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Mid Common Bile Duct Cholangiocarcinoma Involving the Portal Vein and Right Branch of the Hepatic Artery
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Charles W. Kimbrough, Timothy M. Pawlik
Applying these principles to the Case Scenario, an extended right hepatectomy with portal vein resection was performed for this tumor given its location in the porta hepatis. The surgical approach was similar to that described for a hilar en bloc resection (Figure 30.2) [3]. After laparotomy and confirmation of no metastatic disease, the right liver was mobilized with the right hepatic vein dissected and isolated. The proper hepatic artery was identified, and the right branch divided immediately beyond its origin. The distal extrahepatic bile duct was divided at the superior border of the pancreas. Retraction of the proper hepatic artery medially and elevation of the distal common bile duct allowed exposure and dissection of the main portal vein (Figure 30.3A). The left portal vein was identified near the umbilical fissure and isolated, and both the left and main portal veins were controlled with clamps (Figure 30.3B). The main portal vein and left portal vein were divided, allowing the portal bifurcation to be removed en bloc with the specimen (Figure 30.3C). An end-to-end anastomosis was created between the left and main portal vein (Figure 30.3D), followed by parenchymal transection and removal of the specimen. Biliary enteric drainage was restored with a hepaticojejunostomy to the left hepatic duct.
Open surgical management of visceral artery occlusive disease
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
The median arcuate ligament and interdigitating fibers of the crura are divided longitudinally to expose the aorta, which lies just posteriorly. A sufficient length of the supraceliac aorta is dissected and isolated along the anterior two-thirds of its circumference so that a side-biting clamp can be accommodated. The celiac ganglion that surrounds the celiac axis at its origin is divided. Dissection is continued caudally to the proximal few centimeters of the celiac axis (CA) (Figure 50.1). The inferior phrenic artery may be found in about 50% of cases and should be controlled. The left gastric artery is divided to facilitate end-to-end anastomosis to the CA. When an end-to-side anastomosis is chosen, the common or proper hepatic artery is chosen.
Mesenteric and renal angiography
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
The mesenteric arteries arise from the anterior aspect of the lower thoracic and abdominal aorta. These vessels—the celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA)—are responsible for the blood supply to all organs located within the abdominal cavity. The celiac trunk is the first major branch of the abdominal aorta and is an essential source of blood supply to the liver, stomach, and parts of the esophagus, spleen, duodenum, and pancreas. Its origin from the anterior aorta is typically midline at the level of the T12 vertebral body, and it courses inferiorly for 1-2 cm before branching into the left gastric, common hepatic, and splenic arteries (Figure 24.1). The common hepatic artery divides into the proper hepatic artery and, typically, also the gastroduodenal artery. The proper hepatic gives off the right gastric artery before branching into the right and left hepatic arteries. The gastroduodenal artery then goes on to divide into the right gastroepiploic artery and the anterior and posterior superior pancreaticoduodenal arteries. The right gastroepiploic artery and the left gastroepiploic artery (from the splenic artery) join together along the greater curvature of the stomach. The right gastric artery and the left gastric artery join together to run along the lesser curvature of the stomach. Because of the redundant blood supply to the stomach, gastric ischemia is uncommon.
Transarterial drug delivery for liver cancer: numerical simulations and experimental validation of particle distribution in patient-specific livers
Published in Expert Opinion on Drug Delivery, 2021
Tim Bomberna, Ghazal Adeli Koudehi, Charlotte Claerebout, Chris Verslype, Geert Maleux, Charlotte Debbaut
HCC patients for whom tumor resection is not possible (e.g. patients with radiologic evidence of vascular invasion, impaired liver function, or non-solitary tumors) can be treated by transarterial therapies such as chemo-embolization (TACE) or radio-embolization (TARE) [3]. During these procedures, the patient is catheterized through the femoral artery and the catheter is retrogradely advanced via the aorta toward the liver. The aim of TACE and TARE is to cut off the blood supply of the tumor tissue by local administration of embolizing microparticles [5]. Since tumor tissue is generally fed by arterial blood, obstruction of these tumor-feeding arteries leads to tumor tissue starvation and death [3]. In TACE, both the embolic and chemotherapeutic effect of the drug-coated particles act complementarily to permanently damage the tumor tissue [6]. In TARE, the embolic effect of the particles is only subsidiary to the local delivery of destructive high-intensity beta-radiation [7]. Since the goal is to limit the particle spread to the surrounding healthy tissue, target specificity is a key parameter of these therapies [8]. Particle injection close to the tumor can increase target specificity. However, vascular access for catheter navigation is often restricted in complicated geometries (such as tortuous blood vessels in cirrhotic and HCC livers [9]), illustrating the need for identifying suitable upstream injection locations. Therefore, this study investigates the feasibility of targeting specific downstream locations starting from easily accessible injection locations in the proper hepatic artery (PHA).
A novel irinotecan-lipiodol nanoemulsion for intravascular administration: pharmacokinetics and biodistribution in the normal and tumor bearing rat liver
Published in Drug Delivery, 2021
Marites P. Melancon, Steven Yevich, Rony Avritscher, Adam Swigost, Linfeng Lu, Li Tian, Jossana A. Damasco, Katherine Dixon, Andrea C. Cortes, Nina M. Munoz, Dong Liang, David Liu, Alda L. Tam
Animals who received TACE underwent hepatic arterial catheterization using a carotid approach (Nishiofuku et al., 2019). Incision and blunt dissection were used to expose the muscular layer of the left common carotid artery and dissociate the vagus nerve. Using a 20-gauge intravenous catheter (BD Angiocath-IV catheter; 20 G × 1.16”), the carotid artery was cannulated and a 1.6 Fr microcatheter (Tokai Medical, Japan) with a 0.014-inch guidewire (Transcend, Boston Scientific, Natick, MA) were used to select the proper hepatic artery and subsequently the left hepatic artery. Iohexol was injected for digital subtraction angiography and the IRI-lipiodol emulsion was injected under fluoroscopy. Upon completion of the injection of the proposed dose or when stasis of the vessel was observed, the catheters were removed, the common carotid artery was ligated, and the incision closed in two layers with 4–0 Vicryl.
Presence of tumor-infiltrating CD8+ T cells and macrophages correlates to longer overall survival in patients undergoing isolated hepatic perfusion for uveal melanoma liver metastasis
Published in OncoImmunology, 2020
Junko Johansson, Jan Siarov, Roberta Kiffin, Johan Mölne, Jan Mattsson, Peter Naredi, Roger Olofsson Bagge, Anna Martner, Per Lindnér
During IHP catheters are inserted into the iliac vein and the axillary vein to allow for shunting of blood from the lower extremity. A catheter is placed in the retrohepatic portion of the caval vein for perfusion outflow and the caval vein is clamped suprahepatic and below the catheter. The portal vein is clamped and the proper hepatic artery is cannulated via the gastroduodenal artery. The catheters are then connected to the perfusion system. When steady-state conditions in the perfusion circuit are established, melphalan (1 mg/kg bodyweight) is added to the perfusion system. The perfusion is performed with a target liver temperature of 40°C. The leakage from the perfusion circuit is continuously recorded. Perfusion is continued for 60 minutes, after which the perfusion is discontinued and the liver is irrigated. The shunts and the perfusion circuit are disconnected and the catheters are removed.