Mesenteric and renal angiography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in 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.
Use of the stomach as an esophageal substitute
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
The gastroduodenal artery is dissected immediately distal to the pylorus. This allows the common hepatic artery to be easily identified. Dissection proceeds in a medial direction to preserve the origin of the right gastric artery from the common hepatic artery. The right gastric artery may aid the vascularization of the gastric tube, and it should be spared if possible.The lymph nodes are dissected in a manner similar to that used in gastric cancer, which means that all lymph nodes along the common hepatic artery, the celiac trunk, and the medial part of the splenic artery are dissected and taken with the specimen. The ligation of the left gastric artery is performed near its trunk of origin.
Liver transplantation
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
In preparing a left lateral segment graft, the hilar dissection is very similar to that used for a left lobe graft except that the plane of parenchymal transection is just to the right of the falciform ligament. The right-sided branches of the portal triad are dissected and divided outside the liver; the stump of the right hepatic artery is ligated, and the right branch of the portal vein is closed with a continuous polypropylene suture. Portal vein branches to segment 4 are divided within the Rex recessus. Caudate branches from the origin of the left portal vein are divided. The left hepatic vein is incised close to the liver parenchyma, unless vena cava replacement is required. In this case, the middle and right hepatic veins would be divided from the vena cava and their orifices oversewn. The common hepatic artery and main portal trunk are retained with the graft. The main bile duct is preserved in continuity with the left hepatic duct. Care must be taken not to injure the left hepatic duct at the base of segment 4, so the parenchymal division should be away from the hilum as it nears the hilar structures.
Variations in the vascular and biliary structures of the liver: a comprehensive anatomical study
Published in Acta Chirurgica Belgica, 2018
Burak Veli Ülger, Eyüp Savaş Hatipoğlu, Özgür Ertuğrul, Mehmet Cudi Tuncer, Cihan Akgül Özmen, Mesut Gül
Liver arterial blood is supplied by the proper hepatic artery, a branch of the common hepatic artery associated (in the hepatoduodenal ligament) with the hepatic portal vein and the bile duct. The proper hepatic artery divides into two branches (left and right) in the porta hepatis. These branches enter the liver along with branches of the hepatic portal veins. This “normal” anatomy is present in only 55–60% of the population [8]. In addition to these arteries, an accessory hepatic artery may be present. As the embryological development of the coeliac trunk and superior mesenteric artery is complex, variations in the proper hepatic artery are common and must be considered when surgery is being planned. Normally, the common hepatic artery originates from the coeliac trunk. However, variations include arteries originating from the superior mesenteric or left gastric arteries. Such arteries are called replaced arteries because they replace the right branch of the proper hepatic artery. They are located near the lateral hepatic portal vein, and posterior to the common hepatic duct, in the hepatoduodenal ligament, and may be damaged if variations are not detected prior to surgery [9]. One of the first studies on arterial variations in the liver was the frequently cited 1966 work of Michels [10] based on a series of 200 autopsies. Eleven liver arterial variations were defined.
Cephalic pancreaticoduodenectomy with preservation of a right coronary artery bypass graft using the right gastro-epiploic artery: a case report
Published in Acta Chirurgica Belgica, 2019
K. Homsy, J.-L. Paquay, H. Farghadani
The procedure began by an abdominal exploration through a bi-subcostal laparotomy confirming a pulsating right gastro-epiploic artery. The artery was found running anterior to the left hepatic lobe, through a diaphragmatic hiatus reaching the pericardial space. A clamping test of the gastroduodenal and right gastro-epiploic artery confirmed myocardial tolerance to short-term ischemia. After a Kocher manoeuver in order to evaluate the resectability of the tumor, priority was given to isolating the right gastro-epiploic artery. The common hepatic artery as well as the gastroduodenal artery was isolated. The gastro-duodenal artery was clamped and ligated at its origin allowing the section of the vessel. The right gastro-epiploic artery was removed from its origin and an end-to-end re-implantation to the origin of the gastroduodenal artery was made using an 8/0 polypropylene monofilament running suture. With cardiac revascularization restored, a regular cephalic pancreaticoduodenectomy was performed with no complications. Extended lymphadenectomy around the hepatic pedicle, and interaortocaval region was made. Digestive reconstruction was performed by pancreaticojejunostomy, hepaticojejunostomy and gastrojejunostomy using a ‘Roux-en-Y’ anastomosis.
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.
Related Knowledge Centers
- Pancreas
- Pylorus
- Spleen
- Liver
- Stomach
- Blood
- Blood Vessel
- Gallbladder
- Duodenum
- Celiac Artery