Faculty Collaboration Database

Proper hepatic artery reconstruction with gastroduodenal artery transposition during pancreaticoduodenectomy. Perspect Vasc Surg Endovasc Ther 2013 Dec;25(3-4):69-72

Date

12/21/2013

Pubmed ID

24357635

DOI

10.1177/1531003513515304

Scopus ID

2-s2.0-84896338278 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

INTRODUCTION: Vascular injuries to hepatic arterial blood flow present a challenge in reconstruction. The location and extent of the injury dictate intraoperative decision making, with repair being performed expeditiously to preserve hepatic function. Formal arterial repair either primarily or with interposition or transposition grafts is indicated in the majority of patients. Special consideration should be made in patients with underlying liver disease and those undergoing biliary reconstructions. This latter group of patients is at high risk of complications following the injury secondary to bile duct ischemia.

METHODS: A case of proper hepatic artery (PHA) transection repaired with gastroduodenal artery (GDA) transposition is presented with a relevant review of limited literature available on the subject.

RESULTS: During an elective pancreaticoduodenectomy the PHA was inadvertently transected just distal to the origin of the GDA. As the GDA had not been transected at this stage of the operation, it was available for transposition. This was performed, restoring arterial blood flow to the liver and the bile duct. The patient did well postoperatively with no evidence of biliary or pancreatic leak or hepatic dysfunction at both discharge and follow-up clinic visit.

CONCLUSION: Injuries to hepatic artery injury are uncommon in experienced hands. This case report is only the second instance of such injury requiring reconstruction in 434 cases of single operator experience pancreaticoduodenectomies. We present arterial transposition of GDA as a feasible method to ensure adequate arterial supply to the hepatobiliary system.

Author List

Kulkarni GV, Malinowski M, Hershberger R, Aranha GV

Author

Michael Malinowski MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anastomosis, Surgical
Duodenum
Elective Surgical Procedures
Hepatic Artery
Humans
Iatrogenic Disease
Male
Middle Aged
Pancreaticoduodenectomy
Stomach
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures
Vascular System Injuries