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Kacała A, Dorochowicz M, Korbecki A, Sobański M, Puła M, Patrzałek D, Janczak D, Guziński M. Transarterial Bleomycin-Lipiodol Chemoembolization for the Treatment of Giant Hepatic Hemangiomas: An Assessment of Effectiveness. Cancers (Basel) 2024; 16:380. [PMID: 38254869 PMCID: PMC10814004 DOI: 10.3390/cancers16020380] [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: 12/15/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
This study evaluates the effectiveness of superselective transcatheter arterial chemoembolization (TACE) using a bleomycin-lipiodol emulsion in treating giant hepatic hemangiomas. A retrospective review included 31 patients with a mean age of 53 ± 10.42 years who underwent TACE from December 2014 to October 2022, with follow-up imaging examinations to assess outcomes. Technical success was defined as successful embolization of all feeding arteries, and clinical success was defined as a reduction in hemangioma volume by 50% or more on follow-up imaging. This study observed a 100% technical success rate. Post-embolization syndrome was common, and two cases of asymptomatic hepatic artery dissection were noted. Clinical success was achieved in 80.6% of patients, with significant volume reduction observed in the majority. Conclusively, superselective transcatheter arterial chemoembolization with bleomycin-lipiodol emulsions is presented as a viable and effective treatment option for giant hepatic hemangiomas. With no procedure-related mortality and significant volume reduction in most cases, this method offers a promising alternative to surgical intervention. This study's findings suggest a need for further exploration and validation in larger-scale prospective studies.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | | | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Puła
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
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Miyayama S. Radiological Vascular Anatomy of the Caudate Lobe of the Liver Required for Transarterial Chemoembolization of Hepatocellular Carcinoma. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:118-129. [PMID: 38020459 PMCID: PMC10681755 DOI: 10.22575/interventionalradiology.2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/23/2023] [Indexed: 12/01/2023]
Abstract
The caudate lobe is located between the bilateral hepatic lobes and is divided into three subsegments: the Spiegel lobe, paracaval portion, and caudate process. The caudate artery arises from various sites of the bilateral hepatic arteries as an independent branch, common trunk, or arcade. Extrahepatic arteries can enter the caudate lobe mainly by the right inferior phrenic artery. The caudate artery also supplies the main bile duct and posterior aspect of segment IV. Although catheterization into the caudate artery is occasionally difficult because of its small size and sharp angulation, selective embolization of a tumor feeder is a significant prognostic factor in patients with hepatocellular carcinoma originating there. Therefore, we should recognize the peculiarity of its vascular anatomy and should be familiar with catheterization and embolization techniques.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Japan
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3
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Pravisani R, Sepulveda A, Cocchi L, de Mello E, Cauchy F, Dokmak S, Farges O, Durand F, Weiss E, Dondero F, Lesurtel M. Reply: Aberrant arteries-1 may be better than 2 for the liver, but maybe not the bile duct. Liver Transpl 2023; 29:E18-E19. [PMID: 36943101 DOI: 10.1097/lvt.0000000000000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Riccardo Pravisani
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
- Liver-Kidney Transplant Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Ailton Sepulveda
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Lorenzo Cocchi
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Estrella de Mello
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Francois Cauchy
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Olivier Farges
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Francois Durand
- Hepatology and Liver Intensive Care, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Federica Dondero
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
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Lendoire M, Maki H, Haddad A, Jain AJ, Vauthey JN. Biliary Anatomy 2.0 Quiz: Test Your Knowledge. J Gastrointest Surg 2023; 27:1510-1529. [PMID: 37081218 DOI: 10.1007/s11605-023-05634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/11/2023] [Indexed: 04/22/2023]
Abstract
Anatomy has remained an interest of physicians throughout the ages. The biliary tract spans from the liver to the hepatoduodenal mesentery, pancreas, and into the duodenum. Therefore, it is important for not only hepatobiliary surgeons but also general gastrointestinal surgeons, gastroenterologists, radiologists, and pathologists to be familiar with biliary anatomy and its variants. While surgery for hilar cholangiocarcinoma is one of the most challenging procedures, cholecystectomy is one of the most common procedures done from the beginning of surgical training. We hope that by answering the following questions, you will gain a comprehensive understanding of biliary anatomy and a greater appreciation for it.
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Affiliation(s)
- Mateo Lendoire
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Harufumi Maki
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Antony Haddad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Anish J Jain
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA.
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Xu H, Yu X, Hu J. The Risk Assessment and Clinical Research of Bile Duct Injury After Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma. Cancer Manag Res 2021; 13:5039-5052. [PMID: 34234549 PMCID: PMC8253927 DOI: 10.2147/cmar.s303172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To retrospectively evaluate the risk factors and the clinical outcomes of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and to evaluate factors that aid clinical detection and subsequent treatment of the injured bile duct. Materials and Methods All patients undergoing TACE for HCC were retrospectively reviewed for identification of bile duct injury. The clinical spectrum of all the patients analyzed including patients’ demographics, laboratory data, radiologic imaging and mode of treatment. Results From January 2015 to December 2017, a total of 21 patients (4.3%) out of 483 patients with 693 TACE procedures were identified to have bile duct injury at our single institution. There were 17 males and 4 females, with a mean age of 59.8±11.6 years (range 34–84). About 14.3% (3/21) patients show the high-density shadow around the bile duct wall in one week non-enhanced CT, and 76.2% (16/21) cases ALP>200 U/L, all these patients showed bile duct injury on the subsequent follow-up CT. Post-TACE follow-up blood biochemistry showed that alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) increased significantly compared with pre-TACE level. The incidence of various types of bile duct injuries on CT was intrahepatic bile duct dilatation (57.1%), biloma (25.7%) and hepatic hilar biliary strictures (17.1%), respectively. Patients with prior hepatectomy as well as proximal arterial chemoembolization carried a higher risk of post-TACE bile duct injury in terms of microvascular damage to the peribiliary capillary plexus. Conclusion Bile duct injury complicating TACE is not caused by a single factor, but by a variety of factors, and is closely related to the microvascular compromise of the bile ducts and subsequent chronic biliary infection. Lipiodol deposited along the bile duct wall and the sharp rise of ALP>200 U/L in one week after TACE can predict bile duct injury and early intervention may prevent the occurrence of serious complications. The probability of bile duct injury in patients with prior hepatectomy and proximal arterial chemoembolization increases significantly.
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Affiliation(s)
- Houyun Xu
- Department of Radiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, People's Republic of China
| | - Xiping Yu
- Department of Pathology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu,People's Republic of China
| | - Jibo Hu
- Department of Radiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, People's Republic of China
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Iwao Y, Heaton ND. A Review of the Retroportal Artery in the Blood Supply of the Biliary Tree: Implications for Hepato‐Pancreato‐Biliary and Transplant Surgeons. Liver Transpl 2021; 27:918-922. [DOI: https:/doi.org/10.1002/lt.25965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/02/2020] [Indexed: 08/30/2023]
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7
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A Review of the Retroportal Artery in the Blood Supply of the Biliary Tree: Implications for Hepato‐Pancreato‐Biliary and Transplant Surgeons. Liver Transpl 2021; 27:918-922. [PMID: 37160000 PMCID: PMC8248002 DOI: 10.1002/lt.25965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/02/2020] [Indexed: 01/13/2023]
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Ciria R, Navarro E, Sánchez-Frías M, Gallardo AB, Medina J, Ayllón MD, Gomez-Luque I, Ruiz-Rabelo J, Luque A, de la Mata M, Rufián S, López-Cillero P, Briceño J. Preliminary results from the use of intraoperative real-time biliary oxygen monitoring in liver transplantation. Clin Transplant 2018; 32:e13433. [PMID: 30365182 DOI: 10.1111/ctr.13433] [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: 05/17/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Biliary anastomosis is a frequent area of complications after liver transplantation (LT) and a potential area of "microangiopathy". The concept of a "marginal bile duct" is unexplored. The main aim was to make a preliminary evaluation of the utility of an innovative real-time oxygen microtension (pO2mt) testing device for the assessment of bile duct viability during LT and to correlate these pO2mt values with microvascular tissue quality by histopathology and outcomes. PATIENTS AND METHODS Observational prospective cohort study with 23 patients. Oxygen microtension measurements were made placing a micropO2 probe in different areas of recipient and donor's bile duct intraoperative. RESULTS Mean pO2mt in the graft bile duct at the level of the anastomosis 103.82 (31-157) mm Hg, being 121.52 (55-174) mm Hg 1.5 cm proximal to the hilar plate (P < 0.001). Mean pO2mt in the recipient's bile duct was 117.87 (62-185) mm Hg, while a value of 137.30 (81-198) mm Hg was observed 1.5 cm distal to the anastomosis (P < 0.001). Cystic duct resection (12 cases) was also related with higher pO2mt values at anastomosis [117.8 (93-157) vs 88.54 (31-124) mm Hg] and distal to anastomosis [135.6 (111-174) vs 106.2 (55-133) mm Hg; P < 0.001]. Patients with 1-, 3-, and 12-month biliary complications had significantly lower pO2mt in the intraoperative measurements. CONCLUSION Our preliminary results show that distal borders of donor and recipient bile ducts may be low-vascularized areas. Tissue pO2mt is significantly higher in areas close to the hilar plate and to the duodenum in donor and recipient's sides, respectively. Bile duct injury and biliary complications are associated with worse tissue pO2mt.
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Affiliation(s)
- Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Elena Navarro
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | | | - Ana-Belen Gallardo
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Javier Medina
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - María-Dolores Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Irene Gomez-Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Juan Ruiz-Rabelo
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Antonio Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Manuel de la Mata
- Liver Research Unit, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, Cordoba, Spain
| | - Sebastián Rufián
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Pedro López-Cillero
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Ciber-EHD, University of Cordoba, Cordoba, Spain
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Angiographic Anatomy and Relevance of 3 and 9 O’clock Arteries During Radioembolization. Cardiovasc Intervent Radiol 2018; 41:890-897. [DOI: 10.1007/s00270-017-1873-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/29/2017] [Indexed: 01/12/2023]
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10
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Miyayama S, Matsui O. Superselective Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma: Rationale, Technique, and Outcome. J Vasc Interv Radiol 2016; 27:1269-1278. [PMID: 27345337 DOI: 10.1016/j.jvir.2016.04.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/12/2016] [Accepted: 03/18/2016] [Indexed: 12/20/2022] Open
Abstract
Conventional transarterial chemoembolization with ethiodized oil and gelatin sponge (GS) particles is a standard technique for hepatocellular carcinoma. Ethiodized oil can temporarily block tumor sinusoids, portal venules, hepatic sinusoids, and arterial microcommunications. By adding GS embolization, strong ischemic effects not only on the tumor but also on the surrounding liver parenchyma can be achieved. Superselective conventional transarterial chemoembolization is mainly indicated for patients with Child-Pugh scores of 5-8, tumors ≤ 7 cm, and ≤ 5 lesions. According to a Japanese nationwide survey, the 5-year survival rate of patients with Child-Pugh class A and a single tumor was 52%.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
| | - Osamu Matsui
- Department of Radiology, Kanazawa University, Graduate School of Medical Science, Takara-machi, Kanazawa, Japan
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Demetris AJ, Bellamy COC, Gandhi CR, Prost S, Nakanuma Y, Stolz DB. Functional Immune Anatomy of the Liver-As an Allograft. Am J Transplant 2016; 16:1653-80. [PMID: 26848550 DOI: 10.1111/ajt.13749] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/26/2016] [Accepted: 01/28/2016] [Indexed: 01/25/2023]
Abstract
The liver is an immunoregulatory organ in which a tolerogenic microenvironment mitigates the relative "strength" of local immune responses. Paradoxically, necro-inflammatory diseases create the need for most liver transplants. Treatment of hepatitis B virus, hepatitis C virus, and acute T cell-mediated rejection have redirected focus on long-term allograft structural integrity. Understanding of insults should enable decades of morbidity-free survival after liver replacement because of these tolerogenic properties. Studies of long-term survivors show low-grade chronic inflammatory, fibrotic, and microvascular lesions, likely related to some combination of environment insults (i.e. abnormal physiology), donor-specific antibodies, and T cell-mediated immunity. The resultant conundrum is familiar in transplantation: adequate immunosuppression produces chronic toxicities, while lightened immunosuppression leads to sensitization, immunological injury, and structural deterioration. The "balance" is more favorable for liver than other solid organ allografts. This occurs because of unique hepatic immune physiology and provides unintended benefits for allografts by modulating various afferent and efferent limbs of allogenic immune responses. This review is intended to provide a better understanding of liver immune microanatomy and physiology and thereby (a) the potential structural consequences of low-level, including allo-antibody-mediated injury; and (b) how liver allografts modulate immune reactions. Special attention is given to the microvasculature and hepatic mononuclear phagocytic system.
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Affiliation(s)
- A J Demetris
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - C O C Bellamy
- Department of Pathology, University of Edinburgh, Edinburgh, Scotland, UK
| | - C R Gandhi
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - S Prost
- Department of Pathology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Y Nakanuma
- Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - D B Stolz
- Center for Biologic Imaging, Cell Biology, University of Pittsburgh, Pittsburgh, PA
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12
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Chen Y, Li H, Jiang X, Chen D, Ni J, Sun H, Luo J, Yao H, Xu L. Regional thermochemotherapy versus hepatic arterial infusion chemotherapy for palliative treatment of advanced hilar cholangiocarcinoma: a retrospective controlled study. Eur Radiol 2016; 26:3500-9. [PMID: 26822373 DOI: 10.1007/s00330-016-4208-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 10/12/2015] [Accepted: 01/08/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To retrospectively assess the efficacy of regional thermochemotherapy (TCT) compared with hepatic arterial infusion chemotherapy (HAIC)-alone for palliative treatment of advanced hilar cholangiocarcinoma (HC) and to determine the prognostic factors associated with survival. METHODS Forty-three consecutive patients with advanced HC underwent regional TCT (TCT group) and HAIC (HAIC group). We analyzed baseline characteristics, overall survival (OS), progression-free survival (PFS), stent patency time (SPT), adverse events (AEs), and prognostic factors for OS between the two groups. RESULTS OS of patients treated with regional TCT was significantly longer compared to that of patients treated with HAIC (median OS: 20.3 vs. 13.2 months, P = 0.004), and SPT and PFS were significantly increased in the TCT group compared with the HAIC group (median SPT: 26.5 vs. 10.5 months, P < 0.001; median PFS: 16.5 vs. 10.2 months, P = 0.001). TCT and metal stent insertion were two independent prognostic factors associated with survival. The treatment-related AEs were tolerable and similar in the two groups, except for hilar pain (34.6 %) and skin rashes (24.6 %) in the TCT group. CONCLUSIONS Our results show that regional TCT is safe and more effective than HAIC-alone and may be a promising option for palliative treatment of advanced HC. Metal stenting before TCT appears to improve patients' OS. KEY POINTS • Regional TCT is a novel combination for palliative treatment of advanced HC • Our data showed significantly promising outcomes in the TCT group • HC patients with metal stenting appeared to derive greater benefit from TCT.
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Affiliation(s)
- Yaoting Chen
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Huiqing Li
- Health Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Xiongying Jiang
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Dong Chen
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Jiayan Ni
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Hongliang Sun
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Jianghong Luo
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Herui Yao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China.
- Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China.
| | - Linfeng Xu
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China.
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China.
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Dai J, Wu XF, Yang C, Li HJ, Chen YL, Liu GZ, Song YZ, Wu HH, Ding JL, Li N. Study of relationship between the blood supply of the extrahepatic bile duct and duct supply branches from gastroduodenal artery on imaging and anatomy. Chin Med J (Engl) 2015; 128:322-6. [PMID: 25635427 PMCID: PMC4837862 DOI: 10.4103/0366-6999.150097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Liver transplantation has become the treatment of choice for patients with end-stage acute or chronic hepatic disease. Bile duct complications are common events after liver transplantation. The aim of this study was to evaluate the blood supply of the human bile duct and identify the underlying mechanisms of bile duct complications after liver transplantation. Methods: The duct supply branches from gastroduodenal artery and blood supply of extrahepatic bile duct system were re-evaluated through selective hepatic angiography from 600 patients. In addition, 33 cadavers were injected with latex casting material into the common hepatic artery, then the extrahepatic bile duct and the branches from the common hepatic artery were carefully dissected to visualize the gastroduodenal artery and its branching to the extrahepatic bile duct. Results: The bile duct artery arose from the branch of the gastroduodenal artery in 8.1% (49/600). Of these 49 individuals, the bile duct artery was supplied by the gastroduodenal artery (61.22%, 30/49), the proper hepatic artery (14.29%, 7/49), or both the gastroduodenal artery and the proper hepatic artery (24.49%, 12/49). In our study of 33 cadavers, the percentage that the bile duct artery arose from the gastroduodenal artery was 27.27%. The blood supply to the bile extrahepatic bile ducts was divided into different segments and formed longitudinal and arterial network anastomosed on the walls of the duct. Conclusions: There is a close relationship between the duct supply branches from gastroduodenal artery and the blood supplying patterns of the extrahepatic bile duct system. In liver transplant surgery, the initial part of the gastroduodenal artery is preferred to be preserved in the donor liver. It is of great significance to improve the success rate of operation and reduce complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ning Li
- Department of Radiology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
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Vesselle G, Petit I, Boucebci S, Rocher T, Velasco S, Tasu JP. Radioembolization with yttrium-90 microspheres work up: Practical approach and literature review. Diagn Interv Imaging 2014; 96:547-62. [PMID: 24776810 DOI: 10.1016/j.diii.2014.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Radioembolization (RE) is a selective internal radiotherapy technique in which yttrium-90 blended microspheres are infused through the hepatic arteries. It is based on the fact that primary and secondary hepatic tumors are vascularized mostly by arterial blood flow whereas healthy hepatocytes obtain their blood supply mostly from the portal network. This enables high radiation doses to be delivered, sparing the surrounding non-malignant liver parenchyma. Most of the complications are caused by unexpected particles passing into the gastrointestinal tract through branches originating from the main hepatic arterial supply. Knowledge of this hepatic arterial network and of its variations and the technical considerations this raises are required in preparation for treatment. This work describes the specific anatomical features and techniques for this anatomy through recent literature illustrated by cases from our own experience.
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Affiliation(s)
- G Vesselle
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France.
| | - I Petit
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
| | - S Boucebci
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
| | - T Rocher
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
| | - S Velasco
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
| | - J-P Tasu
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
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15
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Ramesh Babu CS, Sharma M. Biliary tract anatomy and its relationship with venous drainage. J Clin Exp Hepatol 2014; 4:S18-26. [PMID: 25755590 PMCID: PMC4244820 DOI: 10.1016/j.jceh.2013.05.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 05/01/2013] [Indexed: 02/08/2023] Open
Abstract
Portal cavernoma develops as a bunch of hepatopetal collaterals in response to portomesenteric venous obstruction and induces morphological changes in the biliary ducts, referred to as portal cavernoma cholangiopathy. This article briefly reviews the available literature on the vascular supply of the biliary tract in the light of biliary changes induced by portal cavernoma. Literature pertaining to venous drainage of the biliary tract is scanty whereas more attention was focused on the arterial supply probably because of its significant surgical implications in liver transplantation and development of ischemic changes and strictures in the bile duct due to vasculobiliary injuries. Since the general pattern of arterial supply and venous drainage of the bile ducts is quite similar, the arterial supply of the biliary tract is also reviewed. Fine branches from the posterior superior pancreaticoduodenal, retroportal, gastroduodenal, hepatic and cystic arteries form two plexuses to supply the bile ducts. The paracholedochal plexus, as right and left marginal arteries, run along the margins of the bile duct and the reticular epicholedochal plexus lie on the surface. The retropancreatic, hilar and intrahepatic parts of biliary tract has copious supply, but the supraduodenal bile duct has the poorest vascularization and hence susceptible to ischemic changes. Two venous plexuses drain the biliary tract. A fine reticular epicholedochal venous plexus on the wall of the bile duct drains into the paracholedochal venous plexus (also called as marginal veins or parabiliary venous system) which in turn is connected to the posterior superior pancreaticoduodenal vein, gastrocolic trunk, right gastric vein, superior mesenteric vein inferiorly and intrahepatic portal vein branches superiorly. These pericholedochal venous plexuses constitute the porto-portal collaterals and dilate in portomesenteric venous obstruction forming the portal cavernoma.
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Key Words
- AIPDV, anterior inferior pancreaticoduodenal vein
- ASPDV, anterior superior pancreaticoduodenal vein
- CA, communicating arcade
- CBD, common bile duct
- CD, cystic duct
- CHA, common hepatic artery
- CHD, common hepatic duct
- FJV, first jejunal vein
- GCT, gastrocolic trunk
- GDA, gastroduodenal artery
- HABr, hepatic arteriolar branches
- IHBD, intrahepatic bile ductules
- LHA, left hepatic artery
- LHD, left hepatic duct
- PBP, peribiliary plexus
- PD, pancreatic duct
- PSPDA, posterior superior pancreaticoduodenal artery
- PSPDV, posterior superior pancreaticoduodenal vein
- PVBr, portal vein branches
- RASD, right anterior sectoral duct
- RGV, right gastric vein
- RHA, right hepatic artery
- RHD, right hepatic duct
- RPSD, right posterior sectoral duct
- SMV, superior mesenteric vein
- SRCV, superior right colic vein
- SV, splenic vein
- epicholedochal plexus
- parabiliary venous system
- paracholedochal plexus
- porto-portal collaterals
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Affiliation(s)
- Chittapuram S. Ramesh Babu
- Muzaffarnagar Medical College, NH-58, Opposite Beghrajpur Industrial Area, Muzaffarnagar, 251203, UP, India,Address for correspondence. Chittapuram S. Ramesh Babu, Associate Professor of Anatomy, Muzaffarnagar Medical College, NH-58, Opposite Beghrajpur Industrial Area, Muzaffarnagar 251203, UP, India. Tel.: +91 9897249202 (mobile).
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, 250001, UP, India
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16
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Polguj M, Podgórski M, Hogendorf P, Topol M. Variations of the hepatobiliary vasculature including coexistence of accessory right hepatic artery with unusually arising double cystic arteries: case report and literature review. Anat Sci Int 2013; 89:195-8. [PMID: 24310410 PMCID: PMC4015057 DOI: 10.1007/s12565-013-0219-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 11/19/2013] [Indexed: 11/09/2022]
Abstract
Familiarity with the different anatomical variations of the arterial supply of the gallbladder and liver is of great importance in all hepatobiliary surgical procedures. A complex anomaly of the hepatobiliary arterial system, which has never been reported before, was found during anatomical dissection of a 73-year-old male Caucasian cadaver. The accessory right hepatic artery (aRHA) took its origin from the gastroduodenal artery. Two cystic arteries were present, the first arising from the gastroduodenal artery (more distal than the aRHA) and the second directly from the aRHA. Potential clinical implications of this anomaly and embryology are discussed. Knowledge of the different anatomical variations of the arterial supply of the gallbladder and liver is of great importance in hepatobiliary surgical procedures.
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Affiliation(s)
- Michał Polguj
- Department of Angiology, Medical University of Łódź, Narutowicza Street 60, 90-136, Lodz, Poland,
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17
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Miyayama S, Yamashiro M, Hashimoto M, Hashimoto N, Ikuno M, Okumura K, Yoshida M, Matsui O. Blood supply of the main bile duct from the caudate artery and medial subsegmental artery of the hepatic artery: Evaluation using images obtained during transcatheter arterial chemoembolization for hepatocellular carcinoma. Hepatol Res 2013; 43:1175-81. [PMID: 23387506 DOI: 10.1111/hepr.12071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/16/2012] [Accepted: 01/06/2013] [Indexed: 02/08/2023]
Abstract
AIM Main bile duct necrosis develops after transcatheter arterial chemoembolization (TACE) through the caudate artery (A1) and medial subsegmental artery (A4) of the hepatic artery in the treatment of hepatocellular carcinoma. The aim of this study was to evaluate the bile duct branch (BD branch) from A1 and A4. METHODS We evaluated the origin and vascular territory of the BD branch in 11 patients who underwent selective A1 and/or A4 arteriography using arteriograms, cone-beam computed tomography (CBCT) and CT obtained 1 week after TACE. Follow-up CT and/or magnetic resonance imaging were also evaluated. RESULTS The BD branch arose from the first branch (n = 4), the second branch (n = 1), and both the first and second branches (n = 1) of A1, and from the first branch of A4 (n = 5). It supplied the bilateral hepatic ducts and common hepatic duct (CHD) (n = 4), the right hepatic duct (RHD) and CHD (n = 2), RHD, CHD and common bile duct (n = 1), the left hepatic duct (LHD) and CHD (n = 2), and LHD alone (n = 2). Anastomosis between A1 or A4 and other branches was demonstrated in seven patients. Bile duct stricture developed in all nine patients 2-8 months after TACE of the BD branch and percutaneous transhepatic bile duct drainage and metallic stent placement was required in one because of jaundice. CONCLUSION The BD branch arises from the proximal portion of A1 and A4 and mainly supplies the hepatic ducts and CHD.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan
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18
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Egorov VI, Petrov RV, Lozhkin MV, Maynovskaya OA, Starostina NS, Chernaya NR, Filippova EM. Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy. World J Gastrointest Surg 2013; 5:51-61. [PMID: 23556062 PMCID: PMC3615305 DOI: 10.4240/wjgs.v5.i3.51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/02/2012] [Accepted: 12/20/2012] [Indexed: 02/06/2023] Open
Abstract
Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type VIIIb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.
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Affiliation(s)
- Vyacheslav I Egorov
- Vyacheslav I Egorov, Ostroumov 14 City Hospital, Department of Surgical Oncology, Sechenov First State Medical University, 117997 Moscow, Russia
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19
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Anjamrooz SH, Azari H. Coexistence of multiple anomalies in the hepatobiliary system. Anat Cell Biol 2012; 45:62-5. [PMID: 22536554 PMCID: PMC3328743 DOI: 10.5115/acb.2012.45.1.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 02/19/2012] [Accepted: 03/09/2012] [Indexed: 12/22/2022] Open
Abstract
The co-occurrence of several anomalies in the hepatobiliary system is uncommon. In the present study, hepatic lobe anomalies occurring in combination with hepatic artery and biliary variations were observed in an adult male cadaver. There are no previous reports in the literature on the coexistence of such anatomical variations. Preoperative diagnosis of such coexisting anomalies is very difficult. Hence, a thorough knowledge of these variations will enable surgeons to select the most appropriate hepatobiliary surgical procedure and postoperative management.
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Affiliation(s)
- Seyed Hadi Anjamrooz
- Department of Anatomical Sciences, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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20
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Abdelmaksoud MHK, Louie JD, Kothary N, Hwang GL, Kuo WT, Hofmann LV, Hovsepian DM, Sze DY. Consolidation of hepatic arterial inflow by embolization of variant hepatic arteries in preparation for yttrium-90 radioembolization. J Vasc Interv Radiol 2012; 22:1364-1371.e1. [PMID: 21961981 DOI: 10.1016/j.jvir.2011.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 06/01/2011] [Accepted: 06/21/2011] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Before yttrium-90 ((90)Y) radioembolization administration, the authors consolidated arterial inflow by embolizing variant hepatic arteries (HAs) to make microsphere delivery simpler and safer. The present study reviews the technical and clinical success of these consolidation procedures. MATERIALS AND METHODS Preparatory and treatment angiograms were retrospectively analyzed for 201 patients. Variant HAs were coil-embolized during preparatory angiography to simplify arterial anatomy. Collateral arterial perfusion of territories previously supplied by variant HAs was evaluated by digital subtraction angiography (DSA), C-arm computed tomography (CT), and technetium-99m ((99m)Tc)-macroaggregated albumin (MAA) scintigraphy, and by follow-up evaluation of regional tumor response. RESULTS A total of 47 variant HAs were embolized in 43 patients. After embolization of variant HAs, cross-perfusion into the embolized territory was depicted by DSA and by C-arm CT in 100% of patients and by (99m)Tc-MAA scintigraphy in 92.7%. Uniform progressive disease prevented evaluation in 33% of patients, but regional tumor response in patients who responded supported successful delivery of microspheres to the embolized territories in 95.5% of evaluable patients. CONCLUSIONS Embolization of variant HAs for consolidation of hepatic supply in preparation for (90)Y radioembolization promotes treatment of affected territories via intrahepatic collateral channels.
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Affiliation(s)
- Mohamed H K Abdelmaksoud
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, CA 94305-5642, USA
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21
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Use of Recipient's Left Hepatic Artery for Artery Reconstruction in Right Lobe Living Donor Liver Transplantation With Duct-to-Duct Anastomosis. Transplantation 2010; 89:1016-21. [DOI: 10.1097/tp.0b013e3181ce77c4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Hashimoto K, Miller CM, Quintini C, Aucejo FN, Hirose K, Uso TD, Trenti L, Kelly DM, Winans CG, Vogt DP, Eghtesad B, Fung JJ. Is impaired hepatic arterial buffer response a risk factor for biliary anastomotic stricture in liver transplant recipients? Surgery 2010; 148:582-8. [PMID: 20227098 DOI: 10.1016/j.surg.2010.01.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 01/12/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Blood flow to the liver is partly maintained by the hepatic arterial buffer response (HABR), which is an intrinsic autoregulatory mechanism. Temporary clamping of the portal vein (PV) results in augmentation in hepatic artery flow (augHAF). Portal hyperperfusion impairs HAF due to the HABR in liver transplantation (LT). The aim of this study is to examine the effect of the HABR on biliary anastomotic stricture (BAS). METHODS In 234 cadaveric whole LTs, PV flow (PVF), basal HAF, and augHAF were measured intra-operatively after allograft implantation. All recipients with a vascular complication were excluded. Buffer capacity (BC) was calculated as (augHAF - basal HAF)/PVF to quantify the HABR. Recipients were divided into 2 groups based on their BC: low BC (<0.074; n = 117) or high BC (> or =0.074; n = 117). RESULTS Of the 234 recipients, 23 (9.8%) had early BAS (< or =60 days after LT) and 18 (7.7%) had late BAS (>60 days after LT). The incidence of late BAS and bile leakage was similar between the groups; however, the incidence of early BAS in the low BC group was greater than that in the high BC group (15% vs 5.1%; P = .0168). In the multivariate analysis, low BC (P = .0325) and bile leakage (P = .0002) were found to be independent risk factors affecting early BAS. CONCLUSION Recipients with low BC who may have impaired HABR are at greater risk of early BAS after LT. Intraoperative measurements of blood flow help predict the risk of BAS.
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Affiliation(s)
- Koji Hashimoto
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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23
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Main bile duct stricture occurring after transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2010; 33:1168-79. [PMID: 20058008 DOI: 10.1007/s00270-009-9781-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 12/03/2009] [Indexed: 01/06/2023]
Abstract
The purpose of this study was to evaluate the clinical course of main bile duct stricture at the hepatic hilum after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Among 446 consecutive patients with HCC treated by TACE, main bile duct stricture developed in 18 (4.0%). All imaging and laboratory data, treatment course, and outcomes were retrospectively analyzed. All patients had 1 to 2 tumors measuring 10 to 100 mm in diameter (mean ± SD 24.5 ± 5.4 mm) near the hepatic hilum fed by the caudate arterial branch (A1) and/or medial segmental artery (A4) of the liver. During the TACE procedure that caused bile duct injury, A1 was embolized in 8, A4 was embolized in 5, and both were embolized in 5 patients. Nine patients (50.0%) had a history of TACE in either A1 or A4. Iodized oil accumulation in the bile duct wall was seen in all patients on computed tomography obtained 1 week later. Bile duct dilatation caused by main bile duct stricture developed in both lobes (n = 9), in the right lobe (n = 3), in the left lobe (n = 4), in segment (S) 2 (n = 1), and in S3 (n = 1). Serum levels of alkaline phosphatase and γ-glutamyltranspeptidase increased in 13 patients. Biloma requiring drainage developed in 2 patients; jaundice developed in 4 patients; and metallic stents were placed in 3 patients. Complications after additional TACE sessions, including biloma (n = 3) and/or jaundice (n = 5), occurred in 7 patients and were treated by additional intervention, including metallic stent placement in 2 patients. After initial TACE of A1 and/or A4, 8 patients (44.4%), including 5 with uncontrollable jaundice or cholangitis, died at 37.9 ± 34.9 months after TACE, and 10 (55.6%) have survived for 38.4 ± 37.9 months. Selective TACE of A1 and/or A4 carries a risk of main bile duct stricture at the hepatic hilum. Biloma and jaundice are serious complications associated with bile duct strictures.
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Nishida S, Nakamura N, Kadono J, Komokata T, Sakata R, Madariaga JR, Tzakis AG. Intrahepatic biliary strictures after liver transplantation. ACTA ACUST UNITED AC 2006; 13:511-6. [PMID: 17139424 DOI: 10.1007/s00534-005-1081-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 11/25/2005] [Indexed: 12/18/2022]
Abstract
Biliary complication has been one of the most common complications after liver transplantation. Nonanastomotic strictures and dilatations involving the intrahepatic biliary tree have been recognized as biliary complications. These lesions were reported to be associated with hepatic artery thrombosis; prolonged preservation time; ABO-incompatible organs; and immunological injury, including injuries to vascular endothelial cells (chronic rejection) and the bile duct (primary sclerosing cholangitis). However, the etiology of these lesions appeared to be mostly related to ischemic injury. Anatomical research on the arterial supply of the bile duct has provided further insights into bile duct blood supply and its surgical implications. The biliary tract is supplied with arterial blood by a vasculature called the peribiliary vascular plexus. Any injury to the peribiliary vascular plexus may contribute to ischemic death of the biliary system mucosa. At many points, the process of liver transplantation exposes the endothelial cells and peribiliary vascular plexus to ischemic injury. The majority of intrahepatic biliary strictures (IHBS) are diffuse or bilateral. A percutaneous or an endoscopic approach has been used as the initial treatment. However, a low threshold for surgical intervention (retransplantation) should be adopted, because these patients demonstrate high mortality. The aim of this article is to review the anatomy, etiology, clinical picture, diagnosis, management, and prognosis of IHBS after liver transplantation.
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Affiliation(s)
- Seigo Nishida
- University of Miami, Miller School of Medicine, Department of Surgery, Division of Transplantation, Highland Professional Building, 1801 N.W. 9th Avenue, Suite 514, Miami, FL 33136, USA
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25
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Gunji H, Cho A, Tohma T, Okazumi S, Makino H, Shuto K, Mochizuki R, Matsubara K, Hayano K, Mori C, Murakami G, Ochiai T. The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries. Am J Surg 2006; 192:276-80. [PMID: 16920417 DOI: 10.1016/j.amjsurg.2006.01.046] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 01/31/2006] [Accepted: 01/31/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is an increasing demand for living donor liver transplants. However, the biliary complication rates are still high. METHODS The anatomy of the communicating arcade (CA) between the right and left livers and its relevance to the blood supply of the hilar bile duct was evaluated using adult cadaveric livers and cast specimens. RESULTS In all specimens that were of sufficient quality for evaluation, the CA was found to be located extrahepatically in the hilar plate with thin tributaries branching to the hilar bile duct. On the left side, 55% of the CA originated from a segment IV artery. On the right side, 73% of the CA originated from the right anterior hepatic artery. CONCLUSIONS To maintain an adequate blood supply for the hilar bile duct of the donor graft during living donor liver transplantation, the branching point of the CA should be preserved.
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Affiliation(s)
- Hisashi Gunji
- Department of Academic Surgery, Chiba University Graduate School of Medicine, and Department of Surgery, Chiba Cancer Center Hospital, Japan.
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26
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Loukas M, Fergurson A, Louis RG, Colborn GL. Multiple variations of the hepatobiliary vasculature including double cystic arteries, accessory left hepatic artery and hepatosplenic trunk: a case report. Surg Radiol Anat 2006; 28:525-8. [PMID: 17006621 DOI: 10.1007/s00276-006-0138-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 06/11/2006] [Indexed: 12/30/2022]
Abstract
Anatomical variations in the origins and branching patterns of the hepatobiliary arterial system may be encountered during both conventional surgical and laparoscopic cholecystectomy. We report a rare case of double cystic arteries arising from both the right hepatic artery and the proximal part of the posterior superior pancreaticoduodenal artery. Additional variations consisting of an accessory left hepatic artery arising from a left gastric which in turn arose from the descending aorta superior to the origin of the celiac trunk and a small left hepatic artery arising from the hepatic proper artery were also noted. The celiac trunk bifurcated into the splenic artery and the common hepatic artery forming a hepatosplenic or lienohepatic trunk. The possible clinical implications are discussed.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, True Blue Campus 001, Grenada, West Indies.
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27
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Affiliation(s)
- Pierre Deltenre
- Service d'Hépato-Gastroentérologie, Hôpital de Jolimont, Haine-Saint-Paul, Belgium
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28
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Liu DM, Salem R, Bui JT, Courtney A, Barakat O, Sergie Z, Atassi B, Barrett K, Gowland P, Oman B, Lewandowski RJ, Gates VL, Thurston KG, Wong CYO. Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 2005; 16:911-35. [PMID: 16002500 DOI: 10.1097/01.rvi.0000164324.79242.b2] [Citation(s) in RCA: 202] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The rapid evolution and increasing complexity of liver-directed therapies has forced the medical community to further advance its understanding of hepatic arterial anatomy. The anatomy of the mesenteric system, and particularly the hepatic arterial bed, has been demonstrated to have a high degree of variation. This is important when considering presurgical planning, catheterization, and transarterial hepatic therapies. Although anatomic variants have been well described, the characterization and understanding of regional hepatic perfusion is also required to optimize endovascular therapy and intervention. Although this is true for patients undergoing bland embolization or chemoembolization, drug delivery, and hepatic infusional pump therapy, it is particularly true for intraarterial brachytherapy. The purpose of this review is to provide historical perspective in angiographic aspects of liver-directed therapy, as well as a discussion of normal vascular anatomy, commonly encountered variants, and factors involved in changes to regional perfusion in the presence of liver tumors. Methods of optimizing the safety and efficacy of liver-directed therapies with use of percutaneous techniques will be discussed. This review is based on the experience gained in treating more than 500 patients with transarterial liver-directed therapies. Although the principles described in this article apply to all liver-directed therapies such as chemoembolization and administration of drug-coated microspheres, they apply particularly to intraarterial brachytherapy.
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Affiliation(s)
- David M Liu
- Department of Radiology, Interventional Radiology Section, St. Vincent's Hospital, Portland, Oregon, USA
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Tohma T, Cho A, Okazumi S, Makino H, Shuto K, Mochiduki R, Matsubara K, Gunji H, Ochiai T. Communicating arcade between the right and left hepatic arteries: evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology 2005; 237:361-5. [PMID: 16118153 DOI: 10.1148/radiol.2371040919] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate prospectively the relationship between the arterial collateral system at the hepatic hilum and the blood supply to the hilar bile duct by using computed tomography (CT) and angiography during temporary balloon occlusion of the right or left hepatic artery. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. The study included 13 patients with no lesions at the hepatic hilum (eight men and five women; age range, 41-78 years; mean, 65.8 years). After serial angiographic studies were performed for preoperative evaluation or transcatheter arterial chemoembolization, a 5.5-F catheter with an occlusion balloon was positioned in the right or left hepatic artery. Eleven patients underwent angiography of the left hepatic artery with temporary occlusion of the right hepatic artery, and two patients underwent angiography of the right hepatic artery with temporary occlusion of the left hepatic artery. In addition, 11 patients underwent single-level dynamic CT during hepatic arteriography (CTHA) with temporary occlusion of the right or left hepatic artery. The images from angiography and CTHA were interpreted by two authors who assessed the existence of the arterial communication and its branching points, location, and relationship to the hilar bile duct and caudate lobe. RESULTS During temporary occlusion of the right or left hepatic artery, the communicating arcade (CA) between the right and left hepatic arteries was immediately evident in all patients. On the left side, the CA originated from the segment IV artery in eight patients (62%) and from the left hepatic artery in five (38%). On the right side, the CA originated from the right anterior hepatic artery in six patients (46%), the right hepatic artery in two (15%), and both arteries in five (38%). The CA was extrahepatically located close to the hilar bile duct and forked into a few branches to the caudate lobe. CONCLUSION The CA may play an important role not only in the interlobar arterial collateral system but also in the blood supplies to the caudate lobe and hilar bile duct.
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Affiliation(s)
- Takayuki Tohma
- Department of Academic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.
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Abstract
AIM: To summarize the experiences of treating bile duct injuries in 40 years of clinical practice.
MATHODS: Based on the experience of more than 40 years of clinical work, 122 cases including a series of 61 bile duct injuries of the Southwest Hospital, Chongqing, and 42 cases (1989-1997) and 19 cases (1998-2001) of the General Hospital of PLA, Beijing, were reviewed with special reference to the pattern of injury. A series of cases of the liver and the biliary tract injuries following interventional therapy for hepatic tumors, most often hemangioma of the liver, were collected. Chinese medical literature from 1995 to 1999 dealing with 2742 traumatic bile duct strictures were reviewed.
RESULTS: There was a changing pattern of the bile duct injury. Although most of the cases of bile duct injuries resulted from open cholecystectomy. Other types of trauma such as laparoscopic cholecystectomy (LC) and hepatic surgery were increased in recent years. Moreover, serious hepato-biliary injuries following HAE using sclerotic agents such as sodium morrhuate and absolute ethanol for the treatment of hepatic hemangiomas were encountered in recent years. Experiences in how to avoid bile duct injury and to treat traumatic biliary strictures were presented.
CONCLUSION: Traumatic bile duct stricture is one of the serious complications of hepato-biliary surgery, its prevalence seemed to be increased in recent years. The pattern of bile duct injury was also changed and has become more complicated. Interventional therapy with sclerosing agents may cause serious hepatobiliary complications and should be avoided.
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Affiliation(s)
- Zhi-Qiang Huang
- Research Institute of General Surgery, The General Hospital of Chinese PLA, Beijing 100853,China.
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Huang XQ, Huang ZQ, Duan WD, Zhou NX, Feng YQ. Severe biliary complications after hepatic artery embolization. World J Gastroenterol 2002; 8:119-23. [PMID: 11833085 PMCID: PMC4656600 DOI: 10.3748/wjg.v8.i1.119] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2001] [Revised: 09/29/2001] [Accepted: 10/12/2001] [Indexed: 02/06/2023] Open
Abstract
AIM To study the mechanism and treatment of severe biliary complications arising from hepatic artery embolization(HAE). METHODS Of seven cases of intra- and extrahepatic biliary damage resulting from hepatic artery embolization reported since 1987, 6 patients suffered from hepatic haemangioma, the other case was due to injection of TH compound into the hepatic artery during operation. The hepatic artery was injected with ethanol so as to evaluate the liver damage in experimental rats. RESULTS All the cases were found to have destructive damage of intra- and extrahepatic bile duct at the hilum with biliary hepatocirrhosis. Experimental results revealed necrosis of the liver parenchyma, especially around the portal tract and obliteration of intrahepatic bile duct. CONCLUSIONS To prevent the severe biliary complications of HAE, the use of HAE for hepatic haemangioma which was widely practiced in China, should be re-evaluated. Hepatic arterial embolization of hepatic haemangioma may resulte in severe destructive biliary damages and its indiscriminate use should be prohibited.
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Affiliation(s)
- Xiao-Qiang Huang
- Department of Hepatobiliary Surgery, General Hospital of PLA, 28 Fuxing Road, Beijing 100853,China.
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Abstract
BACKGROUND This review aims to establish whether increased use of invasive procedures and the trend toward conservative management of major trauma has resulted in an increased incidence of haemobilia. METHOD A Medline (http://igm.nlm.nih.gov/)-based search of the English language literature from January 1996 to December 1999 inclusive was performed using the keywords haemobilia, hemobilia, haematobilia and hematobilia. The presentation, aetiology, investigation, management and outcome of 222 cases were reviewed. RESULTS Two-thirds of cases were iatrogenic while accidental trauma accounted for 5 per cent. Haemobilia may be major, constituting life-threatening haemorrhage, or minor; it may present many weeks after the initial injury. Diagnosis is most commonly confirmed by angiography. Management is aimed at stopping bleeding and relieving biliary obstruction; 43 per cent of cases were managed conservatively and 36 per cent were managed by transarterial embolization (TAE). Surgery was indicated when laparotomy was performed for other reasons and for failed TAE. The mortality rate was 5 per cent. CONCLUSIONS Although the incidence of iatrogenic haemobilia has risen considerably, the bleeding is often minor and can be managed conservatively. When more urgent intervention is required, TAE is usually the treatment of choice. There is no evidence that the conservative management of accidental liver trauma increases the risk of haemobilia.
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Affiliation(s)
- M H Green
- Department of Surgery, Southampton General Hospital, Southampton, UK.
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