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

Hepatopulmonary syndrome (HPS) is a serious complication of end-stage liver disease, which is characterized by hypoxia, intrapulmonary vascular dilatation, and liver cirrhosis. Liver transplantation (LT) is the only curative treatment modality for patients with HPS. However, morbidity and mortality after LT, especially in cases of severe HPS, remain high. This case report describes a patient with typical findings of an extracardiac pulmonary arteriovenous shunt on contrast-enhanced transesophageal echocardiography (TEE), and clubbing fingers, who had complete correction of HPS by deceased donor LT. The patient was a 16-year-old female who was born with biliary atresia and underwent porto-enterostomy on the 55th day after birth. She had been suffered from progressive liver failure with dyspnea, clubbing fingers, and cyanosis. Preoperative arterial blood gas analysis revealed severe hypoxia (arterial O2 tension of 54.5 mmHg and O2 saturation of 84.2%). Contrast-enhanced TEE revealed an extracardiac right-to-left shunt, which suggested an intrapulmonary arteriovenous shunt. The patient recovered successfully after LT, not only with respect to physical parameters but also for pychosocial activity, including school performance, during the 30-month follow-up period.
Adolescent ; Anoxia ; Arteriovenous Fistula/etiology ; Biliary Atresia/*diagnosis/etiology ; Cyanosis/complications ; Dyspnea/complications ; Echocardiography, Transesophageal ; End Stage Liver Disease/complications/*surgery ; Female ; Hepatic Artery/abnormalities ; Hepatopulmonary Syndrome/*diagnosis/ultrasonography ; Humans ; *Liver Transplantation ; Osteoarthropathy, Secondary Hypertrophic/complications

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

OBJECTIVETo explore the application value of the MI-3DVS in patients with hepatic artery variation receiving duodenopancreatectomy.

METHODSA total of 114 patients who had undergone pancreatoduodenectomy were retrospectively summarized and analyzed during January 2010 to July 2012. The clinical data of 64-slice multidetector CT angiography (64-MDCTA) scanning was introduced into MI-3DVS for procedural segmentation, registration and 3-dimensional reconstruction. Based on the reconstructed 3-dimensional model, the origination and bifurcations of variant hepatic artery was observed. And its anatomical relationships with abdominal organs and vessels were also observed. Thereafter, preoperative procedures planning was formulated. The findings were compared to those found during the operation and by postoperative digital subtraction angiography (DSA) of coeliac artery.

RESULTSThe abdominal 3D models can clearly display the size and shape of tumor, the origin and course of the blood vessels, as well as the 3D anatomic relationship between tumors and organs, blood vessels. A total of 14 cases (12.3%, 14/114) were found with variant, including 9 cases (7.9%) with replaced right hepatic artery arising from superior mesenteric artery, 3 cases (2.6%) with replaced common hepatic artery arising from superior mesenteric artery, 2 cases (1.8%) with replaced left hepatic artery arising from left gastric artery. The 14 patients all received standard procedures of duodenopancreatectomy. Compared to the intraoperative findings and postoperative DSA examination, the sensitivity, specificity and accuracy of MI-3DVS to variant hepatic artery is 100%. The preoperative planning guided by MI-3DVS is in line with the intraoperative findings.No postoperative complications occurred in all 14 patients, including hepatic abscesses, biliary fistula and liver failure.

CONCLUSIONSMI-3DVS can accurately diagnose hepatic artery variation before duodenopancreatectomy. Therefore, it contributes to the formulation of preoperative surgical plans.It also increases the success rate of the surgical operations and decreases the occurrence of postoperative complications.

Adult ; Aged ; Aged, 80 and over ; Female ; Hepatic Artery ; abnormalities ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Pancreaticoduodenectomy ; instrumentation ; Retrospective Studies ; Tomography, Spiral Computed ; Young Adult

We describe a unique case of a patient who presented with a linear, transverse, and incidentally-detected main pancreatic duct dilatation that was caused by the intrapancreatic-replaced common hepatic artery, detected on the MDCT, MRCP and endoscopic retrograde cholangiopancreatography. We believe this case to be the first of its kind reported in the literature.
Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic/complications/diagnosis ; Dilatation, Pathologic/diagnosis/etiology ; Hepatic Artery/*abnormalities ; Humans ; Incidental Findings ; Magnetic Resonance Imaging ; Male ; Middle Aged ; *Pancreatic Ducts ; Tomography, X-Ray Computed

No abstract available.
Hepatic Artery/*abnormalities ; Humans ; Male ; *Pancreatic Ducts

Descriptions of the variant hepatic arterial pattern are common and frequently reported in anatomy archives. We describe a noteworthy deviation from the usual branching pattern in a single cadaver. There was a unique division of the hepatic artery proper into two right gastric arteries (RGAs), apart from the usual branches. Furthermore, an arterial loop was formed by these two RGAs, giving off another RGA, which we termed 'right gastric proper'. This report attempts to evaluate the embryological basis of the anomaly. The significance of this anomalous hepatic arterial pattern is appreciated while performing liver transplantations, hepatic artery infusion of chemotherapeutic drugs and Doppler angiographic procedures. We advocate meticulous familiarisation with the anatomy of the coeliac trunk and its topographic relationship to vital viscera for the operating hepatobiliary surgeon and radiologist.
Adult ; Cadaver ; Hepatic Artery ; abnormalities ; Humans ; Male ; Stomach ; abnormalities ; blood supply

OBJECTIVETo investigate the value of virtual surgery in hepatic artery reconstruction in liver recipients with type II hepatic artery variation.

METHODSA patient with cholangiocellular carcinoma and a healthy individual were scanned using 64-slice spiral CT, and image segmentation and three-dimensional (3D) reconstruction were performed using an image processing system. The 3D models in STL format were then imported to the FreeForm Modeling System for smoothing and refinement. Hepatic artery reconstruction was performed in simulated liver transplantation using the virtual surgery system with force feedback (PHANTOM).

RESULTSThe reconstructed model contained the liver, hepatic arteries, biliary system, and bile duct tumor emboli and displayed the entire branching of the hepatic artery with type II variation. Using the virtual surgery system, arterial reconstruction was performed by anastomosing the donor celiac trunk and the recipient abdominal aorta with the virtual scalpel and needle.

CONCLUSIONThe reconstructed model allows clearer views of the 3D structures of the arteries in the liver and helps in preoperative preparations and surgical planning of artery reconstruction during liver transplantation. This approach may also help reduce the surgical risks and potential complications.

Computer Simulation ; Computer-Assisted Instruction ; methods ; Female ; Hepatic Artery ; abnormalities ; surgery ; Humans ; Imaging, Three-Dimensional ; methods ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Liver Transplantation ; Middle Aged ; Surgery, Computer-Assisted ; methods ; Tomography, Spiral Computed

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

Adult ; Aged ; Arteriovenous Fistula ; complications ; diagnostic imaging ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Hepatic Artery ; abnormalities ; Hepatic Veins ; abnormalities ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods