Background/Aims: Mutual interactions between portal vein and hepatic artery can be documented during hepatobiliary surgery. Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a recently introduced surgical technique which can also represent a unique living human model to investigate intrahepatic blood circulation. We report three consecutive cases in which a residual right portal branch flow was clearly detectable after first-step ALPPS, and try to further investigate this unexpected finding with intraoperative clamping tests. Methodology: Every patient was evaluated with CT scan 7 days after first-step ALPPS and Intraoperative Doppler Ultrasonography (IOUS) at both steps of the procedure. Results: In every patient, CT scan and second-step IOUS demonstrated a clear hepatopetal flow distally to the divided right portal branch. The flow was present after right biliary duct clamping and stopped after right total hilar clamping as well as after right hepatic artery occlusion. Conclusions: Neither cross-portal circulation between the two hemilivers nor trans-sinusoidal backflow from the hepatic veins can explain these findings, which are rather consistent with a refilling of the occluded portal branch through the opening of intrahepatic arterioportal shunts (APS). APS could represent the simplest homeostatic mechanism that regulate intrahepatic blood flow

DE CARLIS, L., Sguinzi, R., De Carlis, R., Di Sandro, S., Mangoni, J., Aseni, P., et al. (2014). Residual right portal branch flow after first-step ALPPS: artifact or homeostatic response?. HEPATO-GASTROENTEROLOGY, 61(134), 1712-1716 [10.5754/hge14531].

Residual right portal branch flow after first-step ALPPS: artifact or homeostatic response?

DE CARLIS, LUCIANO GREGORIO
Primo
;
2014

Abstract

Background/Aims: Mutual interactions between portal vein and hepatic artery can be documented during hepatobiliary surgery. Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a recently introduced surgical technique which can also represent a unique living human model to investigate intrahepatic blood circulation. We report three consecutive cases in which a residual right portal branch flow was clearly detectable after first-step ALPPS, and try to further investigate this unexpected finding with intraoperative clamping tests. Methodology: Every patient was evaluated with CT scan 7 days after first-step ALPPS and Intraoperative Doppler Ultrasonography (IOUS) at both steps of the procedure. Results: In every patient, CT scan and second-step IOUS demonstrated a clear hepatopetal flow distally to the divided right portal branch. The flow was present after right biliary duct clamping and stopped after right total hilar clamping as well as after right hepatic artery occlusion. Conclusions: Neither cross-portal circulation between the two hemilivers nor trans-sinusoidal backflow from the hepatic veins can explain these findings, which are rather consistent with a refilling of the occluded portal branch through the opening of intrahepatic arterioportal shunts (APS). APS could represent the simplest homeostatic mechanism that regulate intrahepatic blood flow
Articolo in rivista - Articolo scientifico
Aged; Artifacts; Bile Duct Neoplasms; Female; Hepatectomy; Hepatic Artery; Homeostasis; Humans; Ligation; Liver Neoplasms; Liver Regeneration; Male; Middle Aged; Phlebography; Portal Vein; Time Factors; Tomography, X-Ray Computed; Ultrasonography, Doppler; Liver Circulation
English
1712
1716
5
DE CARLIS, L., Sguinzi, R., De Carlis, R., Di Sandro, S., Mangoni, J., Aseni, P., et al. (2014). Residual right portal branch flow after first-step ALPPS: artifact or homeostatic response?. HEPATO-GASTROENTEROLOGY, 61(134), 1712-1716 [10.5754/hge14531].
DE CARLIS, L; Sguinzi, R; De Carlis, R; Di Sandro, S; Mangoni, J; Aseni, P; Giacomoni, A; Vanzulli, A
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/101000
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