OBJECTIVETo study the principle and surgical managements for the patients with anatomic variants of hepatic artery in the procedure of pancreaticoduodenectomy (PD).

METHODSOne hundred and seventy-six patients who underwent PD between January 2000 and July 2007 were investigated retrospectively. Hepatic arterial variants were analyzed according to the intraoperative finding and CT imaging were reviewed postoperatively.

RESULTSHepatic arterial variants were found intraoperatively in 20 cases of all 176 patients. Accessory right heptic artery, replaced right heptic artery and common heptic artery arising from the superior mesenteric artery (SMA) were present in 9 (5.1%), 5 (2.8%), 4 (2.3%) cases respectively,and replaced right heptic artery coming from the gastroduodenal artery was present in 2 cases (2.9%). All the variants of hepatic arteries arising from the superior mesenteric artery could be observed in spiral CT imaging. Most of the variant arteries were dissected intact intraoperatively except 2 cases with accessory right heptic artery arising from SMA.

CONCLUSIONSPerforming CT scan preoperatively, especially CTA,is effective to diagnose these disorders. Skillful surgical techniques can manage the anatomic variants safely.

Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Radiography ; Retrospective Studies

We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.
Aged ; Arteriovenous Fistula/etiology/radiography/*therapy ; Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/*adverse effects ; Embolization, Therapeutic/*methods ; Enbucrilate/*therapeutic use ; Esophageal and Gastric Varices/etiology/*therapy ; Hepatic Artery/*abnormalities/radiography ; Humans ; Liver Neoplasms/*surgery ; Male ; Portal Vein/*abnormalities/radiography

No abstract available.
Arteriovenous Fistula/complications ; Fatty Liver/complications/radiography/ultrasonography ; Hemangioma/etiology/radiography/*ultrasonography ; Hepatic Artery/abnormalities ; Humans ; Liver Neoplasms/radiography/ultrasonography ; Male ; Middle Aged ; Portal Vein/abnormalities ; Tomography, X-Ray Computed