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Article in English | WPRIM | ID: wpr-887557


INTRODUCTION@#Hepatic artery reconstruction is a critical aspect of liver transplantation. The microsurgeon faces several challenges when reconstructing the hepatic artery-the donor hepatic artery stalk is short and often a poor match for the usually hypertrophic recipient vessels. Previous inflammation impedes vessel dissection, and recipient vessels have a tendency to delaminate with manipulation. We review 51 consecutive liver transplantations to highlight these problems and propose strategies for a successful reconstruction of the hepatic artery.@*METHODS@#A prospective study involving all adult patients undergoing liver transplantation at the Singapore General Hospital from January 2015 to December 2018 was undertaken. All hepatic artery anastomoses were performed by 2 microsurgeons at 10x magnification. Patients were started on a standard immunosuppressive regimen. Postoperative ultrasound scans on days 1, 3, 5, 7, 9 and 14 were used to confirm arterial patency.@*RESULTS@#There were 51 patients who underwent liver transplantation during the study period. Of this number, 31 patients received deceased donor grafts and 20 received living donor grafts. A total of 61 anastomoses were performed (5 dual anastomosis, 4 radial artery interposition grafts) with 1 case of hepatic artery thrombosis that was successfully salvaged. The mean (range) postoperative resistive index and hepatic artery peak systolic velocity were 0.69 (0.68-0.69) and 1.0m/s (0.88-1.10m/s), respectively.@*CONCLUSION@#Hepatic artery thrombosis after liver transplantation is poorly tolerated. The challenges of hepatic artery reconstruction in liver transplantation are related to vessel quality and length. The use of microsurgical technique, appropriate recipient vessel selection, minimisation of vessel manipulation with modified instruments, variation in anastomosis techniques, and use of radial artery interpositional grafts are useful strategies to maximise the chances of success.

Adult , Anastomosis, Surgical , Hepatic Artery/surgery , Humans , Liver Transplantation , Living Donors , Prospective Studies
ABCD arq. bras. cir. dig ; 33(4): e1556, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152639


ABSTRACT Background: Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones. Aim: To evaluate the risk factors for the development of hepatic artery thrombosis. Methods: The sample consisted of 1050 cases of liver transplant. A retrospective and cross-sectional study was carried out, and the variables studied in both donor and recipient. Results: Univariate analysis indicated that the variables related to hepatic artery thrombosis are: MELD (p=0.04) and warm time ischemia (p=0.005). In the multivariate analysis MELD=14.5 and warm ischemia time =35 min were independent risk factors for hepatic artery thrombosis. In the prevalence ratio test for analysis of the anastomosis as a variable, it was observed that patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Conclusions: Prolonged warm ischemia time, calculated MELD and recipient age were independent risk factors for hepatic artery thrombosis after liver transplantation in adults. Transplanted patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Re-transplantation due to hepatic artery thrombosis was associated with higher recipient mortality.

RESUMO Racional: Trombose de artéria hepática é importante causa de falência de enxerto e complicações biliares. Fatores de risco para trombose estão relacionados aos aspectos técnicos da anastomose arterial e fatores não cirúrgicos. Objetivo: Avaliar os fatores de risco para o desenvolvimento de trombose de artéria hepática. Métodos: A amostra consta de 1050 casos de transplante hepático. Foi realizado estudo retrospectivo e transversal, e as variáveis foram avaliadas em doadores e receptores. Resultados: A análise univariada mostrou que as variáveis relacionadas a trombose de artéria hepática são: MELD e tempo de isquemia quente. Na análise multivariada, o MELD=14.5 e tempo de isquemia quente =35 min foram fatores de risco independentes para trombose de artéria hepática. No teste de prevalência para avaliação do tipo de anastomose como variável, foi observado que a sutura contínua tem maior risco de trombose quando comparada com aquela em pontos separados. Conclusão: Tempo de isquemia quente prolongado, MELD calculado e idade do recipiente foram fatores de risco independentes para trombose de artéria hepática após transplante de fígado em adultos. Pacientes submetidos à anastomose com sutura contínua apresentaram mais trombose quando comparados com a em pontos separados. Retransplante por trombose está associado com maior mortalidade.

Humans , Adult , Thrombosis/etiology , Vascular Surgical Procedures/adverse effects , Liver Transplantation/adverse effects , Hepatic Artery/surgery , Vascular Surgical Procedures/methods , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Liver Transplantation/methods , Liver Diseases/surgery
Acta cir. bras ; 34(11): e201901103, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1054680


Abstract Purpose: To evaluate liver regeneration after selective ligation of portal vein and hepatic artery by 3D Computed Tomography in an experimental model. Methods: Sixteen Wistar rats were randomized into four equal groups: Group I- control (sham), Group II- isolated selective ligation of the hepatic artery, Group III- isolated selective ligation of the portal vein and Group IV- combined ligation of portal vein and hepatic artery. Before procedure and five days after a 3D CT Scan was performed to analyze the hypertrophy, weight and function of the remnant liver. Results: The largest regeneration rate and increase of weight in the hypertrophied lobe was detected in group IV, the first with an average of 3.99 (p=0.006) and the last varying from 6.10g to 9.64g (p=0.01). However, total liver weight and the R1 ratio (Hypertrophied Lobe Weight/Total Liver Weight) was higher in group III (P<0.001) when compared with groups I, II and IV and showed no difference between them. The immunohistochemical examination with PCNA also found higher percentages with statistical significance differences in rats of groups III and IV. It was possible to confirm a strong correlation between hypertrophied lobe weight and its imaging volumetric study. Liver function tests only showed a significant difference in serum gamma-glutamyltransferase and phosphorous. Conclusion: There is a largest liver regeneration after combined ligation of portal vein and hepatic artery and this evidence may improve the knowledge of surgical treatment of liver injuries, with a translational impact in anima nobile.

Animals , Male , Portal Vein/surgery , Hepatic Artery/surgery , Liver/diagnostic imaging , Liver Regeneration/physiology , Organ Size/physiology , Immunohistochemistry , Random Allocation , Tomography, X-Ray Computed/methods , Reproducibility of Results , Treatment Outcome , Rats, Wistar , Imaging, Three-Dimensional/methods , Hepatomegaly/physiopathology , Hepatomegaly/diagnostic imaging , Ligation , Liver/blood supply , Liver/pathology
Rev. méd. Chile ; 143(5): 673-676, ilus, tab
Article in Spanish | LILACS | ID: lil-751713


Anatomic variations of the hepatic artery, which occur in 30 to 50% of patients, are a very important factor to be considered for Whipple procedure. The most common variations are those coming from the superior mesenteric artery, left gastric artery and the aorta. We report a 58-year-old woman with a story of one month of epigastric pain, jaundice and progressive itching. Magnetic resonance imaging showed a mass in the head of the pancreas. During pancreatoduodenectomy a left hepatic artery (LHA) emerging from the gastroduodenal artery and an accessory LHA emerging from the left gastric artery, were observed. The rest of the surgery was performed with no incidents. The patient had an uneventful postoperative evolution.

Female , Humans , Middle Aged , Hepatic Artery/abnormalities , Pancreaticoduodenectomy/methods , Anatomic Variation , Hepatic Artery/surgery , Medical Illustration
Rev. chil. pediatr ; 85(5): 594-598, oct. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-731648


Introduction: The most common congenital malformations of the bile duct are biliary atresia and choledochal cyst. In addition, the most common liver anatomical variation is the right hepatic artery aberration. The goal of this study is to characterize a patient with this disease and propose the hepatoduodenal anastomosis as surgical treatment. Case report: One-month-old patient with suspected congenital biliary atresia due to progressive jaundice and acholia since birth. Liver tests consistent with a cholestatic pattern and brain MRI scan consistent with biliary atresia. Periods of decreased bilirubin and sporadic slight pigmentation of depositions were described. The surgical finding was a bile duct stricture due to a vascular ring caused by aberrant right hepatic artery. Resection of bile duct and hepatic-duodenal bypass were performed. The patient evolved satisfactorily from this condition. Conclusion: There are few reports of biliary obstruction due to vascular malformations. It is important to keep in mind that not all neonatal jaundice episodes are caused by biliary atresia or choledo-chal cyst. The clinical course, laboratory tests and imaging should be considered and in the case of suspicion, further exploration should take place.

Introducción: Las malformaciones congénitas de la vía biliar más frecuentes son la atresia de vías biliares y quiste de colédoco. Por otro lado, la variante anatómica hepática más común es la aberración de la arteria hepática derecha. El objetivo es caracterizar un paciente portador de esta patología y plantear la hepato-duodeno anastomosis como tratamiento quirúrgico. Caso clínico: Paciente de 1 mes de edad, con sospecha de Atresia de Vía Biliar congénita por ictericia progresiva y acolia desde recién nacido. Pruebas hepáticas concordantes con un patrón colestásico y resonancia magnética compatible con atresia de vías biliares. Evolucionó con períodos de descenso de bilirrubina y leve pigmentación, esporádica, de deposiciones. El hallazgo quirúrgico fue una estenosis crítica de vía biliar a nivel del conducto hepático común debido a un anillo vascular por una arteria hepática derecha aberrante. Se realizó una sección de vía biliar y una derivación hepato-duodenal. Evolucionó con una resolución completa de su patología. Conclusión: Existen pocos reportes de obstrucción de vía biliar por malformaciones vasculares. Es importante tener presente que no todas las ictericias neonatales son por atresia de vías biliares o quiste de colédoco. Se debe considerar la evolución clínica, laboratorio e imágenes, y si existen sospechas, explorar.

Female , Humans , Infant , Common Bile Duct Diseases/diagnosis , Constriction, Pathologic/diagnosis , Hepatic Artery/abnormalities , Vascular Diseases/diagnosis , Biliary Atresia/diagnosis , Common Bile Duct Diseases/etiology , Common Bile Duct Diseases/surgery , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Hepatic Artery/surgery , Treatment Outcome , Vascular Diseases/complications , Vascular Diseases/surgery
Acta cir. bras ; 28(9): 657-663, Sept. 2013. ilus
Article in English | LILACS | ID: lil-684440


PURPOSE: To investigate the impact of selective hepatic artery clamping (SHAC) in hepatocellular function. METHODS: Three groups of Wistar male rats were subjected to SHAC ischemia period of 60min: Group A continuous SHAC were subjected to SHAC ischemia period of 60min, Group B intermittent SHAC of 30min with 5min of reperfusion and Group C intermittent SHAC of 15min with 5min of reperfusion. Animals without SHAC were included-Group D. To evaluate hepatocellular function blood markers and hepatic extraction function (HEF) using 99mTc-mebrofenin were performed before and after surgery. Flow cytometry was used to analyze oxidative stress and cell viability. RESULTS: A mortality rate of 7.6% in Group A was observed. HEF maintained normal values between the groups. Flow cytometry demonstrated no significant differences between the groups in viability, type of cell death as well as in the production of reactive oxygen species. CONCLUSIONS: The selective hepatic artery clamping compared to other clamping techniques results on increased cell viability and decreased hepatocyte death. The SHAC is a potential alternative to decrease per-operative bleeding while maintaining hepatocellular function.

Animals , Male , Rats , Hepatic Artery/surgery , Hepatocytes/physiology , Liver/blood supply , Liver/cytology , Cell Survival , Constriction , Flow Cytometry , Ischemia/physiopathology , Models, Animal , Oxidative Stress , Peroxides/analysis , Rats, Wistar , Reperfusion , Reactive Oxygen Species/metabolism , Time Factors
ABCD arq. bras. cir. dig ; 26(1): 62-65, jan.-mar. 2013. ilus
Article in Portuguese | LILACS | ID: lil-674145


INTRODUÇÃO: Variações na anatomia da artéria hepática são comuns, com incidência de 20-50%. No transplante hepático, reconstruções durante a operção de bandeja são frequentemente necessárias para proporcionar anastomoses arteriais adequadas. O uso de "patch" é frequente, visando reduzir a incidência de complicações. Entretanto, quando está presente a variação da artéria hepática direita, ramo da artéria mesentérica superior, a reconstrução ocasionalmente produz torções e problemas de fluxo. MÉTODOS: Descreve-se uma técnica cirúrgica alternativa para reconstrução da variação da artéria hepática direita usando um "patch de Carrel" da artéria mesentérica superior. O "patch" é anastomosado no coto da artéria esplênica permitindo orientação vertical e bom fluxo sanguíneo. RESULTADOS: Entre 120 transplantes hepáticos, quatro casos consecutivos de variação da artéria hepática direita foram reconstruídas utilizando essa técnica. Todos eles apresentaram patência e bom fluxo no pós-operatório. CONCLUSÃO: A técnica proposta mostra-se interessante método alternativo para reconstrução da variação da artéria hepática direita no transplante hepático.

INTRODUCTION: Variations on the anatomy of the hepatic artery are common, with incidence of 20-50%. In liver transplantation, back-table reconstruction is often necessary for an easier and prompt arterial anastomosis and so, the use of arterial patches has been related to lower the incidence of complications. However, when a right hepatic artery variation from the superior mesenteric artery is present, the reconstruction occasionally produces twisting and flow problems. METHODS: Is described a surgical alternative for right hepatic artery variation reconstruction using a Carrel-patch from the superior mesenteric artery. The patch is anastomosed with the splenic artery stump to allow vertical orientation and improve blood flow. RESULTS: Among 120 liver transplants, four consecutive cases of right hepatic artery variation were reconstructed using this technique. All of them showed good flow and patency in postoperative period. CONCLUSION: The proposed technique proved to be an interesting alternative for the reconstruction of right hepatic artery variation in liver transplantation.

Humans , Hepatic Artery/surgery , Liver Transplantation/methods , Hepatic Artery/anatomy & histology , Incidence , Practice Guidelines as Topic , Vascular Surgical Procedures/methods
Medicina (Ribeiräo Preto) ; 44(1): 79-86, jan.-mar. 2011.
Article in Portuguese | LILACS | ID: lil-644427


OBJETIVO: Investigar uma abordagem diferente no manejo do trauma hepático, que consiga preservar o máximo possível o parênquima do órgão, expondo apenas a área lesada à isquemia e posterior reperfusão. METODOLOGIA: Pesquisa de artigos publicados nas bases de dados MedLine e pubMedno período de 1980 a 2010, sobre a abordagem dos pedículos glissonianos, e usando como palavrasde busca: fígado, cirurgia, trauma, veia porta e artéria hepática...

AIM: To investigate a different approach in liver trauma, that preserves as much liver parenchyma as possible, exposing only the injured area to ischemia and reperfusion. MATHERIAL AND METHODS: Medline and pubMed search from 1980 to 2010 about the glissonian approach , including, liver, surgery, trauma, portal vein and hepatic artery as key-words...

Hepatic Artery/surgery , Liver/surgery , Liver/injuries , Portal Vein
Acta cir. bras ; 21(6): 416-421, Nov.-Dec. 2006. ilus
Article in English | LILACS | ID: lil-440749


PURPOSE: To verify the development of blood vessels between the greater omentum and the liver in the presence of distinct liver blood intake blockages. METHODS: Two hundred and eighty conventional male Wistar rats were used, divided into 5 groups: control (n=35), laparotomy (n=35); hepatic artery ligature (n=70), ligature of the right-hand branch of the portal vein (n=70); and ligature of both blood vessels (n=70). The last three groups were divided into two subgroups each (n=35), according to the presence or absence of the transposition of the greater omentum onto the right hepatic lobe. The postoperative periods were 1, 3, 7, 15, 30, 60 and 90 days. At the end of each period, the greater omentum and right hepatic lobe were collected for histopathological examination. The presence of blood vessels between the referred tissues was verified by the administration of Indian ink as a marker of vascular lumen. RESULTS: Macroscopic and microscopic observation and the dye marker demonstrated the distribution of blood vessels between the greater omentum and liver tissues. CONCLUSION: The greater omentum was capable of developing blood vessels when fixed to the parenchyma of the liver after the suppression of hepatic blood flow.

OBJETIVO: Verificar o desenvolvimento de vasos sanguíneos entre o omento maior e o fígado em presença de diferentes bloqueios do aporte sanguíneo hepático. MÉTODOS: Foram utilizados 280 ratos machos, Wistar, convencional, divididos em 5 grupos: controle (n = 35), com laparotomia (n = 35), com ligadura da artéria hepática própria (n = 70), com ligadura do ramo direito da veia porta (n = 70) e com ligadura de ambos vasos sanguíneos (n = 70). Os três últimos grupos foram divididos em dois subgrupos (n = 35), de acordo com a transposição ou não do omento maior no lobo direito do fígado. Os períodos de pós-operatório foram de 1, 3, 7, 15, 30, 60 e 90 dias. Em cada período foram coletados o omento maior e o lobo direito do fígado para exame histopatológico. Presença de vasos sanguíneos entre os referidos tecidos foi verificada pela administração da tinta nanquim como marcador de lúmen vascular. RESULTADOS: As observações macroscópicas, microscópicas e do marcador tintorial demonstraram a distribuição dos vasos sanguíneos entre o omento maior transposto e o tecido hepático. CONCLUSÃO: O omento maior foi capaz de desenvolver vasos sanguíneos quando fixado junto ao parênquima do fígado, após supressão do fluxo sanguíneo hepático.

Animals , Male , Rats , Hepatic Artery/surgery , Liver/blood supply , Neovascularization, Physiologic/physiology , Omentum/blood supply , Liver/surgery , Models, Animal , Omentum/surgery , Portal Vein , Postoperative Period , Rats, Wistar , Regional Blood Flow/physiology , Vascular Endothelial Growth Factors
Rev. invest. clín ; 57(2): 262-272, mar.-abr. 2005. ilus
Article in Spanish | LILACS | ID: lil-632480


Liver transplantation (LT) is probably the biggest surgical aggression that a patient can endure. It was considered only as a last option in the era of experimental LT, yet it evolved into the definitive treatment for some types of acute and chronic end stage liver disease. In terms of technique LT is the most complex of all types of transplantations. The surgical procedure in itself is well established and has changed little through time. Liver transplantation owes its improvement to better and more systematic anesthetic procedures and to perioperative care more than being due to improvement of the surgical technique. The first surgical procedure was described by Thomas Starzl in 1969. His initial work has been strengthened with the development of venous bypass, the refinement in vascular and biliary reconstruction technique and the development of the split liver. Up to date technical aspects of orthotopic liver transplantation are described in the present article.

Probablemente, el trasplante hepático (TH) constituye la mayor agresión quirúrgica a la que se pueda someter un paciente. En la era experimental del trasplante de hígado, éste era considerado como una terapéutica de último recurso. Con el paso del tiempo ha terminado por imponerse como el tratamiento definitivo de algunas hepatopatías agudas y crónicas terminales. Técnicamente, el trasplante de hígado es el más complejo de todos los trasplantes. La técnica quirúrgica está bien establecida desde hace muchos años y no ha cambiado mucho. Más que a los avances recientes de la técnica, el TH debe su evolución quirúrgica al dominio protocolizado de la técnica anestésica y de los cuidados perioperatorios. La técnica quirúrgica inicial fue descrita por Thomas Starzl en 1969. Sus aportaciones iniciales han sido fortalecidas con el desarrollo de un sistema de derivación de la sangre venosa, el perfeccionamiento en la reconstrucción vascular y biliar y el desarrollo de avanzadas técnicas de reducción o de bipartición del injerto hepático. En el presente artículo se describen aspectos técnicos actuales relacionados con el trasplante hepático ortotópico (THO).

Humans , Liver Transplantation/methods , Anastomosis, Surgical , Blood Loss, Surgical , Bile Ducts/surgery , Duodenum/surgery , Hepatectomy/methods , Hepatic Artery/surgery , Liver/blood supply , Liver/surgery , Portal Vein/surgery , Tissue Donors , Tissue and Organ Harvesting/methods , Vena Cava, Inferior/surgery
Article in English | WPRIM | ID: wpr-53832


The objective of this study was to develop an experimental animal model of fulminant hepatic failure to test the efficacy of the bioartificial liver system. The portal vein and the hepatic artery were clamped intermittently and then the hepatic artery was ligated (ligation group, n=5). Pigs whose hepatic arteries were not ligated after clamping were assigned to the non-ligation group (n=5). The biochemical changes in blood, histologic alterations of the liver and neurologic examination for pigs were checked up. All animals died within 17 hr in the ligation group. On the other hand, all animals survived more than 7 days in the non-ligation group. In the ligation group, the levels of ammonia, lactic acid and creatinine showed a progressively increasing pattern. Prothrombin time was also prolonged gradually. Cytoplasmic condensation and nuclear pyknosis of hepatocytes were detected histologically at autopsy. Neurologic findings such as decreased pain sensation, tachypnea and no light reflex of pupils were observed. The findings shown in the ligation group are similar to the clinical features of fulminant hepatic failure in human and this animal model is reproducible. Therefore, this can be a suitable animal model to evaluate the efficacy of the bioartificial liver system for treating fulminant hepatic failure.

Acidosis/etiology , Ammonia/blood , Animals , Aspartate Aminotransferases/blood , Bilirubin/blood , Blood Glucose/metabolism , Blood Urea Nitrogen , Comparative Study , Creatinine/blood , Disease Models, Animal , Female , Hepatic Artery/surgery , Lactic Acid/blood , Ligation/adverse effects , Liver Failure, Acute/blood , Portal Vein/surgery , Potassium/blood , Prothrombin Time , Sodium Bicarbonate/pharmacology , Swine
J. vasc. bras ; 4(1): 27-34, 2005. ilus, tab
Article in English | LILACS | ID: lil-421698


Objective: Visceral artery aneurysms, despite being uncommon, are important vascular diseases, since they frequently are life threatening, and often fatal emergencies. The purpose of this study is to review our experience with treatment of visceral artery aneurysms. Method: Between 1988 and June, 2004, 37 visceral artery aneurysms were treated in 35 patients (17 male and 18 female) with average age of 56 mais ou menos 14 years. The most common locations were the splenic artery (18), the hepatic artery (10) and the superior mesenteric artery (four), 22 patients were asymptomatic, 13 patients were symptomatic. Emergency surgery was performed on three patients, elective open surgery on 20 patients, and endovascular treatment onseven patients. Results: Perioperative mortality rate was 3,1 por cento in the surgical group. The perioperative mobidity rate was 5,7 por cento: one case of respiratory distress and one case of bilious fistula were...

Male , Female , Humans , Splenic Artery/surgery , Hepatic Artery/surgery , Mesenteric Artery, Superior/surgery , Splanchnic Circulation/physiology , Aneurysm/complications , Aneurysm/diagnosis , Celiac Artery/surgery
Rev. argent. cir ; 81(5): 122-126, nov. 2001. ilus, tab
Article in Spanish | LILACS | ID: lil-305680


Objetivo: describir las variantes anatómicas de la arteria hepática, resaltar su importancia en la cirugía digestiva y sugerir pautas para su reconocimiento tanto pre como intraoperatorio. Lugar de aplicación: dos hospitales públicos de alta complejidad. Diseño: longitudinal, retrospectivo, descriptivo. Población: 414 hígados para ser implantados en receptores de Trasplante Hepático, 374 fueron obtenidos de donante cadavéricos y 40 segmentados laterales izquierdo de donante vivo relacionado. Método: se disecaron y clasificaron de acuerdo a su disposición anatómica (según la clasificación propuesta por Michels y modificada por Hiatt) todas las arterias hepáticas de 374 hígados obtenidos de donante cadavérico y 40 de donante vivo relacionado. Resultados: encontramos un 70,7 por ciento de variantes tipo I (distribución normal), 10,6 por ciento tipo II (rama izquierda de la coronaria estomáquica), 7 por ciento tipo III (rama derecha de la Mesentérica superior), 4,8 por ciento tipo IV (triple arteria), 2 por ciento tipo V (hepática común de Mesentérica), 0,8 por ciento tipo VI (hepática común directa de aorta) y 4 por ciento otras variantes no clasificadas. Conclusión: las variantes anatómicas de la arteria hepática son más frecuentes de lo que uno puede esperar y rondan entre el 25 y 40 por ciento. Es importante su estudio preoperatorio y su reconocimiento intraquirúrgico para evitar lesiones de alguna de sus ramas que deriven en consecuencias graves e irreversibles tanto sobre la vía biliar como el hígado

Humans , Hepatic Artery/surgery , Cholecystectomy , Biliary Fistula/prevention & control , Pancreaticoduodenectomy , Digestive System Surgical Procedures/standards , Biliary Tract Surgical Procedures/standards , Liver Transplantation/standards , Hepatic Artery/anatomy & histology , Esophagus/surgery , Pancreas , Pancreatic Neoplasms , Retrospective Studies
Radiol. bras ; 32(5): 223-7, set.-out. 1999. ilus
Article in Portuguese | LILACS | ID: lil-268547


Muitos transplantes hepáticos apresentam pelo menos uma complicaçäo pósÄoperatória importante. Esta pode incluir o näoÄfuncionamento do enxerto(fígado), problemas relacionados com a artéria hepática e a veia porta. Reconhecer essas diversas possibilidades de complicaçöes é extremamente importante no processo de tomada de conduta no paciente transplantado. Os autores fazem uma revisäo sobre as complicaçöes envolvendo a arteria hepatica e a veia porta nos pacientes transplantados. Relatam os achados ultraÄsonográficos e de Doppler considerados importantes no diagnóstico das complicaçöes vasculares, assim como os aspectos anatômicos e clínicos de interesse.

Hepatic Artery/surgery , Postoperative Complications/diagnosis , Postoperative Complications , Hepatectomy/adverse effects , Liver Transplantation/adverse effects , Liver Transplantation , Ultrasonography, Doppler, Color , Portography
Medicina (B.Aires) ; 56(5/1): 493-6, sept.-oct. 1996. ilus
Article in Spanish | LILACS | ID: lil-188414


Se presenta un hombre de 45 años etilista crónico portador asintomático de un gran aneurisma de la arteria hepática que fue operado en forma programada. El aneurisma fue resecado y se reemplazó el segmento arterial con vena safena interna. El paciente evolucionó sin complicaciones siendo dado de alta 7 días dsespués de la cirugía. Antiguamente los aneurismas de la arteria hepática tenían una mortalidad muy elevada. Esto obedecía a que por su escasa frecuencia no se pensaba en ellos hasta el momento en que se producía una complicación y casi siempre eran descubiertos en la mesa de autopsias. Podría decirse que era una patología de evolución maligna. En la actualidad, con la ecografía abdominal y la angiografia resulta posible localizar el aneurisma y tratarlo en forma programada. Esto ha provocado un cambio evidente en el pronóstico tan desfavorable.

Middle Aged , Humans , Male , Aneurysm/surgery , Hepatic Artery/surgery , Angiography
Arq. gastroenterol ; 32(3): 116-20, jul.-set. 1995. ilus
Article in Portuguese | LILACS | ID: lil-161607


É descrito um caso de aneurisma roto da artéria-hepática esquerda de 71 anos, do sexo feminino, com dor abdominal, emagrecimento e febre. O diagnóstico foi feito com uso de ultra-som com "doppler", tomografia computadorizada com contraste e angiografia do tronco celíaco e da artéria mesentérica superior. A rapidez no diagnóstico e a hepatectomia esquerda regrada levaram a um resultado satisfatório.

Humans , Female , Aged , Aneurysm, Infected/surgery , Hepatic Artery/surgery , Staphylococcal Infections/surgery , Aneurysm, Infected/diagnosis , Aneurysm, Ruptured/complications , Angiography , Hepatic Artery/pathology , Hepatectomy , Staphylococcal Infections/surgery , Staphylococcal Infections/diagnosis , Portal Vein , Thrombosis/etiology , Tomography, X-Ray Computed , Ultrasonography, Doppler
Article in English | IMSEAR | ID: sea-64949


Use of vascular occlusion techniques during hepatic resection has besides decreasing blood loss improved the feasibility of surgical extirpation of large hepatic tumors. We report successful use of this technique to resect a large hepatoma in the right lobe of the liver. The hemodynamic and biochemical changes in the perioperative period are documented.

Cholecystectomy , Hepatectomy/methods , Hepatic Artery/surgery , Hepatic Duct, Common/surgery , Humans , Ligation , Liver Neoplasms/surgery , Male , Middle Aged , Portal Vein/surgery