Z Gastroenterol 2018; 56(01): E2-E89
DOI: 10.1055/s-0037-1612832
Poster Visit Session IV Tumors, Liver Surgery and Transplantation – Saturday, January 27, 2018, 8:30am – 9:15am, Foyer area West Wing
Georg Thieme Verlag KG Stuttgart · New York

The stand of portal vein arterialization in hepatobiliary surgery: a systematic review

A Majlesara
1   University of Heidelberg, General, Visceral, and Transplantation Surgery, Heidelberg
,
M Golriz
1   University of Heidelberg, General, Visceral, and Transplantation Surgery, Heidelberg
,
O Ghamarnejad
1   University of Heidelberg, General, Visceral, and Transplantation Surgery, Heidelberg
,
A Mehrabi
1   University of Heidelberg, General, Visceral, and Transplantation Surgery, Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2018 (online)

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Background:

Hepatic artery (HA) reconstruction during liver resection can be impossible due to arterial infiltration or anatomical limitations. Portal vein arterialization (PVA) is discussed to improve the hepatic oxygenation and provide a new chance for the patients with dearterialized liver. The aim of this study is to review the clinical application of PVA in hepatobiliary surgeries.

Methods:

A systematic review was performed according to the PRISMA guidelines. PubMed, Embase, and Web of Science databases were searched using the keywords: portal vein arterialization; arterioportal shunt; liver resection; hepatectomy. Experimental studies, review articles, letters, and also articles published in languages other than English were not included.

Results:

A total of 20 studies, involving 57 patients, were included. According to the anatomical location, hilar lesions (38 patients, 70.4%) were the most common indication of the surgery. The reasons for performing PVA were excision of lesions abutting HA (32 patients, 56.1%), HA ligation (11 patients, 19.3%), HA thrombosis (six patients, 10.5%), iatrogenic injury (four patients, 7.0%), and failure of HA reconstruction (four patients, 7.0%). An end-to-side anastomosis between celiac trunk branches and portal vein (PV) is the main performing technique for PVA (35 patients, 59.3%). An anastomosis between mesenterial artery and vein (20 patients 33.9%), and also end-to-side anastomosis between the splenic artery and PV (three patients 5.1%) are the other PVA methods. The most common complication of PVA is portal hypertension (12 of 57, 21.1%). 35 patients (61.4%) survived during the follow-up period of 1 to 87 months in different studies.

Conclusions:

PVA may provide a chance of cure for patients with the unresectable lesions. To prevent portal hypertension and liver injuries due to thrombosis or over-arterialization, calibrating and timely closure of PVA should be considered.