J Exp Pathol. 1993;74(4):367–70.PubMedCentralPubMedGoogle Scholar
  46. 46.
    Nath B, Szabo G. Hypoxia and hypoxia inducible factors: diverse roles in liver diseases. Hepatology. 2012;55(2):622–33.CrossRefPubMedCentralPubMedGoogle Scholar
  47. 47.
    Alves A, Farges O, Nicolet J, Watrin T, Sauvanet A, Belghiti J. Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann Surg. 2003;238(1):93–6.PubMedCentralPubMedGoogle Scholar
  48. 48.
    Traverso LW, Freeny PC. Pancreaticoduodenectomy. The importance of preserving hepatic blood flow to prevent biliary fistula. Am Surg. 1989;55(7):421–6.PubMedGoogle Scholar
  49. 49.
    Kochhar G, Parungao JM, Hanouneh IA, Parsi MA. Biliary complications following liver transplantation. World J Gastroenterol. 2013;19(19):2841–6.PubMedCentralPubMedGoogle Scholar
  50. 50.
    Mezhir JJ, Brennan MF, Baser RE, D’Angelica MI, Fong Y, DeMatteo RP, et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg. 2009;13(12):2163–9.CrossRefPubMedGoogle Scholar
  51. 51.
    van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362(2):129–37.CrossRefGoogle Scholar
  52. 52.
    Tol JA, Busch OR, van der Gaag NA, van Gulik TM, Gouma DJ. The quandary of preresection biliary drainage for pancreatic cancer. Cancer J. 2012;18(6):550–4.CrossRefPubMedGoogle Scholar
  53. 53.
    Miura T, Hakamada K, Ohata T, Narumi S, Toyoki Y, Nara M, et al. Resection of a locally advanced hilar tumor and the hepatic artery after stepwise hepatic arterial embolization: a case report. World J Gastroenterol. 2008;14(22):3587–90.CrossRefPubMedCentralPubMedGoogle Scholar
  54. 54.
    Hasegawa K, Imamura H, Akahane M, Miura Y, Takayama T, Ohtomo K, et al. Endovascular stenting for celiac axis stenosis before pancreaticoduodenectomy. Surgery. 2003;133(4):440–2.CrossRefPubMedGoogle Scholar
  55. 55.
    Halazun KJ, Kotru A, Menon KV, Patel J, Prasad KR. Stenting of coeliac axis stenosis facilitates pancreatectomy. Eur J Surg Oncol. 2006;32(7):811–2.CrossRefPubMedGoogle Scholar
  56. 56.
    Farma JM, Hoffman JP. Nonneoplastic celiac axis occlusion in patients undergoing pancreaticoduodenectomy. Am J Surg. 2007;193(3):341–4. Discussion 4.CrossRefPubMedGoogle Scholar
  57. 57.
    Lochan R, White SA. Pre-operative endovascular stenting of the coeliac trunk. Ann R Coll Surg Engl. 2008;90(2):173–4.CrossRefPubMedCentralPubMedGoogle Scholar
  58. 58.
    Sharafuddin MJ, Olson CH, Sun S, Kresowik TF, Corson JD. Endovascular treatment of celiac and mesenteric arteries stenoses: applications and results. J Vasc Surg. 2003;38(4):692–8.CrossRefPubMedGoogle Scholar
  59. 59.
    van Wanroij JL, van Petersen AS, Huisman AB, Mensink PB, Gerrits DG, Kolkman JJ, et al. Endovascular treatment of chronic splanchnic syndrome. Eur J Vasc Endovasc Surg. 2004;28(2):193–200.CrossRefPubMedGoogle Scholar
  60. 60.
    Cloyd JM, Chandra V, Louie JD, Rao S, Visser BC. Preoperative embolization of replaced right hepatic artery prior to pancreaticoduodenectomy. J Surg Oncol. 2012;106(4):509–12.CrossRefPubMedGoogle Scholar
  61. 61.
    Turrini O, Wiebke EA, Delpero JR, Viret F, Lillemoe KD, Schmidt CM. Preservation of replaced or accessory right hepatic artery during pancreaticoduodenectomy for adenocarcinoma: impact on margin status and survival. J Gastrointest Surg. 2010;14(11):1813–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Eshuis WJ, Olde Loohuis KM, Busch ORC, van Gulik TM, Gouma DJ. Influence of aberrant right hepatic artery on perioperative course and longterm survival after pancreatoduodenectomy. HPB (Oxford). 2011;13(3):161–7.Google Scholar
  63. 63.
    Cikrit DF, Dalsing MC, Sawchuk AP, Lalka SG, Harl MJ, Goulet RJ, et al. Vascular injuries during pancreatobiliary surgery. Am Surg. 1993;59(10):692–6. Discussion 7.PubMedGoogle Scholar
  64. 64.
    Lygidakis NJ. Regional vascular resection for pancreatic head carcinoma. Hepatogastroenterology. 1996;43(11):1327–33.PubMedGoogle Scholar
  65. 65.
    Fischer CP, Rosenberg W, Bridget F, Bass B. Gastroduodenal artery used for arterial reconstruction during the Whipple operation. Hepatogastroenterology. 2007;54(80):2228–9.PubMedGoogle Scholar
  66. 66.
    Kusano T, Tamai O, Miyazato H, Isa T, Shiraishi M, Muto Y. Vascular reconstruction of the hepatic artery using the gastroepiploic artery: a case report. Hepatogastroenterology. 1999;46(28):2278–80.PubMedGoogle Scholar
  67. 67.
    Sarmiento JM, Panneton JM, Nagorney DM. Reconstruction of the hepatic artery using the gastroduodenal artery. Am J Surg. 2003;185(4):386–7.CrossRefPubMedGoogle Scholar
  68. 68.
    Faulds J, Johner A, Klass D, Buczkowski A, Scudamore CH. Hepatic artery transection reconstructed with splenic artery transposition graft. Perspect Vasc Surg Endovasc Ther. 2012;24(2):87–9.CrossRefPubMedGoogle Scholar
  69. 69.
    Ohwada S, Ogawa T, Ohya T, Kawashima Y, Nakamura S, Satoh Y, et al. Gonadal vein graft for hepatic artery reconstruction. Hepatogastroenterology. 1999;46(27):1823–6.PubMedGoogle Scholar
  70. 70.
    Pessaux P, Varma D, Arnaud JP. Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg. 2006;10(4):607–11.CrossRefPubMedGoogle Scholar
  71. 71.
    Dumitrascu T, David L, Popescu I. Posterior versus standard approach in pancreatoduodenectomy: a case-match study. Langenbecks Arch Surg. 2010;395(6):677–84.CrossRefPubMedCentralPubMedGoogle Scholar
  72. 72.
    Pessaux P, Marzano E, Rosso E. A plea for the artery-first dissection during pancreaticoduodenectomy. J Am Coll Surg. 2010;211(1):142–3.CrossRefPubMedGoogle Scholar
  73. 73.
    Weitz J, Rahbari N, Koch M, Buchler MW. The “artery first” approach for resection of pancreatic head cancer. J Am Coll Surg. 2010;210(2):e1–4.CrossRefPubMedGoogle Scholar
  74. 74.
    Lupascu C, Moldovanu R, Andronic D, Ursulescu C, Vasiluta C, Raileanu G, et al. Posterior approach pancreaticoduodenectomy: best option for hepatic artery anatomical variants. Hepatogastroenterology. 2011;58(112):2112–4.PubMedGoogle Scholar
  75. 75.
    Sakamoto Y, Sano T, Shimada K, Kosuge T, Kimata Y, Sakuraba M, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy. Langenbecks Arch Surg. 2006;391(3):203–8.CrossRefPubMedGoogle Scholar
  76. 76.
    Allendorf JD, Bellemare S. Reconstruction of the replaced right hepatic artery at the time of pancreaticoduodenectomy. J Gastrointest Surg. 2009;13(3):555–7.CrossRefPubMedGoogle Scholar
  77. 77.
    Amano H, Miura F, Toyota N, Wada K, Katoh K, Hayano K, et al. Pancreatectomy with reconstruction of the right and left hepatic arteries for locally advanced pancreatic cancer. J Hepatobiliary Pancreat Surg. 2009;16(6):777–80.CrossRefPubMedGoogle Scholar
  78. 78.
    Yamamoto S, Kubota K, Rokkaku K, Nemoto T, Sakuma A. Disposal of replaced common hepatic artery coursing within the pancreas during pancreatoduodenectomy: report of a case. Surg Today. 2005;35(11):984–7.CrossRefPubMedGoogle Scholar
  79. 79.
    Nagai H, Ohki J, Kondo Y, Yasuda T, Kasahara K, Kanazawa K. Pancreatoduodenectomy with preservation of the pylorus and gastroduodenal artery. Ann Surg. 1996;223(2):194–8.CrossRefPubMedCentralPubMedGoogle Scholar
  80. 80.
    Yasuda Y, Larsen PN, Ishibashi T, Yamashita K, Toei H. Resection of hilar cholangiocarcinoma with left hepatectomy after pre-operative embolization of the proper hepatic artery. HPB (Oxford). 2010;12(2):147–52.CrossRefGoogle Scholar
  81. 81.
    de Santibanes E, Ardiles V, Alvarez FA, Pekolj J, Brandi C, Beskow A. Hepatic artery reconstruction first for the treatment of hilar cholangiocarcinoma bismuth type IIIB with contralateral arterial invasion: a novel technical strategy. HPB (Oxford). 2012;14(1):67–70.Google Scholar
  82. 82.
    Blumgart LH, Hann LE. Blumgart's surgery of the liver, pancreas and biliary tract. Vol. 1. New York: Springer; 2012.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Vinod P. Balachandran
    • 1
  • Michael I. D’Angelica
    • 2
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Surgery, Hepatopancreatobiliary DivisionMemorial Sloan Kettering Cancer CenterNew YorkUSA

Personalised recommendations