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Complications of endovascular therapy for aneurysmal disease of splanchnic arteries including renal arteries
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Maen Aboul Hosn, Mel J Sharafuddin
Endovascular treatment of hepatic aneurysms is often reserved for high risk patient and those with inaccessible aneurysms such as intrahepatic aneurysms and pseudoaneurysms. In such instances, embolization using microcatheters and coils may spare the patient a major hepatic resection. Embolization of the common hepatic artery can also be considered only if the portal vein supplies adequate flow to the liver thus avoiding fulminant hepatic necrosis and failure. Alternatively, if there are adequate seal zones proximal and distal to the aneurysm, a covered stent may be deployed across the aneurysm neck to exclude it. The location of the gastroduodenal artery relative to the aneurysm should be considered to avoid back filling of the aneurysm. In an instance when such a scenario is likely, such as with hepatic artery proper aneurysms in proximity to the gastroduodenal artery, embolization of the latter may be required to prevent persistent flow into the aneurysm sac.
Regional Therapy of Liver Metastases: A Surgeon’s View
Published in Neville Willmott, John Daly, Microspheres and Regional Cancer Therapy, 2020
Preoperative arteriograms are assessed and compared with the operative assessment of the hepatic blood supply. With regard to patients with type IA vascular anatomy, the right gastric artery is ligated, and after duodenal mobilization small branches to the duodenal bulb are also divided. The common hepatic artery is dissected thoroughly to expose the gastroduodenal artery. It is essential to ligate all branches of the gastroduodenal artery, especially the supraduodenal branch, which arises within 2 cm of its hepatic artery origin. These ligations are performed to prevent infusion of the drug to the stomach and duodenum. The gastroduodenal artery is then ligated distally and the proximal end temporarily occluded. A transverse arteriotomy is made and a beaded Silastic catheter tip advanced retrogradely into the artery so that its tip lies at the junction of the common hepatic and gastroduodenal arteries. The catheter is then secured in place with nonabsorbable sutures.
Gastrointestinal surgery in gynecologic oncology
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Eileen M. Segreti, Stephanie Munns, Charles M. Levenback
The blood supply to the stomach is derived from the celiac trunk. The greater curvature of the stomach is supplied by the right and left gastroepiploic arteries. The lesser curvature is supplied by the right and left gastric arteries. The right gastric artery and the right gastroepiploic artery are branches of the common hepatic artery and gastroduodenal artery, respectively. The left gastric artery is a branch of the celiac trunk, and the left gastroepiploic artery is a branch of the splenic artery. Routes of venous drainage include the gastric and gastroepiploic veins as well as small tributaries of the esophageal veins.
The role of neoadjuvant conventional transarterial chemoembolization with radiofrequency ablation in the treatment of recurrent hepatocellular carcinoma after initial hepatectomy with microvascular invasion
Published in International Journal of Hyperthermia, 2022
Zhenwei Peng, Xiaoxue Wu, Jiaping Li, Hui Pang, Yaojun Zhang, Manxia Lin, Zaiguo Wang, Han Xiao, Bin Li, Minshan Chen, Shiting Feng, Ming Kuang, Shuling Chen
cTACE was performed by two experienced radiologists with over 10 years of experience in interventional therapy at each center [24–26]. At the beginning of cTACE, visceral angiography via a superior mesenteric artery or common hepatic artery was conducted to evaluate arterial blood supply of the liver and to confirm patency of the portal vein by combining the pre-operational CECT images. Then, a microcatheter was inserted into the segmental or subsegmental tumor-feeding arteries. cTACE was performed using an emulsion of mixtures of lipiodol (3–5mL) and chemotherapeutic agents according to the practice of each center such as epirubicin, cisplatin or oxaliplatin. Subsequently, embolization was finally performed with absorbable gelatin sponge particles (1–2 mm in diameter) until the blood flow was static for more than 10 successive heartbeats. After embolization, angiography was performed to confirm the extent of vascular occlusion and to assess blood flow in other arterial vessels.
Does Arterialization of Portal Vein Have Any Effects in Large-for-Size Liver Transplantation? Hemodynamic, Histological, and Biomolecular Experimental Studies
Published in Journal of Investigative Surgery, 2022
Rafael Rodrigues Torres, Ana Cristina Aoun Tannuri, Suellen Serafini, Alessandro Belon, Josiane Oliveira Gonçalves, Celso di Loreto, Uenis Tannuri
The surgical procedure to remove the donor’s liver was similar in both groups. After opening the cavity with a longitudinal incision, we dissected the hilum and isolated the portal vein and the common hepatic artery. The main biliary duct was ligated. We then performed the donor’s liver biopsy and proceeded with data collection. The following hemodynamic data were collected: flow measurement in the portal vein and hepatic artery (using a T402 flowmeter, Transonic, USA), portal vein pressure by puncture, arterial and central venous pressures, and heart rate. Biopsies were taken for genetic marker testing (preserved in RNALater®-ThermoFisher Scientific Inc.) and histological analysis (preserved in 10% formaldehyde solution). Blood samples were also collected for biochemistry and blood gas analysis. We administered as an anticoagulant to the donor sodium heparin 100 mg per kilogram immediately before the infusion of the preservation solution; we then started the liver graft perfusion with Euro Collins solution and graft retrieval. A total of 4 liters of the preservation solution were used: 3 liters were used for perfusion of the donor liver in situ, 2 liters infused through the portal vein and 1 liter infused through the hepatic artery. After removal of the donor’s liver, during preparation on the back table, the graft was perfused with one 1 liter of solution, partly through the portal vein and partly through the hepatic artery.
Image in transplantation surgery: median arcuate ligament in liver transplantation
Published in Acta Chirurgica Belgica, 2020
Morgan Vandermeulen, Martin Moïse, Nicolas Meurisse, Pierre Honoré, Michel Meurisse, Paul Meunier, Olivier Detry
A 58-year-old male LT candidate suffering from decompensated post-alcoholic cirrhosis (model for end-stage liver disease (MELD) score: 20) had a past medical history including insulin-dependent type 2 diabetes mellitus and ischemic cardiomyopathy. Abdominal computed tomography demonstrated stenosis of the celiac trunk by MAL and post-stenotic dilatation (Figure 1). During LT, recipient’s hepatic artery was dissected and showed normal calibre. Secondary to the ligature of the gastro-duodenal artery, the palpated pressure of the hepatic artery dramatically decreased. The celiac trunk was dissected to the aorta and released by MAL section allowing a satisfying pressure in hepatic artery. An end-to-end anastomosis between donor’s common hepatic artery and recipient’s proper hepatic artery was then performed. Intraoperative Doppler confirmed an excellent arterial flow in the graft hepatic artery. There was no complication in post-operative period and the patient was discharged at postoperative day 15 with normalized laboratory liver tests. At 6-month follow-up, colour Doppler ultrasound showed excellent arterial flow.