Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series
Abstract Background Replaced right hepatic artery (rRHA) is a common vascular variation, and combined resection of this vessel is sometimes needed for the curative resection of pancreatic head malignancy. Safe surgical management has not been established, and there is a small number of reported case...
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Japan Surgical Society
2022-03-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01403-y |
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| author | Shintaro Takeuchi Yoshiyasu Ambo Yoshihisa Kodama Minoru Takada Kentaro Kato Fumitaka Nakamura Satoshi Hirano |
| author_facet | Shintaro Takeuchi Yoshiyasu Ambo Yoshihisa Kodama Minoru Takada Kentaro Kato Fumitaka Nakamura Satoshi Hirano |
| author_sort | Shintaro Takeuchi |
| collection | DOAJ |
| description | Abstract Background Replaced right hepatic artery (rRHA) is a common vascular variation, and combined resection of this vessel is sometimes needed for the curative resection of pancreatic head malignancy. Safe surgical management has not been established, and there is a small number of reported cases. Here, we reported five cases, wherein preoperative embolization of rRHA was performed for combined resection. Case presentation All patients had pancreatic head malignancies that were in contact with rRHA. We performed a preoperative embolization of the rRHA before the scheduled pancreaticoduodenectomy for the combined resection. Arterial embolization was safely accomplished, and the communicating arcade from the left hepatic artery via the hilar plate was clearly revealed in all cases. Four patients underwent the operative procedure, except for one patient who had liver metastasis at laparotomy. No patient suffered from a severe abnormal liver function during the management; however, one patient had multiple liver infarctions during the postoperative course. Conclusions Preoperative embolization for the combined resection of rRHA in pancreaticoduodenectomy can be a management option for the precise evaluation of hemodynamics after sacrificing rRHA. In our cases, arterial flow to the right liver lobe was supplied by the left hepatic artery via the bypass route, including the communicating arcade of the hilar plate. |
| format | Article |
| id | doaj-art-a4d42dce41a846cab2b7a3a34e9aa3d4 |
| institution | Matheson Library |
| issn | 2198-7793 |
| language | English |
| publishDate | 2022-03-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-a4d42dce41a846cab2b7a3a34e9aa3d42025-08-02T15:48:24ZengJapan Surgical SocietySurgical Case Reports2198-77932022-03-01811710.1186/s40792-022-01403-yPreoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case seriesShintaro Takeuchi0Yoshiyasu Ambo1Yoshihisa Kodama2Minoru Takada3Kentaro Kato4Fumitaka Nakamura5Satoshi Hirano6Department of Surgery, Teine Keijinkai HospitalDepartment of Surgery, Teine Keijinkai HospitalDepartment of Radiology, Teine Keijinkai HospitalDepartment of Surgery, Teine Keijinkai HospitalDepartment of Surgery, Teine Keijinkai HospitalDepartment of Surgery, Teine Keijinkai HospitalDepartment of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido UniversityAbstract Background Replaced right hepatic artery (rRHA) is a common vascular variation, and combined resection of this vessel is sometimes needed for the curative resection of pancreatic head malignancy. Safe surgical management has not been established, and there is a small number of reported cases. Here, we reported five cases, wherein preoperative embolization of rRHA was performed for combined resection. Case presentation All patients had pancreatic head malignancies that were in contact with rRHA. We performed a preoperative embolization of the rRHA before the scheduled pancreaticoduodenectomy for the combined resection. Arterial embolization was safely accomplished, and the communicating arcade from the left hepatic artery via the hilar plate was clearly revealed in all cases. Four patients underwent the operative procedure, except for one patient who had liver metastasis at laparotomy. No patient suffered from a severe abnormal liver function during the management; however, one patient had multiple liver infarctions during the postoperative course. Conclusions Preoperative embolization for the combined resection of rRHA in pancreaticoduodenectomy can be a management option for the precise evaluation of hemodynamics after sacrificing rRHA. In our cases, arterial flow to the right liver lobe was supplied by the left hepatic artery via the bypass route, including the communicating arcade of the hilar plate.https://doi.org/10.1186/s40792-022-01403-yReplaced right hepatic arteryPancreaticoduodenectomyTrans-arterial catheter embolization |
| spellingShingle | Shintaro Takeuchi Yoshiyasu Ambo Yoshihisa Kodama Minoru Takada Kentaro Kato Fumitaka Nakamura Satoshi Hirano Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series Surgical Case Reports Replaced right hepatic artery Pancreaticoduodenectomy Trans-arterial catheter embolization |
| title | Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series |
| title_full | Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series |
| title_fullStr | Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series |
| title_full_unstemmed | Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series |
| title_short | Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series |
| title_sort | preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy a small case series |
| topic | Replaced right hepatic artery Pancreaticoduodenectomy Trans-arterial catheter embolization |
| url | https://doi.org/10.1186/s40792-022-01403-y |
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