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Choi TW, Chung JW. Radiation dose during transarterial chemoembolization and associated factors. Abdom Radiol (NY) 2024:10.1007/s00261-024-04370-0. [PMID: 38831076 DOI: 10.1007/s00261-024-04370-0] [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: 10/28/2023] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE To provide detailed reports on radiation doses during transarterial chemoembolization (TACE) in the cone-beam computed tomography (CBCT) era and to identify the associated factors. METHODS This retrospective study included 385 consecutive patients who underwent initial conventional TACE for hepatocellular carcinoma (HCC) between January 2016 and December 2017. In most cases, CBCT was performed at the common hepatic artery or celiac axis to confirm the location of the tumor and the three-dimensional hepatic artery anatomy. Superselective TACE was performed for all technically feasible cases. Information on total dose area product (DAP), total cumulative air kerma (CAK), fluoroscopy time, and DAP and CAK of each digital subtraction angiography (DSA) and CBCT scan was recorded. Multiple linear regression analysis was performed to identify the factors associated with increased DAP during TACE. RESULTS The mean values of total DAP and CAK were 165.2 ± 81.2 (Gy·cm²) and 837.1 ± 571.0 (mGy), respectively. The mean fluoroscopy time was 19.1 ± 10.3 min. The mean DAP caused by fluoroscopy, DSA, and CBCT was 51.8 ± 43.9, 28.0 ± 24.1, and 83.9 ± 42.1 Gy·cm², respectively. Male sex, a high body mass index, largest tumor size > 3 cm, presence of aberrant right and left hepatic arteries, and superselective TACE were identified as independent predictors of increased total DAP during TACE. CONCLUSION We were able to provide detailed reports on radiation doses during TACE and associated factors.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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2
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Uraoka M, Funamizu N, Sogabe K, Shine M, Honjo M, Tamura K, Sakamoto K, Ogawa K, Takada Y. Novel embryological classifications of hepatic arteries based on the relationship between aberrant right hepatic arteries and the middle hepatic artery: A retrospective study of contrast-enhanced computed tomography images. PLoS One 2024; 19:e0299263. [PMID: 38416748 PMCID: PMC10901311 DOI: 10.1371/journal.pone.0299263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/06/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Variations in hepatic arteries are frequently encountered during pancreatoduodenecomy. Identifying anomalies, especially the problematic aberrant right hepatic artery (aRHA), is crucial to preventing vascular-related complications. In cases where the middle hepatic artery (MHA) branches from aRHAs, their injury may lead to severe liver ischemia. Nevertheless, there has been little information on whether MHA branches from aRHAs. This study aimed to investigate the relationship between aRHAs and the MHA based on the embryological development of visceral arteries. METHODS This retrospective study analyzed contrast-enhanced computed tomography images of 759 patients who underwent hepatobiliary-pancreatic surgery between January 2011 and August 2022. The origin of RHAs and MHA courses were determined using three-dimensional reconstruction. All cases of aRHAs were categorized into those with or without replacement of the left hepatic artery (LHA). RESULTS Among the 759 patients, 163 (21.4%) had aRHAs. Five aRHAs patterns were identified: (Type 1) RHA from the gastroduodenal artery (2.7%), (Type 2) RHA from the superior mesenteric artery (SMA) (12.7%), (Type 3) RHA from the celiac axis (2.1%), (Type 4) common hepatic artery (CHA) from the SMA (3.5%), and (Type 5) separate branching of RHA and LHA from the CHA (0.26%). The MHA did not originate from aRHAs in Types 1-3, whereas in Type 4, it branched from either the RHA or LHA. CONCLUSIONS Based on the developmental process of hepatic and visceral arteries, branching of the MHA from aRHAs is considered rare. However, preoperative recognition and intraoperative anatomical assessment of aRHAs is essential to avoid injury.
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Affiliation(s)
- Mio Uraoka
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Naotake Funamizu
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Kyosei Sogabe
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Mikiya Shine
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Masahiko Honjo
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Kei Tamura
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Katsunori Sakamoto
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Kohei Ogawa
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Yasutsugu Takada
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
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Zhao M, Guo Z, Zou YH, Li X, Yan ZP, Chen MS, Fan WJ, Li HL, Yang JJ, Chen XM, Xu LF, Zhang YW, Zhu KS, Sun JH, Li JP, Jin Y, Yu HP, Duan F, Xiong B, Yin GW, Lin HL, Ma YL, Wang HM, Gu SZ, Si TG, Wang XD, Zhao C, Yu WC, Guo JH, Zhai J, Huang YH, Wang WY, Lin HF, Gu YK, Chen JZ, Wang JP, Zhang YM, Yi JZ, Lyu N. Arterial chemotherapy for hepatocellular carcinoma in China: consensus recommendations. Hepatol Int 2024; 18:4-31. [PMID: 37864725 DOI: 10.1007/s12072-023-10599-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/17/2023] [Indexed: 10/23/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies and the third leading cause of cancer-related deaths globally. Hepatic arterial infusion chemotherapy (HAIC) treatment is widely accepted as one of the alternative therapeutic modalities for HCC owing to its local control effect and low systemic toxicity. Nevertheless, although accumulating high-quality evidence has displayed the superior survival advantages of HAIC of oxaliplatin, fluorouracil, and leucovorin (HAIC-FOLFOX) compared with standard first-line treatment in different scenarios, the lack of standardization for HAIC procedure and remained controversy limited the proper and safe performance of HAIC treatment in HCC. Therefore, an expert consensus conference was held on March 2023 in Guangzhou, China to review current practices regarding HAIC treatment in patients with HCC and develop widely accepted statements and recommendations. In this article, the latest evidence of HAIC was systematically summarized and the final 22 expert recommendations were proposed, which incorporate the assessment of candidates for HAIC treatment, procedural technique details, therapeutic outcomes, the HAIC-related complications and corresponding treatments, and therapeutic scheme management.
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Affiliation(s)
- Ming Zhao
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-Sen University Cancer Center, Guangzhou, China.
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China.
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China.
| | - Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Ying-Hua Zou
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Ping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min-Shan Chen
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wei-Jun Fan
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hai-Liang Li
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Ji-Jin Yang
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Ming Chen
- Department of Interventional Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin-Feng Xu
- Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yue-Wei Zhang
- Hepatopancreatbiliary Center, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Kang-Shun Zhu
- Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun-Hui Sun
- Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Interventional Treatment Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia-Ping Li
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yong Jin
- The Interventional Therapy Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hai-Peng Yu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Feng Duan
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Bin Xiong
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guo-Wen Yin
- Department of Interventional Radiology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Lan Lin
- Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yi-Long Ma
- Department of Interventional Therapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Hua-Ming Wang
- Department of Interventional Therapy, The Fifth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Shan-Zhi Gu
- Department of Interventional Therapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Tong-Guo Si
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Xiao-Dong Wang
- Departments of Interventional Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chang Zhao
- Department of Interventional Therapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Wen-Chang Yu
- Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jian-Hai Guo
- Departments of Interventional Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jian Zhai
- Department of Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Yong-Hui Huang
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei-Yu Wang
- Department of Interventional Oncology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hai-Feng Lin
- Department of Medical Oncology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yang-Kui Gu
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jin-Zhang Chen
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian-Peng Wang
- Department of Oncology, First People's Hospital of Foshan, Foshan Hospital of Sun Yat-Sen University, Foshan, China
| | - Yi-Min Zhang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Jun-Zhe Yi
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Ning Lyu
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
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Goto T, Fujimura H, Shintani T, Shibuya T, Miyagawa S. Use of selective visceral angiography in surgical strategy planning for celiac artery aneurysm in the celiacomesenteric trunk. J Cardiothorac Surg 2024; 19:11. [PMID: 38243244 PMCID: PMC10797990 DOI: 10.1186/s13019-024-02483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The celiacomesenteric trunk (CMT) is a common duct of the celiac artery (CA) and the superior mesenteric artery originating from the aorta, which is an uncommon anatomical variant of visceral artery circulation. Because of the variety of visceral circulation in those with CMT, the visceral circulation associated with each branch should be evaluated prior to surgical treatment of visceral artery aneurysm in the CMT. CASE PRESENTATION A 64-year-old woman was diagnosed with a CA aneurysm in the CMT. Aneurysmectomy of the aneurysm was performed successfully. On preoperative selective visceral angiography, the CA was seen to bifurcate into the common hepatic and splenic artery. The left gastric artery was directly isolated from the aorta and perfused to the common hepatic and splenic artery through collateral circulation. These findings showed that celiac artery embolization is anatomically feasible, even in cases of celiac artery aneurysm rupture. CONCLUSIONS Selective visceral angiography can contribute to surgical strategy planning for CA aneurysm with CMT.
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Affiliation(s)
- Takasumi Goto
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan.
| | - Hironobu Fujimura
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Shintani
- Department of Cardiovascular Surgery, Nippon Life Hospital, Osaka, Japan
| | - Takashi Shibuya
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Hyidar Z, Ahmed U, Abid H, Ahmed I. A deviant anterior portal vein in the hepatoduodenal ligament with aberrant origin of hepatic arteries directly from the celiac trunk: A case report of two patients underwent pylorus preserving pancreatoduodenectomy (PPPD). Int J Surg Case Rep 2023; 108:108459. [PMID: 37413758 PMCID: PMC10382803 DOI: 10.1016/j.ijscr.2023.108459] [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: 05/21/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION The portal vein (PV) originates behind the neck of the pancreas, where it is formed classically by the union of the superior mesenteric vein (SMV) and the splenic vein (SV) [1]. It courses upwards towards the liver in the free margin of the lesser omentum, the hepatoduodenal ligament, along with other structures of the portal triad, i.e. proper hepatic artery (PHA) and common bile duct (CBD) anterior to it [1]. The PV is found posterior to the PHA and CBD. The abdominal aorta perfuses abdominal viscera via three ventral branches celiac trunk (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). The celiac trunk supplies the derivates of the foregut and is divided into the left gastric artery (LGA), splenic artery (SA), and common hepatic artery (CHA). The CHA, after its origin, is divided into the gastroduodenal artery (GDA) and PHA. After giving off the right gastric artery (RGA), the PHA bifurcates into the right and left hepatic arteries (RHA, LHA) [2]. IMPORTANCE This case report aims to share the rare variations in the anatomy of hepatoduodenal ligament structures to increase awareness and understanding among fellow surgeons which may reduce complications. CASE PRESENTATION We are reporting 2 cases in which during pancreaticoduodenectomy Portal vein was present anteriorly in the portal triad and the common hepatic artery was absent; instead, both the right and left hepatic arteries originated directly from the CA posterior to PV. This retro-portal origin of hepatic arteries directly from CA is not reported in Michel's classification of hepatic artery variations [3]. CLINICAL DISCUSSION The confluence of SMV and SV posterior to the neck of the pancreas forms the PV. The portal vein runs upwards in the free edge of the lesser omentum. Anteriorly it is related to the CBD laterally and CHA anteromedially. Posteriorly it is related to the inferior vena cava (IVC), and PV is separated from IVC by epiploic foramen [4]. The overall reported incidence in the variation of the portal vein anatomy is 25%. Among all the variations seen, the anterior PV with posteriorly bifurcating hepatic artery is present in only 10 % of the cases [5]. There is an increased risk of hepatic artery anatomical variation in the presence of portal vein variants. Michel's classification [6] classified variations in the hepatic artery anatomy. In our cases, the hepatic artery anatomy was standard and was classified as Type 1. The bile duct was normal anatomic (lateral to the PV). Hence our cases are unique in describing isolated variant locations and courses. Detailed information about the anatomy of the portal triad and all possible variants can help reduce the incidence of iatrogenic complications during surgeries like liver transplants and pancreatoduodenectomies. Before the advancement of modern imaging techniques, the variations in the anatomy of the portal triad were clinically irrelevant and considered less significant. However, recent literature supports that variant anatomy of the hepatic portal triad can prolong the time of surgery and increase the risk of iatrogenic complications. The clinical relevance of variable hepatic artery anatomy has immense importance in hepatobiliary surgeries, including liver transplants where the viability of the graft depends on adequate arterial perfusion. In addition to that, in pancreatoduodenectomies, aberrant arterial anatomy with a reteroportal course is associated with an increased number of reconstructions [7] and bilio-enteric anastomosis disruptions since the CBD derives its blood supply from the hepatic arteries. Therefore, the imaging must be carefully interpreted with radiologists' help before surgical planning. As surgeons preoperative imaging is usually seen for the abnormal origin of hepatic arteries and vascular involvement in case of malignancies. "Eyes don't see what mind doesn't know", the anterior portal vein is a rare entity and should be considered while reviewing preoperative imaging for operative planning. In our cases, EUS and CT scans, both were done but we determined resectability on scans and abnormal origin (replaced or accessory arteries) only. Above mentioned findings were noted during surgery but now in every preoperative scan, we try to determine the presence of all possible variations including the reported ones. CONCLUSION Detailed knowledge about the anatomy of the portal triad and all possible variants can help reduce the incidence of iatrogenic complications during surgeries like liver transplants and pancreatoduodenectomies. It also reduces the time of surgery. A careful review of all possible variations in preoperative scans with appropriate knowledge all anatomical variations helps avoid unpleasant events and hence, reduce morbidity and mortality.
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Affiliation(s)
- Zulqarnain Hyidar
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
| | - Umair Ahmed
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Haider Abid
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Irfan Ahmed
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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Türkyılmaz Z, Kula O, Çelik AO, Demirel T, Günay B. Evaluation of celiac artery and common hepatic artery variations by CT-angiography and new classification model. Surg Radiol Anat 2023:10.1007/s00276-023-03180-1. [PMID: 37340150 DOI: 10.1007/s00276-023-03180-1] [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: 11/20/2022] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Knowledge of anatomical variations is important in all interventional procedures. This study aims to evaluate the variations and prevalence of celiac trunk (CeT) and its branches. METHODS The computerized tomography-angiography (CT-A) findings of 941 adult patients were evaluated retrospectively. Variations of the CeT and common hepatic artery (CHA) were evaluated according to the number of branches and their origin. Findings were compared with classical classification methods. A new classification model has been defined. RESULTS Normal (complete) trifurcation was detected in 856 (90.9%) of them, where left gastric artery (LGA), splenic artery (SpA) and CHA branches were derived from the CeT. Among 856 complete trifurcation cases, 773 (90.3%) had non-classical trifurcation patterns. The rate of classic trifurcation was 8.8%, while non-classic trifurcation was 82.1% in all cases. In one case (0.1%), LGA and left hepatic artery together and right hepatic artery and SpA together appeared as a double bifurcation. Complete celiacomesenteric trunk was observed only in 4 (0.42%) cases. In seven cases (0.7%), LGA, SpA and CHA were coming out of abdominal aorta (AAo) independently. CHA normal anatomy (Michels Type I) was detected in 618 (65.5%) patients. We found that 49 (5.2%) of our cases were ambiguous according to the Michels Classification. We have described five different variations of hepatic arteries directly arising from the AAo. CONCLUSION Preoperative recognition of anatomical variations of CeT, superior mesenteric artery and CHA is of primary importance in both surgical and radiological procedures. With careful evaluation of CT-angiographies, it is possible to detect rare variations.
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Affiliation(s)
- Zeliha Türkyılmaz
- Department of General Surgery, Trakya University Medical Faculty, 22030, Edirne, Turkey.
| | - Osman Kula
- Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey
| | - Ahmet Onur Çelik
- Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey
| | - Tuğrul Demirel
- Department of General Surgery, Trakya University Medical Faculty, 22030, Edirne, Turkey
| | - Burak Günay
- Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey
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Chierici A, Castaldi A, El Zibawi M, Rosso E, Iannelli A. How to deal with right hepatic artery coming from the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review. Hepatobiliary Pancreat Dis Int 2023; 22:121-127. [PMID: 36604294 DOI: 10.1016/j.hbpd.2022.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anatomical variations in the liver arterial supply are quite common and can affect the surgical strategy when performing a minimally invasive pancreaticoduodenectomy (MIPD). Their presence must be preemptively detected to avoid postoperative liver and biliary complications. DATA SOURCES Following the PRISMA guidelines and the Cochrane protocol we conducted a systematic review on the management of an accessory or replaced right hepatic artery (RHA) arising from the superior mesenteric artery when performing an MIPD. RESULTS Five studies involving 118 patients were included. The most common reported management of the aberrant RHA was conservative (97.0%); however, patients undergoing aberrant RHA division without reconstruction did not develop liver or biliary complications. No differences in postoperative morbidity or long-term oncological related overall survival were reported in all the included studies when comparing MIPD in patients with standard anatomy to those with aberrant RHA. CONCLUSIONS MIPD in patients with aberrant RHA is feasible without increase in morbidity and mortality. As preoperative strategy is crucial, we suggested planning an MIPD with an anomalous RHA focusing on preoperative vascular aberrancy assessment and different strategies to reduce the risk of liver ischemia.
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Affiliation(s)
- Andrea Chierici
- Service de Chirurgie Digestive, Centre Hospitalier d'Antibes Juan-les-Pins, Antibes, France.
| | - Antonio Castaldi
- Department of Digestive Surgery and Liver Transplantation, University Hospital Center of Nice, Nice, France
| | - Mohamed El Zibawi
- Department of Radiology, University Hospital Center of Nice, Nice, France
| | - Edoardo Rosso
- Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Antonio Iannelli
- Department of Digestive Surgery and Liver Transplantation, University Hospital Center of Nice, Nice, France; Faculty of Medicine, Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 'Hepatic Complications of Obesity and Alcohol', Nice, France
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Lesion or Pseudolesion? A Comprehensive Description of Perfusion-Based Liver Alterations on Contrast-Enhanced Computed Tomography and Literature Review. J Comput Assist Tomogr 2023; 47:9-23. [PMID: 36584106 DOI: 10.1097/rct.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Pseudolesions on contrast-enhanced computed tomography represent a diagnostic challenge for radiologists because they could be difficult to distinguish from true space-occupying lesions. This article aims to provide a detailed overview of these entities based on radiological criteria (hyperattenuation or hypoattenuation, localization, morphology), as well as a brief review of the hepatic vascular anatomy and pathophysiological process. Relevant examples from hospital case series are reported as helpful hints to assist radiologists in recognizing and correctly diagnosing these abnormalities.
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Raghavendra D, Balachandar TG, Prabhakaran R, Swain SK, Nirmal J, Sunil N, Shekhar H. Replaced right hepatic artery passing anterior to pancreas: a rare and challenging anatomical variant during pancreaticoduodenectomy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00721-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
During pancreaticoduodenectomy proper dissection of local vessels is required. Normal coeliac and hepatic arterial anatomy can be found in only 50–70% of individuals. Good knowledge about aberrant vascular anatomies is necessary to avoid unnecessary complications.
Case presentation
An elderly gentleman presented to us with history of jaundice. Periampullary carcinoma with abnormal right and left hepatic artery morphology was discovered after a contrast enhanced computerized tomography scan.
Conclusion
Despite the anomalous origin and anterior course of replaced right hepatic artery, Classical pancreatoduodenectomy with preservation of replaced right hepatic artery and regional lymphadenectomy with no major intra and post-operative problems was conducted by superior mesenteric artery first approach. Prior to major hepato-pancreatobiliary surgery, a thorough examination of a contrast enhanced computerized tomography scan is required to understand vascular anatomy, recognize anomalous vessels, and understand their significance. Nevertheless, if the abnormal vessel anatomy like replaced right hepatic artery are identified during surgery, a careful dissection of the anomalous vessel is essential to identify all vascular relationships and avoid irreversible injury.
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Wu X, Kang J, Liu Y, Sun G, Shi Y, Niu J. A rare hepatic artery variant reporting and a new classification. Front Surg 2022; 9:1003350. [PMID: 36105121 PMCID: PMC9465518 DOI: 10.3389/fsurg.2022.1003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Variations of the hepatic artery are very common, but they greatly increase the difficulty of surgery and the risk of complications in perihepatic surgeries such as liver transplantation, liver segmentectomy, and gastroduodenal surgery. Thus, it is important to precisely define the type of hepatic artery variant before surgery. However, there are often rare variants that cannot be defined with existing classifications. For example, the type of hepatic artery variant in the current case could not be classified with conventional classifications, and no such variation has been reported to date, involving two accessory left hepatic arteries from the common hepatic and left inferior phrenic arteries, respectively. Based on the existing 3DCT technology and the CRL classification method, which is applicable to the most common hepatic artery variants, we reviewed many rare variant types and proposed a new classification method (ex-CRL classification) for hepatic artery variations that do not fit the classic scope. The ex-CRL classification can accurately classify the vast majority of rare cases in the literature, greatly compensates for the limitations of current hepatic artery classifications, improves the generalization and understanding of rare cases, and reduces surgical complications.
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Affiliation(s)
- Xiaojing Wu
- Department of Hepatology, First Bethune Hospital of Jilin University, Changchun, China
| | - Jianxiong Kang
- General Laboratory of Human Anatomy, Changzhi Medical College, Changzhi, China
| | - Yuwei Liu
- Department of Hepatology, First Bethune Hospital of Jilin University, Changchun, China
| | - Guodong Sun
- General Laboratory of Human Anatomy, Changzhi Medical College, Changzhi, China
- Correspondence: Guodong Sun Ying Shi Junqi Niu
| | - Ying Shi
- Department of Hepatology, First Bethune Hospital of Jilin University, Changchun, China
- Correspondence: Guodong Sun Ying Shi Junqi Niu
| | - Junqi Niu
- Department of Hepatology, First Bethune Hospital of Jilin University, Changchun, China
- Correspondence: Guodong Sun Ying Shi Junqi Niu
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11
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Lawson TR, Schroeder JA. Nuclear imaging in the identification of aberrant vascular anatomy prior to hepatic arterial infusion. Radiol Case Rep 2022; 17:2253-2256. [PMID: 35496749 PMCID: PMC9052064 DOI: 10.1016/j.radcr.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022] Open
Abstract
Hepatic arterial infusion (HAI) pumps are a specialized therapeutic modality designed to deliver high dose local chemotherapy to hepatic metastases in carefully selected patients resulting in improved survival, with patients living an average of 2 years longer than those who did not receive HAI pumps. While beneficial, these chemoinfusion pumps require a multidisciplinary approach to ensure safe and effective treatment for the patient. Here, we present a case where scintigraphic evaluation by the nuclear medicine department directly affected management of a patient with a hepatic arterial infusion pump. Variant vascular anatomy was initially discovered on the postoperative Tc-99m MAA SPECT/CT and was ultimately embolized by interventional radiology prior to initiation of chemoinfusion. This case report demonstrates the utility of obtaining nuclear medicine scintigraphy prior to chemoinfusion in patients with hepatic arterial infusion pumps.
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Affiliation(s)
- Tristan R Lawson
- Department of Diagnostic Radiology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157 USA
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12
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Faria LLD, Darce GF, Bordini AL, Herman P, Jeismann VB, de Oliveira IS, Ortega CD, Rocha MDS. Liver Surgery: Important Considerations for Pre- and Postoperative Imaging. Radiographics 2022; 42:722-740. [PMID: 35363553 DOI: 10.1148/rg.210124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Liver surgery may be a curative treatment option not only for primary liver neoplasms but also for liver metastases in selected patients. The number of liver surgeries performed worldwide has increased, but surgical morbidity associated with these surgeries remains significant. Therefore, radiologists need to understand the terminology, surgical techniques, resectability and unresectability criteria, and possible postoperative complications as these are part of the decision-making process. Because vascular and biliary variations are common, an adequate preoperative anatomic evaluation determines the best surgical technique, helps identify patients in whom additional surgical steps will be required, and reduces the risk of inadvertent injury. The surgeon must ensure that the future liver remnant is sufficient to maintain adequate function, aided by the radiologist who can provide valuable information such as the presence of steatosis, biliary dilatation, signs of cirrhosis, and portal hypertension, in addition to the volume of the future liver remnant. Postoperative complications must also be understood and evaluated. The most common postoperative complications are vascular (bleeding, thrombosis, and ischemia), biliary (fistulas, bilomas, and strictures), infectious (incisional or deep), those related to liver failure, and even tumor recurrence. An invited commentary by Winslow is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Luisa Leitão de Faria
- From the Department of Radiology (L.L.d.F., A.L.B., I.S.d.O., C.D.O., M.d.S.R.) and Liver Surgery Unit, Discipline of Digestive Surgery, Department of Gastroenterology (G.F.D., P.H., V.B.J.), University of São Paulo School of Medicine, Ovídio Pires de Campos 75, São Paulo 05403-010, Brazil
| | - George Felipe Darce
- From the Department of Radiology (L.L.d.F., A.L.B., I.S.d.O., C.D.O., M.d.S.R.) and Liver Surgery Unit, Discipline of Digestive Surgery, Department of Gastroenterology (G.F.D., P.H., V.B.J.), University of São Paulo School of Medicine, Ovídio Pires de Campos 75, São Paulo 05403-010, Brazil
| | - André Leopoldino Bordini
- From the Department of Radiology (L.L.d.F., A.L.B., I.S.d.O., C.D.O., M.d.S.R.) and Liver Surgery Unit, Discipline of Digestive Surgery, Department of Gastroenterology (G.F.D., P.H., V.B.J.), University of São Paulo School of Medicine, Ovídio Pires de Campos 75, São Paulo 05403-010, Brazil
| | - Paulo Herman
- From the Department of Radiology (L.L.d.F., A.L.B., I.S.d.O., C.D.O., M.d.S.R.) and Liver Surgery Unit, Discipline of Digestive Surgery, Department of Gastroenterology (G.F.D., P.H., V.B.J.), University of São Paulo School of Medicine, Ovídio Pires de Campos 75, São Paulo 05403-010, Brazil
| | - Vagner Birk Jeismann
- From the Department of Radiology (L.L.d.F., A.L.B., I.S.d.O., C.D.O., M.d.S.R.) and Liver Surgery Unit, Discipline of Digestive Surgery, Department of Gastroenterology (G.F.D., P.H., V.B.J.), University of São Paulo School of Medicine, Ovídio Pires de Campos 75, São Paulo 05403-010, Brazil
| | - Iraí Santana de Oliveira
- From the Department of Radiology (L.L.d.F., A.L.B., I.S.d.O., C.D.O., M.d.S.R.) and Liver Surgery Unit, Discipline of Digestive Surgery, Department of Gastroenterology (G.F.D., P.H., V.B.J.), University of São Paulo School of Medicine, Ovídio Pires de Campos 75, São Paulo 05403-010, Brazil
| | - Cinthia D Ortega
- From the Department of Radiology (L.L.d.F., A.L.B., I.S.d.O., C.D.O., M.d.S.R.) and Liver Surgery Unit, Discipline of Digestive Surgery, Department of Gastroenterology (G.F.D., P.H., V.B.J.), University of São Paulo School of Medicine, Ovídio Pires de Campos 75, São Paulo 05403-010, Brazil
| | - Manoel de Souza Rocha
- From the Department of Radiology (L.L.d.F., A.L.B., I.S.d.O., C.D.O., M.d.S.R.) and Liver Surgery Unit, Discipline of Digestive Surgery, Department of Gastroenterology (G.F.D., P.H., V.B.J.), University of São Paulo School of Medicine, Ovídio Pires de Campos 75, São Paulo 05403-010, Brazil
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13
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Takeuchi S, Ambo Y, Kodama Y, Takada M, Kato K, Nakamura F, Hirano S. Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series. Surg Case Rep 2022; 8:49. [PMID: 35316851 PMCID: PMC8941043 DOI: 10.1186/s40792-022-01403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 03/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background Replaced right hepatic artery (rRHA) is a common vascular variation, and combined resection of this vessel is sometimes needed for the curative resection of pancreatic head malignancy. Safe surgical management has not been established, and there is a small number of reported cases. Here, we reported five cases, wherein preoperative embolization of rRHA was performed for combined resection. Case presentation All patients had pancreatic head malignancies that were in contact with rRHA. We performed a preoperative embolization of the rRHA before the scheduled pancreaticoduodenectomy for the combined resection. Arterial embolization was safely accomplished, and the communicating arcade from the left hepatic artery via the hilar plate was clearly revealed in all cases. Four patients underwent the operative procedure, except for one patient who had liver metastasis at laparotomy. No patient suffered from a severe abnormal liver function during the management; however, one patient had multiple liver infarctions during the postoperative course. Conclusions Preoperative embolization for the combined resection of rRHA in pancreaticoduodenectomy can be a management option for the precise evaluation of hemodynamics after sacrificing rRHA. In our cases, arterial flow to the right liver lobe was supplied by the left hepatic artery via the bypass route, including the communicating arcade of the hilar plate.
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Affiliation(s)
- Shintaro Takeuchi
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan.
| | - Yoshiyasu Ambo
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Yoshihisa Kodama
- Department of Radiology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Minoru Takada
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Kentaro Kato
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Fumitaka Nakamura
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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14
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Balcerzak A, Tubbs RS, Waśniewska-Włodarczyk A, Olewnik Ł. Classification of the Superior Mesenteric Artery. Clin Anat 2022; 35:501-511. [PMID: 35088464 DOI: 10.1002/ca.23841] [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: 10/26/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/06/2022]
Abstract
The aim of this study was to characterize the branching pattern and morphology of the superior mesenteric artery (SMA), and also to create a new SMA classification, which seems necessary for clinicians performing surgery in this anatomical area. The anatomical variations in the branching patterns of the SMA were examined in 30 cadavers fixed in 10% formalin. Morphometric measurements were then obtained twice by two researchers. In the proposed classification system, Type I, characterized by all normal branches - inferior pancreatoduodenal artery, ileocolic artery, right colic artery, middle colic artery and intestinal arteries - occurred in 53.33% of the specimens. Type II, characterized by absence of the inferior pancreatoduodenal artery, was present in 26.67%. Type III, characterized by absence of the right colic artery, was present in 3.33%. Type IV, characterized by a common trunk for the inferior pancreatoduodenal artery and middle colic arteries, was observed in 3.33%. Type V, characterized by an aberrant hepatic artery and absence of the inferior pancreatoduodenal artery, was observed in 13.33%. The origin of the SMA was at the Th12/L1 level in 10% of cases, at L1 in 43.33%, at L1/L2 in 36.67%, and at L2 in 10%. The SMA is characterized by high morphological variability, the variants being associated with distinct clinical aspects. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.
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Affiliation(s)
- Adrian Balcerzak
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, Grenada
| | | | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
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15
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Pattnaik B, Nayak HK, Mahakud S, Nath VG. Replaced Common Hepatic Artery from Superior Mesenteric Artery and Low Insertion of Right Posterior Sectoral Duct: Dealing with Two Rare Anomalies During Pancreaticoduodenectomy for Ampullary Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Tong VJW, Shelat VG, Chao YK. Clinical application of advances and innovation in radiation treatment of hepatocellular carcinoma. J Clin Transl Res 2021; 7:811-833. [PMID: 34988334 PMCID: PMC8715712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Hepatocellular carcinoma (HCC) management has evolved over the past two decades, with the development of newer treatment modalities. While various options are available, unmet needs are reflected through the mixed treatment outcome for intermediate-stage HCC. As HCC is radiosensitive, radiation therapies have a significant role in management. Radiation therapies offer local control for unresectable lesions and for patients who are not surgical candidates. Radiotherapy also provides palliation in metastatic disease, and acts as a bridge to resection and transplantation in selected patients. Advancements in radiotherapy modalities offer improved dose planning and targeted delivery, allowing for better tumor response and safer dose escalations while minimizing the risks of radiation-induced liver damage. Radiotherapy modalities are broadly classified into external beam radiation therapy and selective internal radiation therapy. With emerging modalities, radiotherapy plays a complementary role in the multidisciplinary care of HCC patients. Aim: We aim to provide an overview of the role and clinical application of radiation therapies in HCC management. Relevance for Patients: The continuous evolution of radiotherapy techniques allows for improved therapeutic outcomes while mitigating unwanted adverse effects, making it an attractive modality in HCC management. Rigorous clinical studies, quality research and comprehensive datasets will further its application in the present era of evidence-based practice in Medicine.
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Affiliation(s)
- Valerie J W Tong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore
| | - Yew Kuo Chao
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 308433, Singapore
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17
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Meng C, Cao S, Liu X, Li L, He Q, Xia L, Jiang L, Chu X, Wang X, Wang H, Hui X, Sun Z, Huang S, Duan Q, Yang D, Zhang H, Tian Y, Li Z, Zhou Y. Effect of preoperative CT angiography examination on the clinical outcome of patients with BMI ≥ 25.0 kg/m 2 undergoing laparoscopic gastrectomy: study protocol for a multicentre randomized controlled trial. Trials 2021; 22:912. [PMID: 34895320 PMCID: PMC8666026 DOI: 10.1186/s13063-021-05887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastric cancer, which is the fifth most common malignancy and the third most common cause of cancer-related death, is particularly predominant in East Asian countries, such as China, Japan and Korea. It is a serious global health issue that causes a heavy financial burden for the government and family. To our knowledge, there are few reports of multicentre randomized controlled trials on the utilization of CT angiography (CTA) for patients who are histologically diagnosed with gastric cancer before surgery. Therefore, we planned this RCT to verify whether the utilization of CTA can change the short- and long-term clinical outcomes. METHOD The GISSG 20-01 study is a multicentre, prospective, open-label clinical study that emphasises the application of CTA for patients who will undergo laparoscopic gastrectomy to prove its clinical findings. A total of 382 patients who meet the inclusion criteria will be recruited for the study and randomly divided into two groups in a 1:1 ratio: the CTA group (n = 191) and the non-CTA group (n = 191). Both groups will undergo upper abdomen enhanced CT, and the CTA group will also receive CT angiography. The primary endpoint of this trial is the volume of blood loss. The second primary endpoints are the number of retrieved lymph nodes, postoperative recovery course, hospitalization costs, length of hospitalization days, postoperative complications, 3-year OS and 3-year DFS. DISCUSSION It is anticipated that the results of this trial will provide high-level evidence and have clinical value for the application of CTA in laparoscopic gastrectomy. TRIAL REGISTRATION ClinicalTrials.gov , NCT04636099. Registered November 19, 2020.
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Affiliation(s)
- Cheng Meng
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Xiaodong Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Jinan, China
| | - Qingsi He
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lijian Xia
- Department of Gastrointestinal Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Lixin Jiang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Xianqun Chu
- Department of Gastrointestinal Surgery, Jining No.1 People's Hospital, Jining, China
| | - Xinjian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China
| | - Hao Wang
- Department of Gastrointestinal Surgery, Dongying People's Hospital, Dongying, China
| | - Xizeng Hui
- Department of Gastrointestinal Surgery, Rizhao People's Hospital, Rizhao, China
| | - Zuocheng Sun
- Department of Oncological Surgery, Weifang People's Hospital, Weifang, China
| | - Shusheng Huang
- Department of Gastrointestinal Surgery, People's Hospital of Jimo District, Qingdao, China
| | - Quanhong Duan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Daogui Yang
- Department of Gastrointestinal Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Huanhu Zhang
- Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Weihai, China
| | - Yulong Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China.
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18
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Toda T, Kanemoto H, Tokuda S, Takagi A, Oba N. Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting: A case report and review of literature. Medicine (Baltimore) 2021; 100:e27788. [PMID: 35049175 PMCID: PMC9191372 DOI: 10.1097/md.0000000000027788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Pancreaticoduodenectomy (PD) is a technically demanding procedure with high rates of morbidity and mortality. Therefore, preoperative evaluation of anatomy is indispensable. Multi-detector row computed tomography (CT) enables us to precisely understand arterial anatomy. It is a well-known fact that anatomical variants are often present in the hepatic artery (HA) but rarely in the gastroduodenal artery (GDA). We present the case of a patient with ampullary cancer with a rare anatomical anomaly, "replaced GDA (rGDA) " arising from the superior mesenteric artery, along with a history of coronary artery bypass grafting (CABG) using right gastroepiploic artery (RGEA). PATIENT CONCERNS A 69-year-old male patient was referred to our department for further investigation of elevated hepatobiliary enzymes. He presented with no symptoms besides intermittent fever of 38°C. He had an operative history of CABG using the RGEA. DIAGNOSIS Abdominal CT and esophagogastroduodenoscopy showed an ampullary tumor and biopsy specimen from the lesion revealed adenocarcinoma. CT angiography revealed the rGDA instead of a normal common HA. INTERVENTION We performed a safe PD, preserving the rGDA and the RGEA to maintain hepatic and cardiac perfusion. OUTCOMES Owing to the presence of a refractory pancreatic fistula, the length-of-hospital stay was extended, and he was discharged on postoperative day 72 without vascular complications. At present, the patient is in good physical condition and does not present with cardiovascular complications as well as tumor recurrence at 6 months after surgery. LESSONS This is possibly the first case of a patient who underwent PD and has a proper HA following a GDA arising from a superior mesenteric artery (rGDA) and has a previous operative history of CABG using the gastroepiploic artery. The coexistence of the history of cardiovascular surgery made PD for this patient considerably more challenging.In the case of a rare anatomical anomaly, a coronary artery bypass via the RGEA should not be considered as an obstacle when R0 resection is achievable.
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Affiliation(s)
- Takeo Toda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Hideyuki Kanemoto
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Satoshi Tokuda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Akihiko Takagi
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Noriyuki Oba
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
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19
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Nosher J, Saifuddin AA, Grandhi MS, Moubarak I. Conjoined right hepatic artery from branches of the common hepatic and gastroduodenal arteries: a rare anatomic variant. Surg Radiol Anat 2021; 44:143-146. [PMID: 34783869 DOI: 10.1007/s00276-021-02856-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe a previously unreported anatomical variant of the hepatic arterial supply: a conjoined right hepatic artery, formed by branches of the common hepatic artery and gastroduodenal artery. METHOD A 54-year-old female with oligometastatic colorectal cancer with metastases to the liver presented for planning stage arteriography in preparation for Y90 radioembolization. RESULTS Arteriography of the common hepatic artery demonstrated bifurcation into a right hepatic artery and gastroduodenal artery. The gastroduodenal artery gave rise to a proximal branch, from which the left hepatic artery originated and then continued to anastomose in the hilum of the liver to the right hepatic artery originating from the common hepatic artery. It was initially identified on visceral artery arteriography and then retrospectively recognized on pre-procedural CT scan. CONCLUSION Anatomical variants of the hepatic arterial supply are important to recognize during planning stage arteriography in preparation for Y90 radioembolization. Knowledge of these variants is also important for pre-operative planning.
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Affiliation(s)
- John Nosher
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ali Abbas Saifuddin
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Miral S Grandhi
- Division of Surgical Oncology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Issam Moubarak
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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20
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An Investigative Study of Hepatic Arterial Anomalies in a West Indian Population. Radiol Res Pract 2021; 2021:9201162. [PMID: 34691781 PMCID: PMC8536413 DOI: 10.1155/2021/9201162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/08/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose There are many known variations in the arterial supply to the liver. We sought to document the incidence and details of anomalies of the extrahepatic arteries in an unselected population in the West Indies. Methods This study spanned 24 months. All 205 CT scans were evaluated at a hepatobiliary referral center in Trinidad and Tobago. We described the anomalies of the arterial supply to the liver using the conventional classification proposed by Michels. Results 205 CT scans were evaluated, and 112 persons (54.6%) had conventional Type 1 anatomy. However, compared to the incidence in the existing medical literature, we encountered a greater incidence of replaced right hepatic arteries (18.1% vs 11%; P 0.04) and a lower incidence of accessory right hepatic arteries (2.4% vs 7%; P 0.030). Conclusion Although 54.6% of persons in this West Indian population have conventional hepatic arterial supply, the distribution of anatomic variants of the right hepatic artery is quite different to that seen in North American and European centers. We found a higher incidence of replaced right hepatic arteries and a lower incidence of accessory right hepatic arteries.
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21
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Commander CW, Mauro DM. Current Approach to Planning Angiography and MAA Administration. Semin Intervent Radiol 2021; 38:397-404. [PMID: 34629705 DOI: 10.1055/s-0041-1735616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transarterial radioembolization of primary and secondary hepatic malignancies utilizing yttrium-90 microspheres is a commonly performed treatment by interventional radiologists. Traditionally performed as a two-part procedure, a diagnostic angiography is performed 1 to 3 weeks prior to treatment with the injection of technetium-99m-macroaggregated albumin followed by planar scintigraphy in the nuclear medicine department. Careful attention must be paid to the details during the diagnostic angiography to ensure the delivery of a safe and optimal dose to the diseased liver and to minimize radiation-induced damage to both unaffected liver and adjacent structures. In this article, we will review the steps and considerations that must be made during the angiography planning and discuss current and future areas of research.
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Affiliation(s)
- Clayton W Commander
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David M Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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22
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Choi TW, Chung JW, Kim HC, Lee M, Choi JW, Jae HJ, Hur S. Anatomic Variations of the Hepatic Artery in 5625 Patients. Radiol Cardiothorac Imaging 2021; 3:e210007. [PMID: 34498005 DOI: 10.1148/ryct.2021210007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/20/2021] [Accepted: 07/19/2021] [Indexed: 12/27/2022]
Abstract
Purpose To analyze the origin and anatomic course of the hepatic arteries by using digital subtraction angiography (DSA) and multidetector CT in a large study sample. Materials and Methods This retrospective study included 5625 patients who underwent liver CT and chemoembolization between January 2005 and December 2018 (mean age, 60 years ± 11 [range, 11-99 years]; 4464 males). The CT and DSA images were reviewed to evaluate the visceral arterial anatomy for variations in the celiac axis and hepatic arteries. Aberrant right hepatic arteries (aRHAs) and aberrant left hepatic arteries (aLHAs) were defined on the basis of their origin and anatomic course. Statistical analyses were performed to evaluate the association between aRHAs and aLHAs and the association between variations in the hepatic artery and celiac axis. Results Right hepatic arteries were categorized as being aRHAs (if originating from the proximal to middle common hepatic artery, gastroduodenal artery, superior mesenteric artery [SMA], celiac axis, aorta, splenic artery, or left gastric artery [LGA]) or as being aLHAs (if arising from the LGA, celiac axis, aorta, or SMA). The prevalence of aRHAs (15.63%; 879 of 5625) and the prevalence aLHAs (16.32%; 918 of 5625) were similar. Patients with an aRHA were more likely to have an aLHA than those without an aRHA (29.01% vs 13.97%; P < .001), and patients with an aLHA were more likely to have an aRHA than those without an aLHA (27.78% vs 13.26%; P < .001). There was no association between the hepatic arterial variations and celiac axis variations. A hypothetical anatomic model summarizing the observed variations was created. Conclusion A comprehensive list of hepatic arterial variations and a three-dimensional hypothetical model for the observed variations were described.Keywords: CT, Angiography, Liver, Anatomy, Arteries© RSNA, 2021 Supplemental material is available for this article. See also commentary by Sutphin and Kalva in this issue.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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Novel variant of hepatic and foregut vasculature. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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24
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Brunner M, Krautz C, Maak M, Weber GF, Grützmann R. [Pylorus-Preserving Pancreaticoduodenectomy (PPPD) with Segmental Portal Vein Resection]. Zentralbl Chir 2021; 147:233-241. [PMID: 34318466 DOI: 10.1055/a-1528-7927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pylorus-preserving partial pancreatoduodenectomy is a complex visceral operation, especially when simultaneous resection and reconstruction of the portal venous axis is necessary. Pancreatic anastomosis plays a decisive role in this procedure, since postoperative pancreatic fistula (POPF) is a frequent complication, with serious consequences (morbidity and mortality) for the affected patient. Various techniques are available for anastomosing the residual pancreas: the duct-to-mucosa pancreaticojejunostomy, invaginating pancreatojejunostomy, Blumgart anastomosis and pancreatogastrostomy. INDICATION Adenocarcinoma of the pancreatic head with portal vein infiltration. PROCEDURE Pylorus-preserving pancreaticoduodenectomy (PPPD) with portal vein resection. CONCLUSION A standardised and structured approach to pylorus-preserving partial pancreatoduodenectomy helps the surgeon to perform this procedure safely. Performing a simultaneous portal vein resection increases the complexity of the procedure, but nonetheless, if infiltration of the portal venous axis is suspected, the indication for en-bloc resection should be given generously, as intraoperatively it is not possible to differentiate reliably between inflammatory adherence and tumour infiltration and portal vein/V.-mesenterica-superior-resection does not increase morbidity and mortality. The choice of the surgical technique for anastomosing the residual pancreas should be made by the surgeon on the basis of his expertise and, if necessary, adapted to the patient's situs, since the most important pancreatic anastomosis techniques appear to be equivalent according to the current evidence.
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Affiliation(s)
- Maximilian Brunner
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Deutschland
| | - Christian Krautz
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Deutschland
| | - Matthias Maak
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Deutschland
| | - Georg F Weber
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Deutschland
| | - Robert Grützmann
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Deutschland
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A comprehensive study of right and left inferior phrenic artery variations in 1000 patients with multidetector computed tomography angiography: an important study for HCC. Surg Radiol Anat 2021; 43:1471-1480. [PMID: 34302198 DOI: 10.1007/s00276-021-02805-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the anatomic variations in the origins of the right and left inferior phrenic arteries (IPAs) using multidetector computed tomography and to classify their combined variations. METHODS This retrospective study included patients undergoing abdominal aorta angiography between January 2015 and October 2019. The RIPA and LIPA origins were evaluated both separately and combined on three-dimensional images. The variant patterns of the IPAs were determined and classified. The numerical evaluation of the data was performed with SPSS 21. RESULTS In total, 1000 patients (478 women, 522 men) were evaluated. The IPAs originated from a common trunk or a common root in 360 (36.00%) patients, while the IPAs originated independently without a common trunk in 609 (60.90%) patients. The most common combined variant detected in the present study was IPAs originating as a common trunk from the coeliac trunk in 197 (19.70%) patients; 14 (1.40%) patients had no inferior phrenic artery (IPA), and 17 (1.70%) patients had only one IPA. CONCLUSION Fifty-two different types of variations in the combined origin of the inferior phrenic arteries were described in this study for the first time in the literature. Awareness of the anatomic variations in the IPAs, which is critical for hepatocellular carcinoma origins, may benefit various clinical procedures, such as transcatheter arterial chemoembolization, organ transplantations, laparoscopic surgical procedures, and radiological procedures.
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Rana P, Singh S. Aberrant gastroduodenal and proper hepatic arteries. Surg Radiol Anat 2021; 43:1421-1424. [PMID: 34047834 DOI: 10.1007/s00276-021-02774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Anatomic variants of the celiac trunk and superior mesenteric artery are common, thus knowledge of these variants is important for preoperative planning of abdominal surgery and interventional procedures. METHODS We report a rare anatomic variant of replaced proper hepatic and gastroduodenal arteries discovered upon CT angiography and diagnostic angiogram. RESULTS Emergent angiogram performed on a 61-year-old male who presented with signs and symptoms of upper gastrointestinal hemorrhage revealed a rare variant of an absent common hepatic artery and its branches with aberrant origins. The replaced proper hepatic artery originated from the superior mesenteric artery and the replaced gastroduodenal artery originated from a gastrosplenic trunk. CONCLUSION This case emphasizes the importance of evaluating preoperative imaging to identify vascular variants prior to undergoing abdominal surgery or interventional procedures.
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Affiliation(s)
- Puneet Rana
- Department of Radiology, Albert Einstein College of Medicine/NYC Health + Hospitals - Jacobi Medical Center, The Bronx, NY, USA
| | - Shashi Singh
- Department of Radiology, Albert Einstein College of Medicine/NYC Health + Hospitals - Jacobi Medical Center, The Bronx, NY, USA.
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Elsamaloty M, Schupp E, Ismail A, Borile C, Chun K, Sutton JM. A Rare Anatomic Variant of Double Replaced Hepatic Arteries: A Case Report and Brief Review of the Anomalous Hepatic Vasculature Literature. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930990. [PMID: 33966033 PMCID: PMC8127860 DOI: 10.12659/ajcr.930990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patient: Male, 78-year-old Final Diagnosis: Double replaced hepatic artery Symptoms: None Medication:— Clinical Procedure: — Specialty: Infectious Diseases • Transplantology
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Affiliation(s)
- Mazzin Elsamaloty
- College of Medicine and Life Sciences, University of Toledo Medical Center, Toledo, OH, USA
| | - Eric Schupp
- College of Medicine and Life Sciences, University of Toledo Medical Center, Toledo, OH, USA
| | - Abdighani Ismail
- College of Medicine and Life Sciences, University of Toledo Medical Center, Toledo, OH, USA
| | - Clariza Borile
- College of Medicine and Life Sciences, University of Toledo Medical Center, Toledo, OH, USA
| | - Krista Chun
- College of Medicine and Life Sciences, University of Toledo Medical Center, Toledo, OH, USA
| | - Jeffrey M Sutton
- Division of Surgical Oncology, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
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Namba Y, Oishi K, Okimoto S, Moriuchi T, Bekki T, Mukai S, Saito Y, Fujisaki S, Takahashi M, Fukuda T, Ohdan H. Imaging diagnosis of aberrant proper hepatic and gastroduodenal arteries prior to pancreaticoduodenectomy: A case report. Radiol Case Rep 2021; 16:1650-1654. [PMID: 34007377 PMCID: PMC8111473 DOI: 10.1016/j.radcr.2021.03.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 12/29/2022] Open
Abstract
In hepatobiliary and pancreatic surgery, an understanding of hepatic artery anomalies is of great importance to surgeons. Cases of the proper hepatic artery originating from the superior mesenteric artery and the gastroduodenal artery originating from the celiac trunk are extremely rare. To our knowledge, there are no reports of these arterial variants being diagnosed before hepatobiliary and pancreatic surgery. A 73-year-old woman underwent subtotal stomach-preserving pancreaticoduodenectomy and lymphadenectomy for duodenal carcinoma. Preoperative vascular construction with 3-dimensional computed tomography showed variants of the proper hepatic artery and gastroduodenal artery. The proper hepatic artery originated from the superior mesenteric artery, and the gastroduodenal artery originated from the celiac trunk. Intraoperative findings and preoperative vascular construction from 3-dimensional computed tomography were found to be matched exactly; both the proper hepatic artery and gastroduodenal artery were preserved. By diagnosing a rare arterial variant preoperatively, we were able to perform the surgery safely. In hepatobiliary and pancreatic surgery, understanding any potential variation of the hepatic artery before surgery is crucial to ensure the best patient outcomes.
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Affiliation(s)
- Yosuke Namba
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Koichi Oishi
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
- Corresponding author.
| | - Sho Okimoto
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | | | - Tomoaki Bekki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Shoichiro Mukai
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yasufumi Saito
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Seiji Fujisaki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | | | | | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Mansour S, Damouny M, Obeid M, Farah A, Halloun K, Marjiyeh R, Ghalia J, Kluger Y, Khuri S. Impact of Vascular Anomalies on Pancreatoduodenectomy Procedure. J Clin Med Res 2021; 13:158-163. [PMID: 33854655 PMCID: PMC8016524 DOI: 10.14740/jocmr4455] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background One of the critical steps during pancreatoduodenectomy (PD) procedure lies in identifying the complicated vascular anatomy of the resected area. The blood supply usually stems from branches of the celiac and the superior mesenteric arteries. However, only in 55-79% of surgeries, the anatomy of the blood vessels encountered by the surgeon is considered normal, while in the remaining cases, there are vascular variations that make these surgeries even more challenging. Any change or deviation from the known surgical course of PD makes surgery difficult and can result in an increase in intra/postoperative complications. In order to reduce difficulties encountered during PD, as well as reducing complication rates and improving surgical outcomes, a preliminary design, which includes preoperative identification of anatomical variations, is needed. The most accurate and accessible tool for identifying such variations is computed tomographic angiography (CTA). The aim of this retrospective study is to assess the prevalence of vascular anomalies encountered during PD, and examine whether there is an association between these anomalies and intra/postoperative morbidity and mortality. Methods A retrospective study over 5 years was performed at the HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel. The charts of all patients submitted to PD were reviewed, and all patients with vascular anomalies were included. The types of anatomical variant as well as other information were collected. For statistical purposes, the group of patients with vascular anomalies was compared to a control group with identical demographic characteristics. A statistical analysis on possible association between vascular anomalies and intra/postoperative complications (mainly bleeding) was performed. Results During the aforementioned period, 202 patients underwent PD, and in 41 (20.3%) vascular anomalies were identified. The majority of these patients (32/41) had single anatomical variant, where two and three anatomical variants were identified in seven and two patients, respectively. The most common vascular anomaly was replaced right hepatic artery, noticed in 34 patients (83%). The most common indication for PD for both groups (anatomical variant and control group) was pancreas adenocarcinoma (56%). Intraoperative complication, in the form of bleeding, developed in 6/41 patients (14.6%) of the anatomical variant group and none in the control group. Postoperative complication rates, including post- pancreatoduodenectomy hemorrhage (PPH), postoperative pancreatic fistula (POPF), intra-abdominal abscess and wound infection were almost identical for both groups. One case of death within 30 days occurred, and it was in the anatomical variant group. Conclusions Anatomical vascular anomalies are a common variant encountered during PD, with RRHA being the most common. Although postoperative morbidity and mortality are not affected by the presence of these anomalies, intraoperative bleeding rate is higher in this specific group, thus; a preoperative diagnosis by means of CTA is mandatory.
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Affiliation(s)
- Subhi Mansour
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Mira Damouny
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Miriam Obeid
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Amir Farah
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Kenan Halloun
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Rozan Marjiyeh
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Jawad Ghalia
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Yoram Kluger
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel.,HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Safi Khuri
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel.,HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel
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Walker BS, Sutton TL, Eil RL, Korngold EK, Kolbeck KJ, Billingsley KG, Mayo SC. Conventional hepatic arterial anatomy? Novel findings and insights of a multi-disciplinary hepatic arterial infusion pump program. Am J Surg 2021; 221:1188-1194. [PMID: 33685717 DOI: 10.1016/j.amjsurg.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Variant hepatic arterial anatomy (vHAA) is thought to occur in 20-30% of patients. Hepatic arterial infusion (HAI) pump placement for liver cancers requires thorough hepatic artery dissection; we sought to compare vHAA identified during pump placement with established dogma. METHODS Between 2016 and 2020, n = 30 patients received a HAI pump. Intra-operatively identified vHAA was characterized and compared with published data. RESULTS vHAA was identified in 60% (n = 18) of patients, significantly higher than 19% (3671 of 19013) in the largest published series (P < 0.001). The most common variations were accessory left (n = 12; 40%) and replaced right (n = 6; 20%) hepatic arteries; six (20%) had ≥2 variants. Pre-operative imaging correctly identified 67% of variant hepatic arteries. DISCUSSION Meticulous operative dissection of the hepatic arterial tree reveals vHAA not captured by imaging or cadaveric dissection. vHAA likely has a higher prevalence than previously reported and should be addressed to optimize therapeutic efficacy of HAI pump therapy.
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Affiliation(s)
- Brett S Walker
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA
| | - Thomas L Sutton
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA
| | - Robert L Eil
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA
| | - Elena K Korngold
- OHSU, Department of Diagnostic Radiology, Section of Body Imaging, Portland, OR, 97239, USA
| | - Kenneth J Kolbeck
- OHSU, Charles T. Dotter Department of Interventional Radiology, Portland, OR, 97239, USA
| | - Kevin G Billingsley
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA
| | - Skye C Mayo
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA.
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Lee S, Son T, Song JH, Choi S, Cho M, Kim YM, Kim HI, Hyung WJ. Adverse Effects of Ligation of an Aberrant Left Hepatic Artery Arising from the Left Gastric Artery during Radical Gastrectomy for Gastric Cancer: a Propensity Score Matching Analysis. J Gastric Cancer 2021; 21:74-83. [PMID: 33854815 PMCID: PMC8020005 DOI: 10.5230/jgc.2021.21.e6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE No consensus exists on whether to preserve or ligate an aberrant left hepatic artery (ALHA), which is the most commonly encountered hepatic arterial variation during gastric surgery. Therefore, we aimed to evaluate the clinical effects of ALHA ligation by analyzing the perioperative outcomes. MATERIALS AND METHODS We retrospectively reviewed the data of 5,310 patients who underwent subtotal/total gastrectomy for gastric cancer. Patients in whom the ALHA was ligated (n=486) were categorized into 2 groups according to peak aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels: moderate-to-severe (MS) elevation (≥5 times the upper limit of normal [ULN]; MS group, n=42) and no-to-mild (NM) elevation (<5 times the ULN; NM group, n=444). The groups were matched 1:3 using propensity score-matching analysis to minimize confounding factors that can affect the perioperative outcomes. RESULTS The mean operation time (P=0.646) and blood loss amount (P=0.937) were similar between the 2 groups. The length of hospital stay was longer in the MS group (13.0 vs. 7.8 days, P=0.022). No postoperative mortality occurred. The incidence of grade ≥ IIIa postoperative complications (19.0% vs. 5.1%, P=0.001), especially pulmonary complications (11.9% vs. 2.5%, P=0.003), was significantly higher in the MS group. This group also showed a higher Comprehensive Complication Index (29.0 vs. 13.9, P<0.001). CONCLUSIONS Among patients with a ligated ALHA, those with peak AST/ALT ≥5 times the ULN showed worse perioperative outcomes in terms of hospital stay and severity of complications. More precise perioperative decision-making tools are needed to better determine whether to preserve or ligate an ALHA.
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Affiliation(s)
- Sejin Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jeong Ho Song
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Seohee Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
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Bendib H, Anou A. A case of Right Hepatic Artery anterior to the common hepatic duct: A not so rare variation. Int J Surg Case Rep 2021; 80:105667. [PMID: 33662912 PMCID: PMC7937739 DOI: 10.1016/j.ijscr.2021.105667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 12/04/2022] Open
Abstract
Anatomical variations in the RHA may concern its number, origin or route. A prebiliary course of the RHA has been described with a prevalence ranging from 15 to 25%. CT Angiography is the exam of choice to establish a complete vascular mapping. The RHA remains an essential anatomical landmark that all surgeons must keep in mind in order to avoid any unfortunate incidents.
Introduction and importance The hepatic arteries may be subject to anatomical variations that can cause operating difficulties with a risk of iatrogenic vascular injuries. A perfect knowledge of anatomy is an essential prerequisite for both surgeons and interventional radiologists. Case presentation During a duodenopancreatectomy for a pancreatic head tumor in a 46-year-old man, we observed an anatomical variation regarding the course of the right hepatic artery (RHA). Indeed, RHA arose from the proper hepatic artery (PHA) at the left edge of the hepatoduodenal ligament and instead of crossing the common hepatic duct (CHD) posteriorly which is the usual course, it passed overhead before ascending and finishing its course in the liver hilum. Clinical discussion Anatomical variations of the hepatic arteries can be explained by the partial or complete persistence of the fetal model. Variations in the RHA may concern its number, origin or route. A prebiliary course of the RHA has been described with a prevalence ranging from 15 to 25% depending on series. The high sensitivity of Multidetector Computed Tomographic Angiography (MCTA) allows performing a complete vascular mapping, which remains essential before any Hepato-Pancreato-Biliary (HPB) surgery. Conclusion This case confirms once again the frequency of anatomical variations of the hepatic arteries, and underlines the value of CT Angiography to detect them in order to best plan any HPB surgery, where RHA remains an essential anatomical landmark that all surgeons must keep in mind in order to avoid any unfortunate incidents.
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Affiliation(s)
- Hani Bendib
- Department of General Surgery, Batna University Hospital, Algeria; Faculty of Medicine, Batna2 University, Algeria.
| | - Abdelkrim Anou
- Department of General Surgery, Batna University Hospital, Algeria; Faculty of Medicine, Batna2 University, Algeria
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Swami A, Yadav T, Varshney VK, Sreesanth KS, Dixit SG. Hepatic Arterial Variations and Its Implication During Pancreatic Cancer Surgeries. J Gastrointest Cancer 2021; 52:462-470. [PMID: 33616844 DOI: 10.1007/s12029-021-00598-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE Aberrant hepatic artery anatomy is a considerable challenge during pancreatic surgery as it warrants extreme caution for the preservation of vascular supply as well as achievement of R0 resection margin. METHOD We reviewed the literature about the aberrant anatomical variations of the hepatic artery and its relevance during pancreatoduodenectomy and distal pancreatectomy. RESULT Preoperative deliberation of peri-pancreatic vascular anatomy using advanced imaging methods is crucial for surgeons. At the same time, intra-operative suspicion and early identification of aberrant anatomy may help to prevent vascular injury and related complications. Yet, vascular reconstruction may be needed in many situations; several techniques like pre-operative embolization provide new options for management in specific situations. CONCLUSION We have provided here an overview of the anatomical variants of the hepatic artery and their implication during pancreatoduodenectomy and distal pancreatectomy.
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Affiliation(s)
- Ashish Swami
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Kelu S Sreesanth
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shilpi Gupta Dixit
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Real-time identification of aberrant left hepatic arterial territories using near-infrared fluorescence with indocyanine green during gastrectomy for gastric cancer. Surg Endosc 2021; 35:2389-2397. [PMID: 33492510 DOI: 10.1007/s00464-020-08265-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND An aberrant left hepatic artery is frequently encountered during upper gastrointestinal surgery, and researchers have yet to propose optimal strategies with which to address this arterial variation. The objective of this study was to determine whether the areas perfused by an aberrant left hepatic artery can be visualized in real-time using near-infrared fluorescence imaging with indocyanine green. METHODS Patients with gastric adenocarcinoma who underwent minimally invasive radical gastrectomy from May 2018 to August 2019 were enrolled and retrospectively analyzed at a single-center. Patients with an aberrant left hepatic artery and normal preoperative liver function were examined. After the clamping of an aberrant left hepatic artery, indocyanine green was administered via a peripheral intravenous route during surgery. Fluorescence at the liver was visualized under near-infrared fluorescence imaging. RESULTS In 31 patients with aberrant left hepatic arteries, near-infrared fluorescence imaging was used without adverse events associated with indocyanine green. Six (19%) patients were reported to have an aberrant left hepatic artery upon preoperative CT imaging, while all other instances were detected during surgery. Fluorescence excitation on the liver was, on average, visible after 43 s (range, 25-65). Fluorescence across the entire surface of the liver was noted in 20 (65%) patients in whom the aberrant left hepatic artery could be ligated. Aberrant left hepatic arteries were safely preserved in 10 (32%) patients who showed areas of no or partial fluorescence excitation. Guided by near-infrared fluorescence imaging, ligation of aberrant left hepatic arteries elicited no significant changes in postoperative liver function. CONCLUSION Near-infrared fluorescence imaging facilitates the identification of aberrant left hepatic arterial territories, guiding decisions on the preservation or ligation of this arterial variation.
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Kikuya K, Einama T, Miyata Y, Iwasaki T, Yamagishi Y, Takihata Y, Morimura F, Edo H, Otsuka Y, Mori S, Tsunenari T, Fujinuma I, Hirose Y, Tsujimoto H, Ueno H, Kishi Y. Destruction of a wandering accessory right hepatic artery in a patient with pancreatic body cancer: a case report. Clin J Gastroenterol 2021; 14:560-565. [PMID: 33394330 DOI: 10.1007/s12328-020-01304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Aberrant right hepatic arteries are sometimes involved in pancreatic head tumors or accidentally damaged during surgical procedures, which could result in postoperative complications. The risk of such injury has been discussed in patients undergoing pancreatoduodenectomy; however, no reports describe the influence of this anomaly in distal pancreatectomy. We report a patient with pancreatic body cancer with an accessory right hepatic artery following a very unique route. A 77-year-old man was referred to our hospital for the treatment of pancreatic cancer. Computed tomography revealed an anomaly in the hepatic artery, with an accessory right hepatic artery encased in the extensive tumor, which also involved the stomach, left gastric artery, and portal vein. Curative resection was achieved by distal pancreatectomy with wedge resection of the stomach and portal vein reconstruction. Both the accessory right hepatic artery and the left gastric artery were sacrificed after confirming intrahepatic arterial flow by intraoperative Doppler ultrasonography. The route of the accessory right hepatic artery in this patient was unique in that it did not run directly into the hepatic hilum but from behind the pancreatic body, where it was incorporated into the tumor. Accurate preoperative assessment and identification of arterial variations is mandatory in any type of pancreatectomy.
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Affiliation(s)
- Kenta Kikuya
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takahiro Einama
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yoichi Miyata
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Toshimitsu Iwasaki
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yoji Yamagishi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.,Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yasuhiro Takihata
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Fumio Morimura
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hiromi Edo
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yasuhiro Otsuka
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Shohei Mori
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takazumi Tsunenari
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Ibuki Fujinuma
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yuichi Hirose
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
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Laparoscopic Cholecystectomy With Medial Segment Artery Mimicking Cystic Artery. Int Surg 2021. [DOI: 10.9738/intsurg-d-17-00103.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction
Laparoscopic cholecystectomy (LC) is the gold standard treatment for cholelithiasis. However, LC is associated with a slightly higher rate of complications than laparotomy. To perform a safe LC, it is important to exercise caution regarding an abnormal course for the hepatic artery, although the incidence itself is low. Here, we report a rare case of LC in which the medial segment artery mimicked cystic artery. To the best of our knowledge, such a case has not yet been reported.
Case Presentation
A 35-year-old man visited our hospital with a complaint of epigastric pain. The symptom had continued for 2 months. Ultrasound and computed tomography revealed cholelithiasis. Magnetic resonance imaging did not show any biliary abnormalities. The patient was scheduled for an elective laparoscopic cholecystectomy. At the time of surgery, the gallbladder was slightly inflamed. After dissection of the Calot triangle, the cystic duct and a single large artery were identified. Although the critical view of safety was confirmed at first glance, dissection of periarterial adhesions revealed that the artery ran into the medial segment of the liver. Further dissection revealed short double cystic arteries branching from the aberrant artery. After the confirmation of the abnormal course of the arteries, the operation was performed safely without arterial injury. The patient made a satisfactory recovery and was discharged 3 days after operation.
Conclusion
The knowledge of the anatomy of the cystic artery and careful dissection are an important aspect in achieving a complication-free LC.
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Subbiah Nagaraj S, Kaman L, Dahiya D, Ramavath K, Kalra N, Behera A. Correlation of Multi-Detector Computed Tomography and Intraoperative Variations of the Celiac Trunk and Hepatic Artery in Resectable Hepatobiliary Pancreatic Cancers. Cureus 2020; 12:e12106. [PMID: 33489523 PMCID: PMC7805500 DOI: 10.7759/cureus.12106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction Knowledge of celiac artery variations is imperative to perform complex hepato-biliary pancreatic surgical procedures to avoid inadvertent complications. Multi-detector computed tomographic (MDCT) angiography aids in detecting these variations preoperatively. Surgical confirmation is considered the gold standard. Aims and objectives Preoperative assessment of celiac artery variations by MDCT angiography and surgical confirmation intraoperatively in resectable hepato-biliary pancreatic cancers. Patients and methods MDCT angiography was performed in 40 patients with clinical evidence of resectable hepato-biliary-pancreatic cancers. Three dimensional (3D) reconstructions were performed to confirm the celiac artery variations. Surgery was performed as per the institute’s protocol in all these patients for resection of tumor and confirmation of celiac artery anatomy. Variations were confirmed surgically that were identified through imaging. Results MDCT angiography identified normal trifurcated celiac artery anatomy in 33 (82.5%) patients and variant anatomy in seven (17.5%) patients. The most common variation was a replaced right hepatic artery (r-RHA) from the superior mesenteric artery (SMA) in four (10%) of patients. A replaced left hepatic artery (r-LHA) from the celiac trunk, a common hepatic artery (CHA) from the abdominal aorta, and an accessory right hepatic artery (ac-RHA) from the proper hepatic artery itself were identified in one (2.5%) patient each, respectively. All these findings were confirmed intraoperatively. There was a 100% statistical correlation between imaging and surgical findings. Conclusion Surgical confirmation of radiological data of celiac artery variations is the gold standard to avoid disastrous complications such as inadvertent vascular bleeds, biliary injuries, and hepatic necrosis. Since the presence of variations warrants the preservation or excision of the arterial system without oncological compromise and minimizing surgical complications.
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Affiliation(s)
- Satish Subbiah Nagaraj
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Lileswar Kaman
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Divya Dahiya
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Krishna Ramavath
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Naveen Kalra
- Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Arunanshu Behera
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Replaced right and common hepatic arteries with lienogastric trunk: a rare variant of celiaco-mesenteric anatomy. Surg Radiol Anat 2020; 42:1475-1477. [DOI: 10.1007/s00276-020-02505-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
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Zhang W, Wang K, Liu S, Wang Y, Liu K, Meng L, Chen Q, Jia B, Liu Y. A single-center clinical study of hepatic artery variations in laparoscopic pancreaticoduodenectomy: A retrospective analysis of data from 218 cases. Medicine (Baltimore) 2020; 99:e20403. [PMID: 32481341 PMCID: PMC7249910 DOI: 10.1097/md.0000000000020403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Hepatic artery variations increase the difficulty of laparoscopic pancreaticoduodenectomy (LPD). The safety and efficacy of LPD in the presence of aberrant hepatic arteries (AHA) must be further verified.Patients with normal and variant hepatic arteries who underwent LPD and preoperative arterial angiography were retrospectively analyzed. Variation type, intraoperative management, and clinical treatment outcomes were compared.There were 54 cases (24.8%) of AHA. The most common hepatic artery variation was accessory right hepatic artery (RHA) from the superior mesenteric artery (SMA, n = 12, 5.5%), followed by replaced RHA from the SMA (n = 10, 4.6%), accessory left hepatic artery from the SMA (n = 10, 4.6%), and replaced common hepatic artery from the SMA (n = 6, 2.8%). Each type of arterial variation was successfully preserved in all cases, and there were no significant effects on the evaluated surgical indices, conversion rate, incidence of postoperative complications, or follow-up results.Our findings indicated that preservation of AHAs during total LPD is feasible. There were no significant effects on surgical indices, incidence of postoperative complications, or follow-up outcomes.The influence of AHA on the safety and efficacy of LPD must be further verified. Patients with normal and variant hepatic arteries who underwent LPD and preoperative arterial angiography were retrospectively analyzed. There were 54 cases (24.8%) of AHA. There were no significant effects of AHAs on surgical indices, incidence of postoperative complications, or follow-up outcomes.
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Raj G, Kaushik N, Singh R, Singh N, Chauhan A, Narayan S, Kumar T, Dixit NA. Assessment of Celiac Axis and Hepatic Artery Variations in Hepatobiliary and Pancreatic Malignancy with Multidetector Computed Tomography Angiography. ASIAN JOURNAL OF ONCOLOGY 2020. [DOI: 10.1055/s-0040-1710203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Introduction Delineation of variant anatomy in celiac trunk and superior mesenteric artery including its origin and branching pattern and variations in branching pattern of hepatic artery in patients of hepatopancreaticobiliary malignancy with the use of mutidetector CT (computed tomography) angiograpgy was performed.
Materials and Methods All CT examinations were performed on a 64-multidetector computed tomography (MDCT) scanner. Technical features of multislice computed tomography (MSCT) are as follows: 64 mm × 1 mm collimation, minimum slice thickness of 0.625, gantry rotation time of 320 ms, 120 kV, and 320 mAs. CT angiography was performed with intravenous (IV) administration of nonionic contrast material, that is, iodixanol (Visipaque). The contrast medium and saline solution were injected with a Medrad power injector at 3 mL/sec through an 18-gauge plastic intravenous catheter placed in an antecubital vein in most of the cases. Contrast medium volumes varied between 100 and 150 mL at 1.5 mL/kg. Images were obtained in triphasic pattern at arterial (20–30 seconds), portal (60–70 seconds), and equilibrium (at 3 minutes) phases.
Results Five types of celiac axis anatomic variations and nine type of variants in celiac axis branching was found in the study sample of 124 patients. Classical celiac axis anatomy was seen in 92.7% of the cases, while the five types of variation in branching were found in nine patients. Majority of cases showed pattern I (59.6%) followed by patterns V (12.1%), II (9.7%), and III (8.9%). There were three (2.4%) cases each showing pattern VIII and AA, and two (1.6%) cases each showing patterns IV and VI, respectively. There was one (0.8%) case each showing pattern VII and IX. A total of three (2.4%) cases showed right hepatic artery arising from celiac axis.
Conclusion We conclude that most common pattern of celiac axis and superior mesenteric artery (SMA) branching is classical pattern (92.7%) which is in concordance with literature. Type-I pattern of hepatic artery branching was most common (59.6%), similar to that documented in literature. Although the most common variation in our study is type V (12.1%), followed by types II (9.7%) and III (8.9%), the most common variation in most of the literature was found to be type III. CT angiography hence is an excellent diagnostic modality for depiction of arterial anatomic variations and provides a roadmap for surgical treatment.
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Affiliation(s)
- Gaurav Raj
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Namrata Kaushik
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ragini Singh
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Singh
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhishek Chauhan
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shamrendra Narayan
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tushant Kumar
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nitin A. Dixit
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Ekingen A, Tuncer MC, Ertuğrul Ö. Investigation of proper hepatic artery and gastroduodenal artery variations by multidetector computed tomography angiography method. Acta Chir Belg 2020; 120:102-115. [PMID: 30714485 DOI: 10.1080/00015458.2019.1570744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The purpose of this study is to evaluate the clinical anatomic variations of the proper hepatic artery (PHA) and the gastroduodenal artery (GDA). For this purpose, angiographic images of patients were evaluated.Materials and methods: We retrospectively reviewed the multiple-detector computed tomography angiography images of 671 patients.Results: In this retrospective study, 35 different types were identified as associated with PHA and GDA. There were 292 patients (43.52%; 175 females and 117 males) included in normal anatomical classification. Different anatomic variations were detected in 300 patients (44.71%; 129 females and 171 males). In 79 patients, arterial branch follow-up failed. These patients were evaluated as an unidentified group.Conclusion: We described different vascular variations in the PHAs and GDAs of our patients.
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Affiliation(s)
- Arzu Ekingen
- Vocational School of Health Services, University of Batman, Batman, Turkey
| | - Mehmet Cudi Tuncer
- Department of Anatomy Faculty of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Özgür Ertuğrul
- Department of Radiology, Memorial Hospital, Diyarbakır, Turkey
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Gilyard S, Shinn K, Nezami N, Findeiss LK, Dariushnia S, Grant AA, Hawkins CM, Peters GL, Majdalany BS, Newsome J, Bercu ZL, Kokabi N. Contemporary Management of Hepatic Trauma: What IRs Need to Know. Semin Intervent Radiol 2020; 37:35-43. [PMID: 32139969 DOI: 10.1055/s-0039-3401838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Trauma remains one of the leading causes of death in the United States in patients younger than 45 years. Blunt trauma is most commonly a result of high-speed motor vehicular collisions or high-level fall. The liver and spleen are the most commonly injured organs, with the liver being the most commonly injured organ in adults and the spleen being the most affected in pediatric blunt trauma. Liver injuries incur a high level of morbidity and mortality mostly secondary to hemorrhage. Over the past 20 years, angiographic intervention has become a mainstay of treatment of hepatic trauma. As there is an increasing need for the interventional radiologists to embolize active hemorrhage in the setting of blunt and penetrating hepatic trauma, this article aims to review the current level of evidence and contemporary management of hepatic trauma from the perspective of interventional radiologists. Embolization techniques and associated outcome and complications are also reviewed.
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Affiliation(s)
- Shenise Gilyard
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kaitlin Shinn
- Department of Medical Education, Emory University School of Medicine, Atlanta, Georgia
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Laura K Findeiss
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sean Dariushnia
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - April A Grant
- Division of Trauma/Surgical Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - C Matthew Hawkins
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Gail L Peters
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bill S Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Janice Newsome
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary L Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Yan J, Feng H, Wang H, Yuan F, Yang C, Liang X, Chen W, Wang J. Hepatic artery classification based on three-dimensional CT. Br J Surg 2020; 107:906-916. [PMID: 32057096 DOI: 10.1002/bjs.11458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/22/2019] [Accepted: 11/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Precise classification of the hepatic artery is helpful for preoperative surgical planning in hepatobiliary-pancreatic surgery. However, the anatomy of hepatic arteries is variable. This study investigated anatomical variation using three-dimensional visualization and evaluation (3DVE) to develop a nomenclature system. METHODS The origin and course of the hepatic artery were tracked and analysed by using three-dimensional visualization of CT images acquired between 2013 and 2017. The new classification and nomenclature system, named CRL, was developed based on the origins of the common, right and left hepatic arteries. RESULTS Scans from 770 adults were evaluated. Preoperative 3DVE correlated better with surgical findings than the original CT images alone. Using the CRL classification system, hepatic arteries were divided into nine subtypes. Only 87·4-89·2 per cent of the hepatic arteries of 610 living-donor liver transplant donors were depicted in Michels', Hiatt's or Varotti's classification, compared with 100 per cent identified by the CRL classification. The CRL classification was validated against external data sets from previous studies, with 99·6-100·0 per cent of patients classified by the CRL system. CONCLUSION The CRL classification covers hepatic artery variants and may be used for planning liver surgery.
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Affiliation(s)
- J Yan
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - H Feng
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - H Wang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China.,University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - F Yuan
- Graduate School, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - C Yang
- Graduate School, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - X Liang
- University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - W Chen
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - J Wang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
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Rare combined variations of accessory left hepatic artery and accessory right hepatic artery: a case report and literature review. Surg Radiol Anat 2019; 42:443-447. [PMID: 31811353 DOI: 10.1007/s00276-019-02396-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
Variations in the hepatic artery are commonly described in the literature, which is vital for the success procedure of all hepatobiliary surgery. Usually a variation occurs in either the accessory right hepatic artery (aRHA) or the accessory left hepatic artery (aLHA). However, we report an extremely rare case where the variation occurs in both simultaneously. We over served the aRHA arising from the gastroduodenal artery and branching into the superior pancreatic duodenum artery, while the aLHA arose from the common hepatic artery and branched into right gastric artery. This situation has never been reported in literature. We will discuss the meaning of this hepatic artery variation in a clinical setting.
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Izumi H, Yoshii H, Abe R, Yamamoto S, Mukai M, Nomura E, Sugiyama T, Tajiri T, Makuuchi H. Pancreaticoduodenectomy following surgery for esophageal cancer with gastric tube reconstruction: a case report and literature review. Surg Case Rep 2019; 5:191. [PMID: 31811418 PMCID: PMC6898709 DOI: 10.1186/s40792-019-0751-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/20/2019] [Indexed: 12/15/2022] Open
Abstract
Background Synchronous and asynchronous multiple cancers have become more pervasive in recent years despite advances in medical technologies. However, there have been only six cases (including the present case) that underwent pancreaticoduodenectomy (PD) for pancreas head cancer following surgery for esophageal cancer. PD for treating pancreas head cancer is extremely challenging; thus, the confirmation of vessel variation and selection of surgical procedures are vital. Case presentation The patient was a 78-year-old Japanese male who was synchronously diagnosed with esophageal and cecal cancer 7 years previously at our hospital. He was admitted with densely stained and jaundiced urine and presented no remarkable family medical history. Following various examinations, surgery was performed due to the diagnosis of distal cholangiocarcinoma (pancreatic head cancer). Since the tumor was located far from the gastroduodenal artery (GDA) and no significant lymph node metastases could be found, subtotal stomach-preserving PD was performed instead of the resection of GDA with the right gastroepiploic artery (RGEA) for gastric tube blood flow preservation. The common hepatic artery (CHA) and GDA were confirmed, and RGEA diverged from GDA was identified. Subsequently, their respective tapings were preserved. The right gastric artery (RGA) was identified, taped, and preserved considering the gastric tube blood flow. The inflow area of the right gastroepiploic vein (RGEV) through gastric colic vein trunk in the superior mesenteric vein was exposed and preserved as the outflow of gastric tube blood flow. PD was completed without any complications on the shade of the gastric tube. Conclusions This case report describes successfully preserved gastric blood flow without the resection of GDA, RGEA, RGEV, or RGA. To preserve the gastric tube, GDA inflow, RGEA, RGA, and RGEV outflow should be preserved if possible. When performing PD after tube reconstruction, it is essential to confirm the relative positions of the blood vessel, blood flow, and tumor through three-dimensional computed tomography angiography before surgery and to consider the balance between the invasiveness and optimal curability of the surgery.
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Affiliation(s)
- Hideki Izumi
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan.
| | - Hisamichi Yoshii
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Rin Abe
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Soichiro Yamamoto
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Masaya Mukai
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Eiji Nomura
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Tomoko Sugiyama
- Department of Pathology, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Takuma Tajiri
- Department of Pathology, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Hiroyasu Makuuchi
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
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Garg S, Kumar KH, Sahni D, Yadav TD, Aggarwal A, Gupta T. Anatomy of the hepatic arteries and their extrahepatic branches in the human liver: A cadaveric study. Ann Anat 2019; 227:151409. [PMID: 31400446 DOI: 10.1016/j.aanat.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/11/2019] [Accepted: 07/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND To describe the hepatic arterial anatomy in detail, tracing the individual hepatic arteries from their origin, extrahepatic course, branching to their segmental territorial supply as applicable to the vascular mapping for hepatic endovascular procedures. METHODS The study was conducted on 100 formalin fixed adult cadaveric livers. The hepatic arterial anatomy was dissected from the origin of hepatic arteries up to their segmental branching. RESULTS The origin of hepatic arteries was standard in 72% and aberrant in 28% livers. In livers with standard origin, extrahepatic branching of the main hepatic artery was close to the hepatic hilum in 48% and was in the lower part of the hepatoduodenal ligament in 24% livers. The pattern of extrahepatic branching in each type was three and five respectively. Aberrant arterial anatomy was broadly categorized into three groups. The mapping of segmental arterial vascularization of individual hepatic arteries in each type was also done. CONCLUSIONS In the present study, an attempt was made to systematically describe the complex hepatic arterial anatomy in a clinically applicable fashion. High variability was seen in the hepatic arterial anatomy at each level, a lot of which could not be included in the current classification systems. The information provided is an important prerequisite for performing accurate intra-arterial hepatic interventions.
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Affiliation(s)
- Shallu Garg
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - K Hemanth Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Daisy Sahni
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Thakur Deen Yadav
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Anjali Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
| | - Tulika Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Zimmermann M, Schulze-Hagen M, Pedersoli F, Isfort P, Heinzel A, Kuhl C, Bruners P. Y90-radioembolization via variant hepatic arteries: Is there a relevant risk for non-target embolization? World J Radiol 2019; 11:102-109. [PMID: 31396373 PMCID: PMC6682496 DOI: 10.4329/wjr.v11.i7.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/03/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The hepatic arterial anatomy is highly variable, with the two most common variants being a replaced right hepatic artery (RHA) originating from the superior mesenteric artery (SMA) and a left hepatic artery (LHA) originating from the left gastric artery (LGA). These anatomical variants could potentially increase the risk for non-target embolization during Y90-Radioembolization due to the close proximity between hepatic and enteric vessel branches.
AIM To evaluate the safety of Yttrium-90 radioembolization (90Y-RE) with resin microspheres in patients with a variant hepatic arterial anatomy.
METHODS In this retrospective single-center observational study, 11 patients who underwent RE with 90Y-resin microspheres via a LHA originating from the LGA, and 13 patients via a RHA originating from the SMA were included. Patient and treatment data were reviewed regarding clinical and imaging evidence of non-target embolization of 90Y-resin microspheres to the GI tract. Positioning of the tip of the microcatheter in relationship to the last hepatoenteric side branch was retrospectively analyzed using angiographic images, cone-beam CT and pre-interventional CT-angiograms.
RESULTS None of the 24 patients developed clinical symptoms indicating a potential non-target embolization to the GI tract within the first month after 90Y-RE. On the postinterventional 90Y-bremsstrahlung images and/or 90Y-positron emission tomographies, no evidence of extrahepatic 90Y-activity in the GI tract was noted in any of the patients. The mean distance between the tip of the microcatheter and the last enteric side branch during delivery of the 90Y microspheres was 3.2 cm (range: 1.9-5 cm) in patients with an aberrant LHA originating from a LGA. This was substantially shorter than the mean distance of 5.2 cm (range: 2.9-7.7 cm) in patients with an aberrant right hepatic originating from the SMA.
CONCLUSION 90Y-RE via aberrant hepatic arteries appears to be safe; at least with positioning of the microcatheter tip no less than 1.9 cm distal to the last hepatoenteric side branch vessel.
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Affiliation(s)
- Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Alexander Heinzel
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, Aachen 52074, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
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Aberrant left hepatic arteries arising from left gastric arteries and their clinical importance. Surgeon 2019; 18:100-112. [PMID: 31337536 DOI: 10.1016/j.surge.2019.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/13/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Aberrant Left Hepatic Artery (ALHA) is replaced when it does not originate from the hepatic artery proper and it is the only supply to that part of the liver, while an accessory artery coexists with a normal artery. The aim of this systematic review is to evaluate the incidence of ALHAs including the one arising from the Left Gastric Artery, also named Hyrtl's artery. METHODS A literature search in PubMed, SCOPUS, WOS and Google Scholar was performed. The risk of bias was assessed by means of the AQUA tool. The main outcome was the prevalence of ALHA. Secondary outcomes were the prevalence of the accessory and replaced left hepatic arteries. A subgroup analysis was conducted by geographic region and type of evaluation. RESULTS This review included 57 studies, with a total of 19,284 patients. The majority of the studies involved the use of radiological techniques -especially Angio-CT-and were performed in Asia. The overall risk of bias was moderate. The overall prevalence of the ALHA was 13.52%; the overall prevalence was 8.26% for the Replaced ALHA and 5.55% for the Accessory ALHA. In the 18 studies that employed Michels' classification, Type II had the lowest prevalence (0.36%) and Type VII the highest prevalence (6.62%). DISCUSSION Some of the studies included did not distinguish between the ''replaced'' and ''accessory'' ALHA (34.25%). Some surgical dissection techniques proved insufficient for the localization of other hepatic arteries. These results suggest that an accurate preoperative radiological evaluation is needed to localize replaced arteries.
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Living Donor Liver Transplantation: Preoperative Planning and Postoperative Complications. AJR Am J Roentgenol 2019; 213:65-76. [DOI: 10.2214/ajr.18.21064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Coco D, Leanza S. Celiac Trunk and Hepatic Artery Variants in Pancreatic and Liver Resection Anatomy and Implications in Surgical Practice. Open Access Maced J Med Sci 2019; 7:2563-2568. [PMID: 31666865 PMCID: PMC6814475 DOI: 10.3889/oamjms.2019.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 11/17/2022] Open
Abstract
The presence of celiac trunk or hepatic arterial anomaly influences preservation of vascular arterial system and achievement of an R0 resection in the liver and pancreatic resection. The objective of this study is to review the literature, to describe the anomalous arterial variations of the celiac trunk and hepatic artery reiterating the importance of identification of the anomaly.
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