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Jiang J, Yang D, Yang Z, Han X, Xu L, Wang Y, Wang X, Yang Z, Xu H. The timing phase affected the inconsistency of APHE subtypes of liver observations in patients at risk for HCC on the multi-hepatic arterial phase imaging. Abdom Radiol (NY) 2024; 49:1092-1102. [PMID: 38195799 DOI: 10.1007/s00261-023-04096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To investigate whether liver observations in patients at risk for hepatocellular carcinoma (HCC) display inconsistent arterial phase hyperenhancement (APHE) subtypes on the multi-hepatic arterial phase imaging (mHAP) and to further investigate factors affecting inconsistent APHE subtype of observations on mHAP imaging. METHODS From April 2018 to June 2021, a total of 141 patients at high risk of HCC with 238 liver observations who underwent mHAP MRI acquisitions were consecutively included in this retrospective study. Two experienced radiologists reviewed individual arterial phase imaging independently and assessed the enhancement pattern of each liver observation according to LI-RADS. Another two experienced radiologists identified and recorded the genuine timing phase of each phase independently. When a disagreement appeared between the two radiologists, another expert participated in the discussion to get a final decision. A separate descriptive analysis was used for all observations scored APHE by the radiologists. The Kappa coefficient was used to determine the agreement between the two radiologists. Univariate analysis was performed to investigate the factors affecting inconsistent APHE subtype of liver observations on mHAP imaging. RESULTS The interobserver agreement was substantial to almost perfect agreement on the assessment of timing phase (κ = 0.712-0.887) and evaluation of APHE subtype (κ = 0.795-0.901). A total of 87.8% (209/238) of the observations showed consistent nonrim APHE and 10.2% (24/238) of the observations showed consistent rim APHE on mHAP imaging. A total of 2.1% (5/238) of the liver observations were considered inconsistent APHE subtypes, and all progressed nonrim to rim on mHAP imaging. 87.9% (124/141) of the mHAP acquisitions were all arterial phases and 12.1% (17/141) of the mHAP acquisitions obtained both the arterial phase and portal venous phase. Univariate analysis was performed and found that the timing phase of mHAP imaging affected the consistency of APHE subtype of liver observations. When considering the timing phase and excluding the portal venous phase acquired by mHAP imaging, none of the liver observations showed inconsistent APHE subtypes on mHAP imaging. CONCLUSION The timing phase which mHAP acquisition contained portal venous phase affected the inconsistency of APHE subtype of liver observations on mHAP imaging. When evaluating the APHE subtype of liver observations, it's necessary to assess the timing of each phase acquired by the mHAP technique at first.
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Affiliation(s)
- Jiahui Jiang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Zhenzhen Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Xinjun Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Lixue Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Yuxin Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Xiaopei Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
| | - Hui Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
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Motohara T, Yamamura K, Ueno S, Takeno H, Nagayama Y, Oda E, Karashima R, Ozaki N, Masuda T, Beppu T. A rare incidence of a hepatic artery pseudoaneurysm following plastic biliary stent insertion. Clin J Gastroenterol 2024; 17:352-355. [PMID: 38363445 DOI: 10.1007/s12328-024-01920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Abstract
Hepatic artery pseudoaneurysms have been reported to occur in approximately 1% of cases after metal stenting for malignant biliary obstruction. In contrast, only a few cases have been reported as complications after plastic stenting for benign biliary disease. We report a 61-year-old man with cholangitis who presented with a rare complication of hemobilia after implantation of 7 Fr double pigtail plastic biliary stents. No bleeding was observed approximately one month after biliary stent tube removal. Contrast-enhanced CT scan revealed a circularly enhanced lesion (5 mm in diameter) in the arterial phase at the tip of the previously inserted plastic bile duct stent. Color Doppler ultrasonography enhanced the lesion and detected arterial blood flow inside. He was diagnosed with a hepatic artery pseudoaneurysm. However, he had no risk factors such as prolonged catheterization, severe cholangitis, liver abscess, or long-term steroid use. Superselective transarterial embolization using two metal microcoils was successfully completed without damage to the surrounding liver parenchyma. If hemobilia is suspected after insertion of a plastic bile duct stent, immediate monitoring using contrast-enhanced computed tomography or Doppler ultrasonography is recommended.
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Affiliation(s)
- Toshihiko Motohara
- Department of Gastroenterology, Yamaga City Medical Center, yamaga, Japan
| | - Kensuke Yamamura
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Shigenori Ueno
- Department of Gastroenterology, Yamaga City Medical Center, yamaga, Japan
| | - Hiroshi Takeno
- Department of Gastroenterology, Yamaga City Medical Center, yamaga, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Eri Oda
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | | | - Nobuyuki Ozaki
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Toshiro Masuda
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan.
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Wong P, Hoffman D, Pollini T, Zampese M, Corvera CU, Maker AV. Intraoperative hepatic artery infusion pump perfusion testing with indocyanine green near-infrared imaging offers multiple potential advantages. J Gastrointest Surg 2024; 28:598-599. [PMID: 38583918 DOI: 10.1016/j.gassur.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Paul Wong
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, California, United States
| | - Daniel Hoffman
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, California, United States
| | - Tommaso Pollini
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, California, United States
| | - Marco Zampese
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, California, United States
| | - Carlos U Corvera
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, California, United States
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, California, United States.
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Kadaba P, Beitia L, Rosen A, Weinberg A, Lewis S, Simpson WL. Utility of nifedipine use for Doppler ultrasound early after liver transplantation to predict short-term complications and long-term outcomes. Abdom Radiol (NY) 2024; 49:1103-1112. [PMID: 38219253 DOI: 10.1007/s00261-023-04152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To evaluate the response to nifedipine administration measured by changes in hepatic arterial (HA) flow on post-operative Doppler ultrasound (US) to predict short-term complications and long-term outcomes in liver transplant (LT) patients. METHODS Patients who underwent LT with post-operative Doppler US within 3 days between 1 January 2005 and 31 December 2015 were included in this retrospective single center study. The patients who received and did not receive nifedipine during the Doppler US comprised the study and control groups, respectively. A positive response to nifedipine was defined as the detection of HA flow when none was present initially or a reduction in HA resistive index (RI) ≥ 0.1 after nifedipine administration. The rates of re-transplantation, re-operation, percutaneous intervention (PCI), and overall survival (OS) were recorded. Cox proportional hazards regression was used to evaluate the association of clinic-demographic variables and Doppler findings with the outcome measures. RESULTS 444 LT patients (305 M/139F, mean age 51.7 ± 17.4 years, mean interval between LT-Doppler US 1.12 ± 0.9 days) are presented. 220 patients comprised the nifedipine study group [n = 157/220 (71.4%) responder, n = 63/220 (28.6%) nonresponder] and 224 patients comprised the control group. There was no difference in re-transplantation or PCI rates between the groups (all p-values ≥ 0.2 and ≥ 0.08, respectively). The responder group had a lower rate of re-operation vs. the control group (15.9% vs. 24.1%, p = 0.03) and nonresponder group (15.9% vs. 31.8%, p = 0.004). 1-year and 2-year OS were similar between the groups (all p-values > 0.37). CONCLUSION Short-term complication rates and long-term outcomes for patients with liver transplant who responded to nifedipine administration on Doppler US are similar to those who did not require nifedipine administration. A lack of response to nifedipine was associated with a higher re-operation rate.
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Affiliation(s)
- Priyanka Kadaba
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, Box 1234, New York, NY, 10029, USA
| | - Laura Beitia
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, Box 1234, New York, NY, 10029, USA
| | - Ally Rosen
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, Box 1234, New York, NY, 10029, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Alan Weinberg
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, Box 1234, New York, NY, 10029, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - William L Simpson
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, Box 1234, New York, NY, 10029, USA.
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Humphreys WJE, Sumping JC, Maddox TW, Marwood R. Enlargement of the hepatic artery is present in dogs with a congenital extrahepatic portosystemic shunt and is independent of shunt insertion into the systemic circulation. Vet Radiol Ultrasound 2024; 65:149-156. [PMID: 38318990 DOI: 10.1111/vru.13329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/15/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024] Open
Abstract
The accurate diagnosis of portovascular anomalies has been facilitated by improvements in diagnostic imaging technology. In humans, hepatic arterial blood flow changes in response to the reduction in portal blood flow. The hepatic arterial buffer response characterizes an intrinsic regulatory mechanism in response to reduced portal venous blood flow, which results in hepatic arterial enlargement. At the authors' institution, enlargement of the hepatic artery has been anecdotally observed in a population of dogs with extrahepatic portosystemic shunting, consistent with previous literature that documents variability in hepatic arterial size. In this retrospective, blinded, analytical study, a hepatic artery:aorta (Ha:Ao) ratio was assessed on CT studies from 112 dogs, with (n = 43) and without (n = 69) an extrahepatic congenital portosystemic shunt in order to compare the hepatic artery size independent of body weight between the two populations. A significant increase in the Ha:Ao ratio was documented in dogs with an extrahepatic portosystemic shunt (EHPSS) compared with those dogs with no EHPSS independent of the location of shunt insertion into the systemic circulation (P < .001). Three cases had repeat CT after surgery, and all had Ha:Ao ratio reductions following treatment. The authors propose that this may be an additional imaging feature observed in dogs with an EHPSS.
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Affiliation(s)
- William J E Humphreys
- Small Animal Teaching Hospital, School of Veterinary Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
| | - Jessica C Sumping
- Small Animal Teaching Hospital, School of Veterinary Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
| | - Thomas W Maddox
- Small Animal Teaching Hospital, School of Veterinary Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
| | - Rachel Marwood
- Small Animal Teaching Hospital, School of Veterinary Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
- North Downs Specialist Referrals, Bletchingley, UK
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An C, Yao W, Zuo M, Li W, Chen Q, Wu P. Pseudo-capsulated Hepatocellular Carcinoma: Hepatic Arterial Infusion Chemotherapy Versus Transcatheter Arterial Chemoembolization. Acad Radiol 2024; 31:833-843. [PMID: 37487879 DOI: 10.1016/j.acra.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/10/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023]
Abstract
RATIONALE AND OBJECTIVES The effectiveness and safety of hepatic arterial infusion chemotherapy (HAIC) or transarterial chemoembolization (TACE) for cases with single pseudo-capsuled hepatocellular carcinoma (pHCC), as well as their survival outcomes, were investigated. MATERIALS AND METHODS A total of 196 cases with single pHCC (diameter >5 cm) receiving initial HAIC (n = 92) and TACE (n = 104) were enrolled. The propensity score match (PSM) approach based on Cox models was employed to tune any possible imbalance in treatment assignment. The overall survival (OS), objective response rate (ORR), progression-free survival (PFS), and partial response rate (PRR) of the subjects were investigated using the log-rank test. The independent risk factors for outcomes were investigated by univariate and multivariate analyses, and the results were analyzed using the Cox regression model. RESULTS The median follow-up of the subjects was 22.3 months. After PSM, no significant difference was found in the OS of the HAIC and TACE groups (OS, 12.0 vs. 16.8 months; P = .267), while the median PFS of the TACE group was prolonged compared with the HAIC group (PFS, 5.7 vs. 2.8 months; P = .003). Moreover, PRR and ORR of the TACE group were prolonged compared with the HAIC group (PRR, 34.6% vs. 21.7%; P = .046; ORR, 35.6% vs. 21.7%; P = .033). The nomogram model showed high predictive accuracy and significant discrimination. CONCLUSION TACE therapy could delay tumor progression compared with HAIC for cases with a single pHCC.
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Affiliation(s)
- Chao An
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651, Dongfeng East Road, Guangzhou 510060, PR China (C.A., M.Z., W.L., Q.C., P.W.)
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China (W.Y.)
| | - Mengxuan Zuo
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651, Dongfeng East Road, Guangzhou 510060, PR China (C.A., M.Z., W.L., Q.C., P.W.)
| | - Wang Li
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651, Dongfeng East Road, Guangzhou 510060, PR China (C.A., M.Z., W.L., Q.C., P.W.)
| | - Qifeng Chen
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651, Dongfeng East Road, Guangzhou 510060, PR China (C.A., M.Z., W.L., Q.C., P.W.)
| | - Peihong Wu
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651, Dongfeng East Road, Guangzhou 510060, PR China (C.A., M.Z., W.L., Q.C., P.W.).
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Arunachalam VS, Valakkada J, Ayyappan A. Inadvertent Hepatic Arterial Cannulation during Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol 2024; 35:483-484. [PMID: 38395476 DOI: 10.1016/j.jvir.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 02/25/2024] Open
Affiliation(s)
- Venkata Subbaih Arunachalam
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Anoop Ayyappan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Uraoka M, Funamizu N, Sogabe K, Shine M, Honjo M, Tamura K, Sakamoto K, Ogawa K, Takada Y. Novel embryological classifications of hepatic arteries based on the relationship between aberrant right hepatic arteries and the middle hepatic artery: A retrospective study of contrast-enhanced computed tomography images. PLoS One 2024; 19:e0299263. [PMID: 38416748 PMCID: PMC10901311 DOI: 10.1371/journal.pone.0299263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/06/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Variations in hepatic arteries are frequently encountered during pancreatoduodenecomy. Identifying anomalies, especially the problematic aberrant right hepatic artery (aRHA), is crucial to preventing vascular-related complications. In cases where the middle hepatic artery (MHA) branches from aRHAs, their injury may lead to severe liver ischemia. Nevertheless, there has been little information on whether MHA branches from aRHAs. This study aimed to investigate the relationship between aRHAs and the MHA based on the embryological development of visceral arteries. METHODS This retrospective study analyzed contrast-enhanced computed tomography images of 759 patients who underwent hepatobiliary-pancreatic surgery between January 2011 and August 2022. The origin of RHAs and MHA courses were determined using three-dimensional reconstruction. All cases of aRHAs were categorized into those with or without replacement of the left hepatic artery (LHA). RESULTS Among the 759 patients, 163 (21.4%) had aRHAs. Five aRHAs patterns were identified: (Type 1) RHA from the gastroduodenal artery (2.7%), (Type 2) RHA from the superior mesenteric artery (SMA) (12.7%), (Type 3) RHA from the celiac axis (2.1%), (Type 4) common hepatic artery (CHA) from the SMA (3.5%), and (Type 5) separate branching of RHA and LHA from the CHA (0.26%). The MHA did not originate from aRHAs in Types 1-3, whereas in Type 4, it branched from either the RHA or LHA. CONCLUSIONS Based on the developmental process of hepatic and visceral arteries, branching of the MHA from aRHAs is considered rare. However, preoperative recognition and intraoperative anatomical assessment of aRHAs is essential to avoid injury.
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Affiliation(s)
- Mio Uraoka
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Naotake Funamizu
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Kyosei Sogabe
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Mikiya Shine
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Masahiko Honjo
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Kei Tamura
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Katsunori Sakamoto
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Kohei Ogawa
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Yasutsugu Takada
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
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Li N, Fei P, Tous C, Rezaei Adariani M, Hautot ML, Ouedraogo I, Hadjadj A, Dimov IP, Zhang Q, Lessard S, Nosrati Z, Ng CN, Saatchi K, Häfeli UO, Tremblay C, Kadoury S, Tang A, Martel S, Soulez G. Human-scale navigation of magnetic microrobots in hepatic arteries. Sci Robot 2024; 9:eadh8702. [PMID: 38354257 DOI: 10.1126/scirobotics.adh8702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
Using external actuation sources to navigate untethered drug-eluting microrobots in the bloodstream offers great promise in improving the selectivity of drug delivery, especially in oncology, but the current field forces are difficult to maintain with enough strength inside the human body (>70-centimeter-diameter range) to achieve this operation. Here, we present an algorithm to predict the optimal patient position with respect to gravity during endovascular microrobot navigation. Magnetic resonance navigation, using magnetic field gradients in clinical magnetic resonance imaging (MRI), is combined with the algorithm to improve the targeting efficiency of magnetic microrobots (MMRs). Using a dedicated microparticle injector, a high-precision MRI-compatible balloon inflation system, and a clinical MRI, MMRs were successfully steered into targeted lobes via the hepatic arteries of living pigs. The distribution ratio of the microrobots (roughly 2000 MMRs per pig) in the right liver lobe increased from 47.7 to 86.4% and increased in the left lobe from 52.2 to 84.1%. After passing through multiple vascular bifurcations, the number of MMRs reaching four different target liver lobes had a 1.7- to 2.6-fold increase in the navigation groups compared with the control group. Performing simulations on 19 patients with hepatocellular carcinoma (HCC) demonstrated that the proposed technique can meet the need for hepatic embolization in patients with HCC. Our technology offers selectable direction for actuator-based navigation of microrobots at the human scale.
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Affiliation(s)
- Ning Li
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Phillip Fei
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Cyril Tous
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Mahdi Rezaei Adariani
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
- Inria, Palaiseau 91120, France
| | - Marie-Lou Hautot
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Inès Ouedraogo
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Nantes, Nantes 44035, France
| | - Amina Hadjadj
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Ivan P Dimov
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Quan Zhang
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, China
- School of Artificial Intelligence, Shanghai University, Shanghai 200444, China
| | - Simon Lessard
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Zeynab Nosrati
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Courtney N Ng
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Katayoun Saatchi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Urs O Häfeli
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Charles Tremblay
- Department of Computer Engineering and Software Engineering, Polytechnique Montréal, Montréal, Québec H3T 1J4, Canada
| | - Samuel Kadoury
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Department of Computer Engineering and Software Engineering, Polytechnique Montréal, Montréal, Québec H3T 1J4, Canada
| | - An Tang
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec H2X 0C1, Canada
| | - Sylvain Martel
- Department of Computer Engineering and Software Engineering, Polytechnique Montréal, Montréal, Québec H3T 1J4, Canada
- Department of Bioengineering, McGill University, Montréal, Québec H3A 0E9, Canada
| | - Gilles Soulez
- Clinical Laboratory of Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Université de Montréal, Montréal, Québec H3T 1J4, Canada
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec H2X 0C1, Canada
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10
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Rastogi A, Gupta AA, Piplani T, Yadav KS, K V F, Bhangui P, Soin AS. Hilar Anatomy in 3035 Living Liver Donors: A Novel Classification for Donor Surgery and Suitability, Hepatic Surgeries, and Hepatobiliary Interventions. Transplantation 2024; 108:455-463. [PMID: 37953482 DOI: 10.1097/tp.0000000000004807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND This study examines the vascular and biliary variations in 3035 liver donors. We propose a novel classification of hepatic arteries, portal veins, and bile ducts and clinically relevant donor classification. METHODS Preoperative imaging and operative details of 3035 donors from 2005 to 2020 were reviewed. Hilar anatomical variations were identified and grouped on the basis of incidence and clinical relevance. RESULTS Hilar structures are classified according to the numbers supplying or draining the graft: for the hepatic artery, right (R) and left (L), RA1/LA1 (1 artery), RA2/LA2 (2 arteries), and RA3/LA3 (3 arteries), respectively, further defined on the basis of the inflow trunk into C (for common hepatic artery), S (for superior mesenteric artery), and L (for left gastric artery); for the portal vein, RP1 (1 vein) and RP2 (2 veins) for the right lobe; and for the hepatic duct, RB1/LB1 (1 duct), RB2/LB2 (2 ducts), RB3 (3 right ducts), and RB4 (4 right ducts). Donors were classified on the basis of anatomical variations into 3 groups: class 1 and class 2 donors, who can donate liver with acceptable risks, and class 3 donors, who are high-risk donors because they are anatomically unacceptable ( Figures S1 to S4, SDC , http://links.lww.com/TP/C918 ). CONCLUSIONS Defining hilar anatomical variations and donor grouping into anatomy-based clinical classes helps in operative planning of donors, hepatobiliary surgeries, and interventional procedures.
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Affiliation(s)
- Amit Rastogi
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Ankur A Gupta
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Tarun Piplani
- Division of Liver and GI Radiology, Institute of Radiology, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Kamal S Yadav
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Fysal K V
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Prashant Bhangui
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
| | - Arvinder S Soin
- Division of Liver Transplantation and HPB (Hepato-Pancreato-Biliary) Surgery, Institute of Liver Transplantation, Medanta, Gurugram (Delhi NCR), Haryana, India
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11
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Keshelava G, Gogichaishvili L, Gogorishvili I. Transarterial chemoembolization in a patient with the replaced right hepatic and left gastric arteries arising from the abdominal aorta: a new anatomical variation. Surg Radiol Anat 2024; 46:231-233. [PMID: 38238595 DOI: 10.1007/s00276-023-03296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/27/2023] [Indexed: 02/15/2024]
Abstract
PURPOSE Knowing the anatomical variation of the coeliac trunk (CT) and its detailed interpretation in the preoperative period is important for the prevention of iatrogenic injury during liver surgery or endovascular intervention on the coeliac trunk and its branches. METHODS A diagnostic abdominal computed tomography angiography (CTA) was performed in a 61-year-old male patient, who was investigated for a liver cancer and chemoembolization was planned. RESULTS CTA reveals that right hepatic artery (RHA) arises directly from the abdominal aorta, at the level of CT. This vessel coursing to the right hepatic lobe, functioning therefore as a replaced right hepatic artery (RRHA). Also, the left gastric artery (LGA) arises directly from the abdominal aorta. This patient successfully underwent chemoembolization from RRHA. CONCLUSION We presented a case of new anatomical variation involving the origination of RRHA and LGA from the abdominal aorta.
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Affiliation(s)
- Grigol Keshelava
- Department of Vascular Surgery, Clinic "Healthycore", Tevdore Mgvdeli St. 13, 0121, Tbilisi, Georgia.
| | - Levan Gogichaishvili
- Department of Visceral Surgery, Geo Hospitals Tbilisi Multiprofile Medical Center, Tbilisi, Georgia
| | - Irakli Gogorishvili
- Department of Interventional Cardiology, Clinic "Healthycore", Tbilisi, Georgia
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12
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de Jesus Cruz J, Bernardeco J, Rijo C, Cohen A, Serrano F. Hepatic arterial buffer response: activation in donor fetuses and the effect of laser ablation of intertwin anastomosis. J Perinat Med 2024; 52:71-75. [PMID: 37850825 DOI: 10.1515/jpm-2023-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Hepatic arterial buffer response (HABR) is an important defence mechanism for maintaining liver blood flow. It is suspected that HABR is active in monochorionic diamniotic twins (MCDA) with twin-to-twin transfusion syndrome (TTTS) where donor compensates a setting of volume depletion and the recipient an overload. The present study investigates whether in TTTS, HABR is active in donor and/or recipient individually and try to determine if the activation of HABR is a direct response to TTTS. METHODS Hepatic artery (HA) peak systolic velocity (PSV) was measured in normal MCDA fetuses and TTTS. Correlation with relevant fetal Dopplers and characteristics were determined. Z-scores for HA-PSV (HAV-Z) were calculated and its association with TTTS in donors and recipients were determined as well as changes in HAV-Z after laser treatment. RESULTS In this study 118 MCDA were included, 61.9 % normal and 38.1 % TTTS. Of the TTTS 22 required laser treatment. A total of 382 scans were performed in normal group and 155 in TTTS. Our data demonstrates that in donors HAV-Z was 2.4 Z-scores higher compared to normal fetuses (β=2.429 95 % CI 1.887, 2.971; p<0.001) and after laser treatment HAV-Z reduced (β=-1.829 95 % CI -2.593, -1.064; p<0.001). There was no significant difference between recipients and normal (β=-0.092 95 % CI -0.633, 0.449; p=0.738). CONCLUSIONS HABR is active in TTTS, promoting an increased hepatic blood flow in donors. The activation is direct response to TTTS as shown by the reduction in HAV-Z after laser. This finding provides important insights into the pathophysiology of TTTS.
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Affiliation(s)
- Jader de Jesus Cruz
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Joana Bernardeco
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Claudia Rijo
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Alvaro Cohen
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Fatima Serrano
- Department of Obstetrics, Central Lisbon University Hospitals, Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
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13
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Ge Z, Wang K, Zhang Z, Zhang X, Sun P, Chen N, Tan Y, Shen T, Dai H, Li W. Successful treatment of refractory ascites in a patient with liver cirrhosis combined with hepatic artery-portal vein malformation: A case report. Medicine (Baltimore) 2024; 103:e36886. [PMID: 38277566 PMCID: PMC10817139 DOI: 10.1097/md.0000000000036886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/18/2023] [Indexed: 01/28/2024] Open
Abstract
INTRODUCTION Hepatic artery-portal vein malformation is rarely encountered in clinical practice. Here, we reported a case of liver cirrhosis combined with hepatic artery-portal vein malformation with refractory ascites as the main symptom. And it was successfully treated by us. The present case demonstrates the role of hepatic artery-portal vein malformation in cirrhotic ascites and the importance of early diagnosis and interventional treatment. This article may provides some experience for the treatment of such patients. PATIENT CONCERNS The patient was a 72-year-old woman with a 40-year history of Hepatitis B virus surface antigen positivity who sought medical advice with a chief complaint of abdominal distension for 1 week. DIAGNOSES Enhanced abdominal computed tomography imaging of this patient revealed liver cirrhosis, splenomegaly, esophageal and gastric varices, massive ascites, and a low-density area in the S4 segment of the liver with an ambiguous boundary. Widening of the left branch of the portal vein was evident, and the portal vein was highlighted in the arterial phase and the venous phase. Digital subtraction angiography revealed substantial thickening of the left hepatic artery, and the administered contrast agent drained through the malformed vascular mass to the thickened left portal vein. Liver cirrhosis combined with hepatic artery-portal vein malformation were diagnosed. And we considered that the artery-portal vein malformation in this patient might be caused by cirrhosis. INTERVENTIONS The patient was applied diuretics, entecavir and transcatheter embolization. OUTCOMES The patient ascites did not resolve significantly when treated with diuretics alone. After the transcatheter embolization, the patient ascites relieved remarkably. CONCLUSION The patient underwent transcatheter embolization for hepatic artery-portal vein malformation, after which her ascites resolved with good short-term curative efficacy. So, the patients who suffered from liver cirrhosis combined with hepatic artery-portal vein malformation and refractory ascites, should be active on transcatheter embolization.
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Affiliation(s)
- Zhenyu Ge
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Kai Wang
- Department Vascular intervention, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Zhaomei Zhang
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Xiaoqian Zhang
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Peng Sun
- Department Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Ning Chen
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Yang Tan
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Tingting Shen
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Hongsheng Dai
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Wenwen Li
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
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14
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Lazzarotto-da-Silva G, Santos LM, Lucena IRS, Rabolini BB, Hallal CP, Feier FH, Grezzana-Filho TJM, Chedid MF, Leipnitz I, Chedid AD, de Araujo A, Alvares-da-Silva MR, Kruel CRP. Celiac trunk stenosis by median arcuate ligament in orthotopic liver transplantation: a potential hidden foe to the biliary tree. HPB (Oxford) 2024; 26:137-144. [PMID: 37722997 DOI: 10.1016/j.hpb.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Celiac trunk compression by the median arcuate ligament (MAL) increases the risk of ischemic complications following gastrointestinal surgical procedures. Previous studies suggest increased risk of hepatic artery thrombosis (HAT) in orthotopic liver transplant (OLT) recipients. The aim of this study is to investigate the impact of untreated MAL compression (MAL-C) on biliary complications in OLT. METHODS Contrast-enhanced imaging was used to classify celiac trunk stenosis by MAL-C. Medical records were reviewed to extract pre-transplant, transplant and post-transplant data. Patients were divided into two groups: no MAL compression (nMAL-C) and MAL-C. The primary endpoint was biliary complications. Secondary endpoints were HAT and graft survival. RESULTS 305 OLT were performed from 2010 to 2021, of which 219 were included for analysis: 185 (84.5%) patients without and 34 (15.5%) with MAL-C. The incidence of HAT was 5.9% in both groups. Biliary complications were more common in the MAL-C group (35.3% vs. 17.8%, p = 0.035). Graft survival was decreased in patients with MAL-C (p = 0.035). CONCLUSIONS MAL-C of the celiac trunk was associated with increased risk of biliary complications and inferior graft survival in OLT patients. These findings highlight the importance of preoperative screening and treatment of MAL in this population.
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Affiliation(s)
| | | | - Iara R S Lucena
- Radiology Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | - Bruno B Rabolini
- Post-Graduate Program in Surgical Sciences, Medical School of UFRGS, Brazil
| | - Celina P Hallal
- Post-Graduate Program in Surgical Sciences, Medical School of UFRGS, Brazil
| | - Flavia H Feier
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | | | - Marcio F Chedid
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | - Ian Leipnitz
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | - Aljamir D Chedid
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | - Alexandre de Araujo
- Gastroenterology and Hepatology Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | | | - Cleber R P Kruel
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
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15
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Masuya R, Nakame K, Kai K, Tsuchimochi Y, Hamada T, Imamura N, Hiyoshi M, Nanashima A, Ieiri S. An unusual presentation of a rare formation of the common hepatic duct and right hepatic artery in a case of pediatric congenital biliary dilatation. Asian J Endosc Surg 2024; 17:e13264. [PMID: 37990363 DOI: 10.1111/ases.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
A 15-year-old girl with recurrent upper abdominal pain was diagnosed with congenital biliary dilatation. Abdominal enhanced computed tomography (CT) showed the anterior segmental branch of the right hepatic artery (RHA) running across the ventral aspect of the dilated common hepatic duct (CHD). Laparoscopic extrahepatic dilated biliary duct excision and Roux-en-Y hepaticojejunostomy were planned. Intraoperatively, the dilated CHD was observed to bifurcate into the ventral and dorsal ducts, between which the anterior segmental branch of the RHA crossed through the CHD. The CHD rejoined on the distal side as one duct. We transected the CHD just above the cystic duct. The patency of the ventral and dorsal sides of the bifurcated CHD was confirmed. Laparoscopic hepaticojejunostomy was performed at the distal side of the rejoined CHD, without sacrificing the anterior segmental branch of the RHA. There was no postoperative blood flow impairment in the right hepatic lobe or anastomotic stenosis.
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Affiliation(s)
- Ryuta Masuya
- Division of the Gastrointestinal, Endocrine and Pediatric Surgery, Faculty of Medicine, Department of Surgery, University of Miyazaki, Miyazaki, Japan
| | - Kazuhiko Nakame
- Division of the Gastrointestinal, Endocrine and Pediatric Surgery, Faculty of Medicine, Department of Surgery, University of Miyazaki, Miyazaki, Japan
| | - Kengo Kai
- Division of Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, Department of Surgery, University of Miyazaki, Miyazaki, Japan
| | - Yuki Tsuchimochi
- Division of Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, Department of Surgery, University of Miyazaki, Miyazaki, Japan
| | - Takeomi Hamada
- Division of Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, Department of Surgery, University of Miyazaki, Miyazaki, Japan
| | - Naoya Imamura
- Division of Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, Department of Surgery, University of Miyazaki, Miyazaki, Japan
| | - Masahide Hiyoshi
- Division of Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, Department of Surgery, University of Miyazaki, Miyazaki, Japan
| | - Atsushi Nanashima
- Division of Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, Department of Surgery, University of Miyazaki, Miyazaki, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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16
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Bonde A, Fung AW, Mayo SC, Li P, Walker BS, Jaganathan S, Mallak N, Korngold EK. Imaging of the hepatic arterial infusion pump: Primer for radiologists. Clin Imaging 2024; 105:110022. [PMID: 37992624 DOI: 10.1016/j.clinimag.2023.110022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023]
Abstract
Hepatic arterial infusion (HAI) pumps are used to deliver liver-directed therapy by allowing the administration of selective chemotherapy to the liver via a catheter implanted most commonly into the gastroduodenal artery connected to a subcutaneous pump. This selective administration helps maximize the chemotherapeutic effect within the hepatic tumors while minimizing systemic toxicity. While HAI therapy has primarily been used to treat liver-only metastatic colorectal cancer, the indications have expanded to other malignancies, including intrahepatic cholangiocarcinoma. Radiologists play an important role in pre-operative planning, assessment of treatment response, and evaluation for potential complications using various imaging studies, including computed tomography angiography, magnetic resonance imaging, and perfusion scintigraphy. This article describes the radiologist's role as part of a multi-disciplinary oncology team to help maximize the success of HAI therapy and also helps radiologists familiarize themselves with various aspects of HAI pumps.
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Affiliation(s)
- Apurva Bonde
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States of America.
| | - Alice W Fung
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Skye C Mayo
- Department of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Peter Li
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Brett S Walker
- Department of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Sriram Jaganathan
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, AR 72205, United States of America
| | - Nadine Mallak
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Elena K Korngold
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
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17
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Cizman Z, Saad W. Transplant Hepatic Artery Complications. Tech Vasc Interv Radiol 2023; 26:100923. [PMID: 38123292 DOI: 10.1016/j.tvir.2023.100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Hepatic artery complications can be divided into 2 different categories, nonocclusive and steno-occlusive disease. Steno-occlusive disease is a collective term that encompasses hepatic artery thrombosis, hepatic artery stenosis, and hepatic arterial kinks, while nonocclusive arterial disease encompasses less than 5% of complications and is a collective term used to describe arteriovenous fistulae, pseudoaneurysms, arterial rupture and nonocclusive hepatic artery hypoperfusion syndrome. This article details the angiographic techniques and definitions needed to accurately diagnose arterial transplant complications and describes the technical aspects and results of endoluminal management of these arterial complications. In addition, this article discusses the presentation, etiology and indications for treatment, including surgical management of these various complications.
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Affiliation(s)
- Ziga Cizman
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT.
| | - Wael Saad
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT
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18
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Soto Dopazo M, Díaz González MD, García Antuña E, Fernández Fernández JC. Obstructive jaundice secondary to a pseudoaneurysm in anatomical variant of the hepatic artery. Gastroenterol Hepatol 2023; 46:813-814. [PMID: 36435377 DOI: 10.1016/j.gastrohep.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Macarena Soto Dopazo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Cabueñes, Gijón, Asturias, España.
| | - María Desirée Díaz González
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - Elsa García Antuña
- Servicio de Radiodiagnóstico, Hospital Universitario de Cabueñes, Gijón, Asturias, España
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19
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Khan A, Fosby B, Labori KJ, Lanari J, Dorenberg E, Line PD. Management of Coeliac and Hepatic Artery Aneurysms: An Experience of 84 Cases. Eur J Vasc Endovasc Surg 2023; 66:814-820. [PMID: 37722651 DOI: 10.1016/j.ejvs.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 08/22/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To report outcomes following open or endovascular treatment of true hepatic and coeliac artery aneurysms at a single referral centre. METHODS This was a retrospective cohort study of consecutive patients treated for true hepatic and coeliac artery aneurysms between May 2002 and December 2021. Outcome measures included complications, graft patency, and survival rate. RESULTS Overall, 84 patients were included with a median age of 63 years (interquartile range 55, 79). The majority (76%) of the patients were men. Frequent comorbidities included a history of tobacco (69%), hypertension (65%), hyperlipidaemia (32%), and diabetes (15%). Multiple synchronous aneurysms were detected in 22 patients (26%). There were 33 (39%) symptomatic aneurysms (abdominal pain without rupture [n = 18], rupture [n = 10], and sepsis [n = 5]). Seventeen patients (20%) had mycotic aetiology. Fifty patients (60%) underwent endovascular treatment with either covered stent placement (n = 29) or coil embolisation (n = 21), and 34 patients (40%) were treated with open surgery using allogenic iliac artery (n = 15), autologous saphenous vein (n = 15), GoreTex graft (n = 2), or ligation (n = 2). The complication rate was 32% in the open group and 18% in the endovascular group (p = .048). The overall 90 day post-operative mortality rate was 1.2%, five year primary patency was 90.0%, five year survival rate was 81.2%, and mean follow up was 6.9 ± 4.2 years. CONCLUSION Endovascular treatment is the preferred approach whenever technically possible. Despite higher post-operative morbidity, an open approach with vascular reconstruction using autologous or allogenic vascular grafts yields acceptable long term results.
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Affiliation(s)
- Ammar Khan
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjarte Fosby
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut J Labori
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Jacopo Lanari
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Eric Dorenberg
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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20
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He Y, Liu N, Liu X, Liu X. Superior mesenteric artery thrombosis caused by hepatic artery anomaly: A case report. Asian J Surg 2023; 46:5820-5821. [PMID: 37673736 DOI: 10.1016/j.asjsur.2023.08.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Yongming He
- Department of Emergency, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, 518110, China
| | - Naibo Liu
- Department of Emergency, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, 518110, China
| | - Xiaoti Liu
- Department of Emergency, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, 518110, China
| | - Xing Liu
- Department of Emergency, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, 518110, China.
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21
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Minciuna I, den Hoed C, van der Meer AJ, Sonneveld MJ, Sprengers D, de Knegt RJ, de Jonge J, Maan R, Polak WG, Darwish Murad S. The Yield of Routine Post-Operative Doppler Ultrasound to Detect Early Post-Liver Transplantation Vascular Complications. Transpl Int 2023; 36:11611. [PMID: 38093807 PMCID: PMC10716223 DOI: 10.3389/ti.2023.11611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023]
Abstract
Early detection of liver transplantation (LT) vascular complications enables timely management. Our aim was to assess if routine Doppler ultrasound (rDUS) improves the detection of hepatic artery thrombosis (HAT), portal vein thrombosis (PVT) and hepatic venous outflow obstruction (HVOO). We retrospectively analysed timing and outcomes, number needed to diagnose one complication (NND) and positive predictive value (PPV) of rDUS on post-operative day (POD) 0,1 and 7 in 708 adult patients who underwent primary LT between 2010-2022. We showed that HAT developed in 7.1%, PVT in 8.2% and HVOO in 3.1% of patients. Most early complications were diagnosed on POD 0 (26.9%), 1 (17.3%) and 5 (17.3%). rDUS correctly detected 21 out of 26 vascular events during the protocol days. PPV of rDUS was 53.8%, detection rate 1.1% and NND was 90.5. Median time to diagnosis was 4 days for HAT and 47 days for PVT and 21 days for HVOO. After intervention, liver grafts were preserved in 57.1%. In conclusion, rDUS protocol helps to detect first week's vascular events, but with low PPV and a high number of ultrasounds needed.
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Affiliation(s)
- Iulia Minciuna
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
- Department V- Gastroenterology, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Cluj-Napoca, Romania
| | - Caroline den Hoed
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Adriaan J. van der Meer
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Milan J. Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dave Sprengers
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert J. de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jeroen de Jonge
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wojciech G. Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
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22
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Hien PN, Chun HJ, Oh JS, Kim SH, Choi BG. Usefulness of tumor perfusion on cone-beam CT after hepatic arterial infusion port implantation for evaluating tumor response to hepatic arterial infusion chemotherapy in hepatocellular carcinoma treatment. Diagn Interv Radiol 2023; 29:832-837. [PMID: 37695260 PMCID: PMC10679554 DOI: 10.4274/dir.2023.232311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE To compare tumor perfusion on cone-beam computed tomography (CBCT) after hepatic artery infusion port implantation with the tumor response to hepatic arterial infusion chemotherapy (HAIC) in patients with hepatocellular carcinoma (HCC). METHODS This retrospective study was conducted in patients with advanced HCC treated with HAIC from 2015 to 2020. We performed CBCT with contrast injection via a port on the day following implantation. We classified tumor perfusion on CBCT into three groups: hyperperfusion, isoperfusion, and hypoperfusion. We also evaluated tumor response to HAIC on follow-up images using RECIST 1.1 and compared it with tumor perfusion on CBCT. RESULTS This study included 206 tumors in 193 patients (mean: 60.5 years) with HCC. There were 100 hyperperfusion tumors (48.5%), 92 isoperfusion tumors (44.7%), and 14 hypoperfusion tumors (6.8%). The tumor response to HAIC included 10 tumors with a complete response (CR) (4.9%), 66 tumors with a partial response (32%), 60 tumors with stable disease (29.1%), and 70 tumors with progressive disease (34%). Hyperperfusion tumors had a 65% objective response rate (ORR) and a 92% disease control rate (DCR). Isoperfusion tumors had a 12% ORR and a 46.8% DCR, while hypoperfusion tumors had a 0% ORR and a 7.1% DCR. A CR was shown only in hyperperfusion tumors. The ORR and DCR of the three groups were different, with statistical significance (P < 0.001). CONCLUSION Hyperperfusion tumors on CBCT showed a better tumor response to HAIC, with a 65% ORR in patients with HCC. Tumor perfusion on CBCT after implantation of the hepatic arterial infusion port was associated with the tumor response to HAIC.
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Affiliation(s)
- Phan Nhan Hien
- Department of Radiology, Seoul St. Mary’s Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Jong Chun
- Department of Radiology, Seoul St. Mary’s Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary’s Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Ho Kim
- Department of Radiology, Seoul St. Mary’s Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung Gil Choi
- Department of Radiology, Seoul St. Mary’s Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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23
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Songtanin B, Brittan K, Sanchez S, Le M, Schmidt C, Ingviya T, Manatsathit W. Diagnostic performance of contrast-enhanced ultrasound in diagnosing hepatic artery occlusion after liver transplantation: A systematic review and meta-analysis. Clin Transplant 2023; 37:e15070. [PMID: 37398993 DOI: 10.1111/ctr.15070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/03/2023] [Accepted: 06/25/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Hepatic artery occlusion (HAO) is a significant complication post-liver transplantation. Doppler ultrasound (DUS) has been widely used as an initial screening test for detecting HAO; however, its performance is often not sufficient. Although other diagnostic tests such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), and angiogram are more accurate, they are invasive and have several limitations. Contrast-enhanced ultrasound (CEUS) is an emerging tool for detecting HAO; however, the results from previous studies were limited due to a small number of patients. Therefore, we aimed to evaluate its performance by performing a meta-analysis. METHOD We performed a systemic review and meta-analysis of studies evaluating the performance of CEUS for the detection of HAO in an adult population. A literature search of EMBASE, Scopus, CINAHL, and Medline was conducted through March 2022. Pooled sensitivity, specificity, log diagnostic odd ratio (LDOR), and area under summary receiver operating curve (AUC) were calculated. Publication bias was assessed by Deeks' funnel plot. RESULT Eight studies were included, with 434 CEUS performed. Using a combination of CTA, MRA, angiography, clinical follow-up, and surgery as the gold standard, the sensitivity, specificity, and LDOR of CEUS for detection of HAO were .969 (.938, .996), .991 (.981, 1.001), and 5.732 (4.539, 6.926), respectively. AUC was .959. The heterogeneity between studies appeared universally low, and no significant publication bias was found (p = .44). CONCLUSION CEUS appeared to have an excellent performance for the detection of HAO and could be considered as an alternative when DUS is non-diagnostic or when CTA, MRA, and angiogram are not feasible.
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Affiliation(s)
- Busara Songtanin
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Kevin Brittan
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sebastian Sanchez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Michelle Le
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Cynthia Schmidt
- McGoogan Library of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Thammasin Ingviya
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Medical Data Center for Research and Innovation, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wuttiporn Manatsathit
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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24
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Alagappan A, Sahoo B, Prakash JH, Panigrahi MK, Tripathy T. Hepatic Vascular Variants in Hereditary Haemorrhagic Telangiectasia: Imaging findings. Sultan Qaboos Univ Med J 2023; 23:551-555. [PMID: 38090247 PMCID: PMC10712384 DOI: 10.18295/squmj.1.2023.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/18/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterised by vascular dysplasia. Hepatic vascular malformations (VMs) range from small telangiectases to significant vascular shunting. Here we report two cases of HHT. Case 1 had diffuse ectasia of the hepatic artery along its intrahepatic and extrahepatic course with a hepatic arterial aneurysm. Case 2 presented with ileal and hepatic telangiectases. Knowledge of these vascular variants is indispensable for clinicians and radiologists in aiding diagnosis and surgical and interventional management.
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Affiliation(s)
- Alamelu Alagappan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Biswajit Sahoo
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jain H. Prakash
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manas K. Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Taraprasad Tripathy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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25
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McDonald HG, Sarvestani AL, Owen JW, Rueckert J, Wierman ME, Kiseljak-Vassiliades K, Pandalai PK, Ellis CS, Patel RA, Del Rivero J, Hernandez JM, Cavnar MJ. Response of adrenocortical carcinoma liver metastases to hepatic artery infusion floxuridine. HPB (Oxford) 2023; 25:1446-1449. [PMID: 37453816 DOI: 10.1016/j.hpb.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Hannah G McDonald
- Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Amber Leila Sarvestani
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joseph W Owen
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Justin Rueckert
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Margaret E Wierman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine at Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA; Research Service Veterans Affairs Medical Center, Denver, CO, 80220, USA
| | - Katja Kiseljak-Vassiliades
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine at Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA; Research Service Veterans Affairs Medical Center, Denver, CO, 80220, USA
| | - Prakash K Pandalai
- Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Reema A Patel
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan M Hernandez
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael J Cavnar
- Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.
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26
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Marra P, Muglia R, Capodaglio CA, Dulcetta L, Carbone FS, Sansotta N, Pinelli D, Celestino A, Muscogiuri G, Bonanomi E, Fagiuoli S, D'Antiga L, Colledan M, Sironi S. Current Endovascular Management of Arterial Complications After Pediatric Liver Transplantation in a Tertiary Center. Cardiovasc Intervent Radiol 2023; 46:1610-1620. [PMID: 37831217 PMCID: PMC10616219 DOI: 10.1007/s00270-023-03557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/02/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Pediatric liver transplant surgery is burdened by arterial complications whose endovascular treatment is not standardized. We report the outcomes of a cohort of pediatric recipients with hepatic artery complications treated by endoluminal procedures. MATERIALS AND METHODS From December 2019 to December 2022, consecutive transplanted pediatric patients who underwent endovascular treatment of hepatic artery complications were reviewed. The analysis included: type of complication (occlusion, stenosis, pseudoaneurysm); onset (acute = < 15 days, subacute = 15-90 days, late = > 90 days); endovascular technique (angioplasty, stenting); complications and outcomes. Technical success was defined as the opacification of the hepatic artery at the final angiogram with < 50% residual stenosis and no pseudoaneurysms. Clinical success was defined by graft's and patient's survival. RESULTS Seventeen patients (8 males; median age 33 months, IQR 9-103) underwent 21 hepatic arteriography procedures for predominantly acute or subacute occlusions (n = 7) or stenosis (n = 11) with concurrent pseudoaneurysms (n = 4). Primary and secondary technical success was achieved in 13/18 and 3/3 procedures, respectively, with overall technical success of 76%. Angioplasty alone was successful in 5/21 procedures; stent-retriever thrombectomy was performed in one occlusion with thrombosis; stenting was required in 9/17 (53%) patients. Clinical success was obtained in 14/17 (82%) patients with hepatic artery patency after a median of 367 days (IQR 114.5-500). Clinical failure occurred in 3 permanent occlusions, with 2 deaths and 1 re-transplantation. Procedure-related complications included minor events in 3/17 (18%) patients and 1/17 (6%) death. CONCLUSION In liver transplanted children with hepatic artery complications, endovascular treatment may provide clinical success, with stenting often required in acute and subacute conditions. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Paolo Marra
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy.
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.
| | - Riccardo Muglia
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Carlo Alberto Capodaglio
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Ludovico Dulcetta
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Francesco Saverio Carbone
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Naire Sansotta
- Department of Pediatric Hepatology, Gastroenterology, Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Antonio Celestino
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Ezio Bonanomi
- Pediatric Intensive Care Unit, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Stefano Fagiuoli
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Gastroenterology, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Pediatric Hepatology, Gastroenterology, Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Michele Colledan
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
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27
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Kao CT, Teoh B, Kok HK, Hodgson R. Endovascular repair of a giant common hepatic aneurysm. BMJ Case Rep 2023; 16:e253327. [PMID: 37857536 PMCID: PMC10603437 DOI: 10.1136/bcr-2022-253327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Hepatic artery aneurysms are a rare phenomenon but their diagnosis and prompt treatment are imperative due to a high risk of mortality and complications. Appropriate management depends on patient characteristics, anatomical location of the aneurysm, operative risk and collateral arterial supply. Management options include surgical and endovascular approaches. The endovascular approach has gained popularity over recent years as it is an effective and less invasive alternative to surgical management. In this case report, we present a giant common hepatic artery aneurysm and its successful endovascular management. The patient had a complete resolution of symptoms after the procedure and remained well 8 months postprocedure.
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Affiliation(s)
- Chien-Tse Kao
- Surgery, Northern Health, Epping, Victoria, Australia
| | - Basilie Teoh
- Surgery, Northern Health, Epping, Victoria, Australia
| | - Hong Kuan Kok
- Radiology, Northern Health, Epping, Victoria, Australia
| | - Russell Hodgson
- Surgery, Northern Hospital Health Sciences Library, Epping, Victoria, Australia
- Surgery, University of Melbourne, Epping, Victoria, Australia
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28
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Velayati S, Elsakka A, Zhao K, Erinjeri JP, Marinelli B, Soliman M, Chevallier O, Ziv E, Brody LA, Sofocleous CT, Solomon SB, Harding JJ, Abou-Alfa GK, D’Angelica MI, Wei AC, Kingham PT, Jarnagin WR, Yarmohammadi H. Safety and Efficacy of Hepatic Artery Embolization in Heavily Treated Patients with Intrahepatic Cholangiocarcinoma: Analysis of Clinicopathological and Radiographic Parameters Associated with Better Overall Survival. Curr Oncol 2023; 30:9181-9191. [PMID: 37887563 PMCID: PMC10605490 DOI: 10.3390/curroncol30100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
The safety and efficacy of hepatic artery embolization (HAE) in treating intrahepatic cholangiocarcinoma (IHC) was evaluated. Initial treatment response, local tumor progression-free survival (L-PFS), and overall survival (OS) were evaluated in 34 IHC patients treated with HAE. A univariate survival analysis and a multivariate Cox proportional hazard analysis to identify independent factors were carried out. Objective response (OR) at 1-month was 79.4%. Median OS and L-PFS from the time of HAE was 13 (CI = 95%, 7.4-18.5) and 4 months (CI = 95%, 2.09-5.9), respectively. Tumor burden < 25% and increased tumor vascularity on preprocedure imaging and surgical resection prior to embolization were associated with longer OS (p < 0.05). Multivariate logistic regression analysis demonstrated that tumor burden < 25% and hypervascular tumors were independent risk factors. Mean post-HAE hospital stay was 4 days. Grade 3 complication rate was 8.5%. In heavily treated patients with IHC, after exhausting all chemotherapy and other locoregional options, HAE as a rescue treatment option appeared to be safe with a mean OS of 13 months. Tumor burden < 25%, increased target tumor vascularity on pre-procedure imaging, and OR on 1 month follow-up images were associated with better OS. Further studies with a control group are required to confirm the effectiveness of HAE in IHC.
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Affiliation(s)
- Sara Velayati
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Ahmed Elsakka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Ken Zhao
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Joseph P. Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Brett Marinelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Mohamed Soliman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Olivier Chevallier
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Etay Ziv
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Lynn A. Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Constantinos T. Sofocleous
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Stephen B. Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - James J. Harding
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.J.H.); (G.K.A.-A.)
| | - Ghassan K. Abou-Alfa
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.J.H.); (G.K.A.-A.)
| | - Michael I. D’Angelica
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.I.D.); (A.C.W.); (P.T.K.); (W.R.J.)
| | - Alice C. Wei
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.I.D.); (A.C.W.); (P.T.K.); (W.R.J.)
| | - Peter T. Kingham
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.I.D.); (A.C.W.); (P.T.K.); (W.R.J.)
| | - William R. Jarnagin
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.I.D.); (A.C.W.); (P.T.K.); (W.R.J.)
| | - Hooman Yarmohammadi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
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Shah OJ, Singh M. Delayed hemobilia due to portal vein pseudoaneurysm: a rare complication of laparoscopic cholecystectomy. ANZ J Surg 2023; 93:2511-2512. [PMID: 37095569 DOI: 10.1111/ans.18496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Omar J Shah
- GI & HPB Surgery, Sher-i-Kashmir of Medical Sciences, Srinagar, India
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Kikuchi M, Iwai T, Nishida M, Kudo Y, Omotehara S, Sato M, Sugita J, Goto H, Yokota I, Teshima T. Assessment of hepatic veno-occlusive disease/sinusoidal obstruction syndrome using different scanning approaches for the ultrasonographic evaluation of portal vein blood flow and hepatic artery resistive index in hematopoietic stem cell transplant recipients. J Med Ultrason (2001) 2023; 50:465-471. [PMID: 37402021 DOI: 10.1007/s10396-023-01335-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/15/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Sinusoidal obstruction syndrome (SOS) is a fatal complication of hematopoietic stem cell transplantation (HSCT). Previously, we established a scoring system (Hokkaido ultrasound-based scoring system-10; HokUS-10) comprising 10 ultrasound parameters for SOS diagnosis. In HokUS-10, the portal vein time-averaged flow velocity (PV TAV) and hepatic artery resistive index (HA RI) are measured using subcostal scanning. However, measurement errors and delineation difficulties occur. Therefore, we aimed to prospectively evaluate PV TAV and HA RI measurements obtained via intercostal scanning as an alternative method to subcostal scanning and determine their cutoff values. METHODS HokUS-10 was administered before and after HSCT. PV TAV and HA RI were measured on subcostal and right intercostal scans. RESULTS We performed 366 scans on 74 patients. The median value (range) of PV TAV in the main and right portal veins was 15.0 cm/s (2.2-49.6 cm/s) and 10.5 cm/s (1.6-22.0 cm/s), respectively. A low correlation was observed between the two values (r = 0.39, p < 0.01). The highest diagnostic value of the right portal vein was less than 8.0 cm/s. The median value (range) of HA RI in the proper and right hepatic arteries was 0.72 (0.52-1.00) and 0.70 (0.51-1.00), respectively. A strong correlation was observed between the two values (r = 0.65, p < 0.01). The highest diagnostic value of the right HA RI was 0.72 or higher. CONCLUSION Quantitative measurement of PV TAV and HA RI using intercostal scanning can be appropriately performed as an alternative method to using subcostal scanning.
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Affiliation(s)
- Momoka Kikuchi
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Takahito Iwai
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Department of Planning and Management, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan.
| | - Yusuke Kudo
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Satomi Omotehara
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Megumi Sato
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Junichi Sugita
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Hideki Goto
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takanori Teshima
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
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Cho MY, Sung PS, Lee SH. Multiple Hepatic Artery Pseudoaneurysms With Eosinophilia. Gastroenterology 2023; 165:843-847. [PMID: 37116831 DOI: 10.1053/j.gastro.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Mun Young Cho
- Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea; The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Sung Hak Lee
- Department of Hospital Pathology, The Catholic University of Korea, Seoul, Republic of Korea.
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Noorbakhsh S, Gomez L, Joung Y, Meyer C, Hanos DS, Freedberg M, Klingensmith N, Grant AA, Koganti D, Nguyen J, Smith RN, Sciarretta JD. Hepatic Arterioportal Fistula Following Liver Trauma: Case Series and Review of the Literature. Vasc Endovascular Surg 2023; 57:749-755. [PMID: 36940466 PMCID: PMC10724846 DOI: 10.1177/15385744231165155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
PURPOSE Hepatic arterioportal fistula (HAPF) is an uncommon complication of hepatic trauma, which can manifest with abdominal pain and the sequelae of portal hypertension months to years after injury. The purpose of this study is to present cases of HAPF from our busy urban trauma center and make recommendations for management. METHODS One hundred and twenty-seven patients with high-grade penetrating liver injuries (American Association for the Surgery of Trauma [AAST] - Grades IV-V) between January 2019 and October 2022 were retrospectively reviewed. Five patients were identified with an acute hepatic arterioportal fistula following abdominal trauma from our ACS-verified adult Level 1 trauma center. Institutional experience with overall surgical management is described and reviewed with the current literature. RESULTS Four of our patients presented in hemorrhagic shock requiring emergent operative intervention. The first patient had postoperative angiography and coil embolization of the HAPF. Patients 2 through 4 underwent damage control laparotomy with temporary abdominal closure followed by postoperative transarterial embolization with gelatin sponge particles (Gelfoam) or combined Gelfoam/n-butyl cyanoacrylate. The final patient went directly for angiography and Gelfoam embolization after identification of the HAPF. All 5 patients had resolution of HAPF on follow-up imaging with continued post management for traumatic injuries. CONCLUSION Hepatic arterioportal fistula can present as a complication of hepatic injury and manifest with significant hemodynamic aberrations. Although surgical intervention was required to achieve hemorrhage control in almost all cases, management of HAPF in the setting of high-grade liver injuries was achieved successfully with modern endovascular techniques. A multidisciplinary approach to such injuries is necessary to optimize care in the acute setting following traumatic injury.
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Affiliation(s)
- Soroosh Noorbakhsh
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Lissette Gomez
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Yoo Joung
- Grady Memorial Hospital, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Courtney Meyer
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Dustin S. Hanos
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Mari Freedberg
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Nathan Klingensmith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - April A. Grant
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Deepika Koganti
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Jonathan Nguyen
- Grady Memorial Hospital, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Randi N. Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Jason D. Sciarretta
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
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Zhu AY, Seyfi D, Sandroussi C, Abeysinghe JD. Aberrant Vascular Anatomy During Laparoscopic Cholecystectomy: A Case Report of Double Cystic Artery. CRSLS 2023; 10:e2023.00038. [PMID: 37942207 PMCID: PMC10629475 DOI: 10.4293/crsls.2023.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Introduction Laparoscopic cholecystectomy is the standard surgical procedure for the management of benign gallbladder pathology. Anatomical variation, including aberrant cystic artery, increases the risk of complications during laparoscopic cholecystectomy. Obtaining a critical view of safety is important to avoid major vascular and bile duct injury. Case description We present a case of aberrant anatomy with two cystic arteries of equal caliber in a 41-year-old female undergoing laparoscopic cholecystectomy for acute cholecystitis. Discussion This case report aims to emphasize the importance of thorough knowledge of hepatobiliary vascular anatomy, as well as variations beyond the critical view of safety, which will contribute to the safety and success of laparoscopic cholecystectomy.
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Affiliation(s)
- Alison Y Zhu
- Department of General Surgery, Canterbury Hospital, Campsie, Australia. (Drs Zhu and Abeysinghe)
| | - Doruk Seyfi
- Department of Upper Gastrointestinal Surgery, Chris O'Brien Lifehouse, Camperdown, Australia. (Drs. Seyfi and Sandroussi)
| | - Charbel Sandroussi
- Department of Upper Gastrointestinal Surgery, Chris O'Brien Lifehouse, Camperdown, Australia. (Drs. Seyfi and Sandroussi)
| | - Jayantha D Abeysinghe
- Department of General Surgery, Canterbury Hospital, Campsie, Australia. (Dr. Zhu and Mr. Abeysinghe)
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Choi R, Lee M, Choi JW, Kim HC. Safety of Radioembolization via the Cystic Artery in Patients with Hepatocellular Carcinoma and Parasitized Arterial Supply. J Vasc Interv Radiol 2023; 34:1802-1808. [PMID: 37364731 DOI: 10.1016/j.jvir.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/17/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of radioembolization through the cystic artery supplying hepatocellular carcinoma (HCC) adjacent to the gallbladder. MATERIALS AND METHODS This retrospective, single-center study included 24 patients who underwent radioembolization via the cystic artery between March 2017 and October 2022. The median tumor size was 8.3 cm (range, 3.4-20.4 cm). Twenty-two (92%) patients had Child-Pugh Class A disease, and 2 (8%) patients had Class B cirrhosis. Technical issues, adverse events, and tumor response were analyzed. RESULTS Infusion of radioactive microspheres was performed from the main cystic artery (n = 6), the deep cystic artery (n = 9), and small feeders from the cystic artery (n = 9). The cystic artery supplied the primary index tumor in 21 patients. The median radiation activity delivered via the cystic artery was 0.19 GBq (range, 0.02-0.43 GBq). The median total radiation activity administered was 4.1 GBq (range, 0.9-10.8 GBq). There was no case of symptomatic cholecystitis requiring invasive intervention. One patient experienced abdominal pain during injection of radioactive microspheres via the cystic artery. Eleven (46%) patients received pain medication during or within 2 days of the procedure. Twelve (50%) patients had gallbladder wall thickening on a 1-month follow-up computed tomography scan. Based on follow-up imaging, 23 (96%) patients showed an objective response (complete or partial response) of the tumor supplied by the cystic artery. CONCLUSION Radioembolization via the cystic artery may be safe in patients with HCC partially supplied by the cystic artery.
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Affiliation(s)
- Rebecca Choi
- Department of Radiology, the Johns Hopkins Hospital, Baltimore, Maryland
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Mostafa S, Sakai A, Irie Y, Tanaka T, Kodama Y. Ruptured Right Hepatic Artery Aneurysm after Side by Side Uncovered Metallic Stent Placement for Hilar Cholangiocarcinoma. J Gastrointestin Liver Dis 2023; 32:288. [PMID: 37774215 DOI: 10.15403/jgld-4986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/07/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Sadek Mostafa
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Internal Medicine, Al-Azhar Faculty of Medicine, Al-Azhar University, Cairo, Egypt. .
| | - Arata Sakai
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. .
| | - Yosuke Irie
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Takeshi Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
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Whitehead JF, Laeseke PF, Periyasamy S, Speidel MA, Wagner MG. In silico simulation of hepatic arteries: An open-source algorithm for efficient synthetic data generation. Med Phys 2023; 50:5505-5517. [PMID: 36950870 PMCID: PMC10517083 DOI: 10.1002/mp.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND In silico testing of novel image reconstruction and quantitative algorithms designed for interventional imaging requires realistic high-resolution modeling of arterial trees with contrast dynamics. Furthermore, data synthesis for training of deep learning algorithms requires that an arterial tree generation algorithm be computationally efficient and sufficiently random. PURPOSE The purpose of this paper is to provide a method for anatomically and physiologically motivated, computationally efficient, random hepatic arterial tree generation. METHODS The vessel generation algorithm uses a constrained constructive optimization approach with a volume minimization-based cost function. The optimization is constrained by the Couinaud liver classification system to assure a main feeding artery to each Couinaud segment. An intersection check is included to guarantee non-intersecting vasculature and cubic polynomial fits are used to optimize bifurcation angles and to generate smoothly curved segments. Furthermore, an approach to simulate contrast dynamics and respiratory and cardiac motion is also presented. RESULTS The proposed algorithm can generate a synthetic hepatic arterial tree with 40 000 branches in 11 s. The high-resolution arterial trees have realistic morphological features such as branching angles (MAD with Murray's law= 1.2 ± 1 . 2 o $ = \;1.2 \pm {1.2^o}$ ), radii (median Murray deviation= 0.08 $ = \;0.08$ ), and smoothly curved, non-intersecting vessels. Furthermore, the algorithm assures a main feeding artery to each Couinaud segment and is random (variability = 0.98 ± 0.01). CONCLUSIONS This method facilitates the generation of large datasets of high-resolution, unique hepatic angiograms for the training of deep learning algorithms and initial testing of novel 3D reconstruction and quantitative algorithms designed for interventional imaging.
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Affiliation(s)
- Joseph F. Whitehead
- Department of Medical Physics, University of Wisconsin – Madison, Madison, WI 53705, USA
| | - Paul F. Laeseke
- Department of Radiology, University of Wisconsin – Madison, Madison, WI 53792, USA
| | - Sarvesh Periyasamy
- Department of Radiology, University of Wisconsin – Madison, Madison, WI 53792, USA
| | - Michael A. Speidel
- Department of Medical Physics, University of Wisconsin – Madison, Madison, WI 53705, USA
- Department of Medicine, University of Wisconsin – Madison, Madison WI 53705, USA
| | - Martin G. Wagner
- Department of Medical Physics, University of Wisconsin – Madison, Madison, WI 53705, USA
- Department of Radiology, University of Wisconsin – Madison, Madison, WI 53792, USA
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Esgueva Angulo M, Perfecto Valero A, Prieto Calvo M, Ventoso Castiñeira A, Valdivieso López A. Right hepatic artery pseudoaneurysm due to cholecystitis. Cir Esp 2023; 101:650-653. [PMID: 36265773 DOI: 10.1016/j.cireng.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Marina Esgueva Angulo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Cruces, Instituto de Investigación Sanitaria BioCruces, Bizkaia, Spain.
| | - Arkaitz Perfecto Valero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Cruces, Instituto de Investigación Sanitaria BioCruces, Bizkaia, Spain; Unidad de Cirugía Hepatobiliar y Trasplante Hepático
| | - Mikel Prieto Calvo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Cruces, Instituto de Investigación Sanitaria BioCruces, Bizkaia, Spain; Unidad de Cirugía Hepatobiliar y Trasplante Hepático; Universidad del País Vasco, Bizkaia, Spain
| | - Alberto Ventoso Castiñeira
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Cruces, Instituto de Investigación Sanitaria BioCruces, Bizkaia, Spain; Unidad de Cirugía Hepatobiliar y Trasplante Hepático
| | - Andrés Valdivieso López
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Cruces, Instituto de Investigación Sanitaria BioCruces, Bizkaia, Spain; Unidad de Cirugía Hepatobiliar y Trasplante Hepático; Universidad del País Vasco, Bizkaia, Spain
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Panpikoon T, Treesit T, Bua-Ngam C, Feinggumloon S, Pichitpichatkul K, Sriprachyakul A, Aimprasittichai S, Chimcherd A, Thirapattaraphan C, Lertudomphonwanit C, Tanpowpong P. Early postoperative duplex ultrasound findings of the hepatic artery in postoperative vascular complications from paediatric liver transplantation. J Ultrasound 2023; 26:703-710. [PMID: 36264540 PMCID: PMC10468478 DOI: 10.1007/s40477-022-00738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/28/2022] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate duplex US findings of the HA in all three postoperative vascular (HA, PV, HV and IVC) complications of paediatric LT for early detection and some helpful secondary signs to determine these vascular complications. MATERIALS AND METHODS We collected data from 44 post-LT paediatric patients who underwent daily duplex US for seven consecutive days and three months after LT during January 2017-June 2020. Four duplex US parameters of the HA (extrahepatic PSV, intrahepatic PSV, RI and AT) were compared in patients with and without complications. RESULTS The PSV of the extrahepatic HA in patients with HA complications was higher than that in patients without complications (P value = 0.019). The PSV at 107.7 cm/s is the optimal cut-off parameter associated with HA complications [a sensitivity of 88.9% and a specificity of 80.0% (ROC area is 0.84)]. The intrahepatic RI was higher on the first day than on the last day and gradually decreased in patients without vascular complications (P value = 0.000). The intrahepatic PSV significantly decreased with time when comparing the first and last days in patients without PV and HV-IVC complications (P value = 0.014 and 0.038). In contrast, patients with vascular complications showed no significant decrease. CONCLUSION The extrahepatic PSV relates to HA complications after paediatric LT but not PV and HV-IVC complications. Non-significantly decreased intrahepatic RI and PSV from the first day to the day of complication diagnosis may correlate with the occurrence of vascular complications.
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Affiliation(s)
- Tanapong Panpikoon
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Tharintorn Treesit
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Chinnarat Bua-Ngam
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Sasikorn Feinggumloon
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Kaewpitcha Pichitpichatkul
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Apichaya Sriprachyakul
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Satita Aimprasittichai
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Apinya Chimcherd
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Chollasak Thirapattaraphan
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Chatmanee Lertudomphonwanit
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Pornthep Tanpowpong
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd. Phyathai, Ratchathewi, Bangkok, 10400, Thailand
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Sequeira C, Santos I, Lopes S, Carvalheiro V, Mangualde J, Oliveira AP. Gastroduodenal artery pseudoaneurysm presenting with hyperamylasemia. Rev Esp Enferm Dig 2023; 115:535-536. [PMID: 36537340 DOI: 10.17235/reed.2022.9407/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
We present the case of a 75-year-old male admitted due to severe epigastric pain. His medical history was remarkable for chronic alcohol abuse, diabetes mellitus type 2, arterial hypertension, dyslipidemia. At admission he was hemodynamically stable. The initial workup showed elevated amylase, and the abdominal ultrasound excluded gallstone disease, so the diagnosis of acute pancreatitis was assumed. Despite appropriate fluid therapy, the patient developed hemodynamic instability. No signs of GIB were detected. An urgent laboratory workup revealed a new onset anemia and liver tests, including hyperbilirrubinemia. He underwent an urgent abdominal computed tomography with contrast, which showed a bleeding gastroduodenal artery (pseudoaneurysm and a hematoma adjacent to the second part of the duodenum. The patient underwent coil embolization achieving hemostasis without complications. GAD (pseudo)aneurysm is rare, accounting for 1.5% of all visceral artery aneurysms. Our patient presented with elevated pancreatic and liver enzymes, a more unique and challenging presentation since another more common differential diagnosis should be considered. The aneurysm can cause extrinsic common bile duct and main pancreatic duct pressure, which could explain the raised liver tests. Gastroenterologists should be aware of this rare and life-threatening entity, especially among patients presenting with common findings such as elevated amylase, jaundice, or altered liver tests. Hemodynamic instability is the main clue unmasking this diagnosis.
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Affiliation(s)
| | - Inês Santos
- Gastroenterology , Centro Hospitalar de Setúbal
| | - Sara Lopes
- Gastroenterology, Centro Hospitalar de Setúbal
| | - Vitor Carvalheiro
- Interventional Radiology , Centro Hospitalar Universitário de Coimbra
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Kim SH, Chun HJ, Kim Y, Oh JS, Choi BG, Lee HG. Impact of aortoceliac angle in implantation of subcutaneous hepatic artery port-catheter system for hepatic arterial infusion chemotherapy via femoral approach. Acta Radiol 2023; 64:2667-2672. [PMID: 37337646 DOI: 10.1177/02841851231181321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND In patients with an acute aortoceliac angle, the diagnostic catheter often fails to enter the common hepatic artery. PURPOSE To retrospectively evaluate the impact of aortoceliac angle on the implantation of a port-catheter system via a femoral approach for hepatic arterial infusion chemotherapy (HAIC) in patients with advanced hepatocellular carcinoma (HCC). MATERIAL AND METHODS A total of 399 patients with advanced HCC underwent percutaneous implantation of a port-catheter system for HAIC. Among these patients, 383 underwent successful implantation via a femoral artery approach (success group). In 16 patients, port-catheter systems were implanted via a subclavian artery approach (failure group) after failure of the initial attempt via the femoral artery due to failed catheter tip fixation to the gastroduodenal artery. We statistically analyzed aortoceliac angle, ostial celiac stenosis, sex, age, weight, height, and body mass index (BMI) between groups. RESULTS The average aortoceliac angle, weight, and BMI were significantly different between the two groups (P < 0.001, P = 0.02, P < 0.001, respectively). Among them, only the aortoceliac angle was a significant risk factor in logistic regression analysis. The smaller the aortoceliac angle, the more often the femoral approach failed (P < 0.001, odds ratio = 0.817, 95% confidence interval = 0.752-0.887). There were no significant differences in ostial celiac stenosis, sex, or age between the two groups (P = 0.549, 0.056, 0.173, and 0.773, respectively). CONCLUSION For patients with an acute aortoceliac angle, the femoral approach is likely to fail. A subclavian artery approach should be preferentially considered for percutaneous implantation of a port-catheter system in such patients.
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Affiliation(s)
- Su Ho Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
| | - Ho Jong Chun
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
| | - Youdong Kim
- Vascular Center, MINT Intervention Hospital, Songpa-gu, Seoul, Republic of Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
| | - Byung Gil Choi
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
| | - Hae Giu Lee
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
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Qi X, Tamizuddin S, Gisi B, Lee P. Multiple liver abscesses secondary to Listeria monocytogenes complicated by hepatic artery mycotic aneurysm. BMJ Case Rep 2023; 16:e256328. [PMID: 37640412 PMCID: PMC10462936 DOI: 10.1136/bcr-2023-256328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
A woman in her 50s presented to the emergency department with 5 days of abdominal pain, nausea and vomiting. CT imaging of her liver demonstrated three enhancing, cystic lesions in her hepatic parenchyma and a large enhancing lesion in her porta hepatis concerning for a hepatic artery aneurysm. Radiographic-guided drainage was performed on two accessible liver abscesses, and cultures from this drainage grew Listeria monocytogenes Serial imaging of the aneurysm demonstrated that the aneurysm spontaneously thrombosed and did not require further intervention. She was subsequently discharged on intravenous ampicillin with a plan to continue until radiographic resolution of the abscesses.
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Affiliation(s)
- Xin Qi
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sara Tamizuddin
- Infectious Disease, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Brandon Gisi
- Radiology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Pamela Lee
- Infectious Disease, Harbor-UCLA Medical Center, Torrance, California, USA
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Khalid A, Saleem MA, Ihsan-Ul-Haq, Khan Y, Rashid S, Dar FS. Anatomical variations in living donors for liver transplantation-prevalence and relationship. Langenbecks Arch Surg 2023; 408:323. [PMID: 37597008 DOI: 10.1007/s00423-023-03066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Living donor liver transplantation (LDLT) is a widely accepted option to address the lack of a deceased liver program for transplantation. Understanding vascular and biliary anatomy and their variants is crucial for successful and safe graft harvesting. Anatomic variations are common, particularly in the right hepatic lobe. To provide evidence for screening potential liver transplant donors, the presence of vascular and biliary anatomic variations in Pakistan's preoperative assessment of transplantation donor candidates was explored. METHODS This retrospective cross-sectional study evaluated the hepatic artery, portal vein, hepatic vein, and biliary variations in living liver donors. The study included 400 living liver donors; data were collected from March 2019 to March 2023. We used a CT scan and MRCP to assess the anatomical variations. RESULTS The study examined 400 liver donors aged 18 to 53 years. Conventional arterial anatomy was the most common (65.8%), followed by replaced right hepatic artery (16%) and replaced left hepatic artery (10.8%). Conventional type 1 biliary anatomy was seen in 65.8% of cases. The dominant right hepatic vein was found in 13.3% of donors. There was a significant association between the prevalence of variant portal venous anatomy with variant biliary anatomy. CONCLUSION Variations of the hepatic arterial, portal venous, and biliary systems are frequent and should be carefully evaluated while selecting a suitable living donor. A strong relationship between variant portal venous and biliary anatomy was found. These findings can aid in selecting suitable candidates and improving surgical planning for liver transplantation.
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Affiliation(s)
- Abdullah Khalid
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan.
| | - M Asad Saleem
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Ihsan-Ul-Haq
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Yasir Khan
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Sohail Rashid
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Faisal Saud Dar
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
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Tang R, Wu GD, Li A, Yu LH, Tong X, Yan J, Lu Q. Caudate lobe-sparing subtotal hepatectomy as treatment for extensive intrahepatic arterioportal fistula. Hepatobiliary Pancreat Dis Int 2023; 22:409-411. [PMID: 35227617 DOI: 10.1016/j.hbpd.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/10/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Rui Tang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing 102218, China
| | - Guang-Dong Wu
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing 102218, China
| | - Ang Li
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing 102218, China
| | - Li-Han Yu
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing 102218, China
| | - Xuan Tong
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing 102218, China
| | - Jun Yan
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing 102218, China
| | - Qian Lu
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing 102218, China.
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Feldman K, Baraboo J, Dinakarpandian D, Chan SS. Machine Learning Algorithm Improves the Prediction of Transplant Hepatic Artery Stenosis or Occlusion: A Single-Center Study. Ultrasound Q 2023; 39:86-94. [PMID: 36103456 DOI: 10.1097/ruq.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The aim of this study was to determine if machine learning can improve the specificity of detecting transplant hepatic artery pathology over conventional quantitative measures while maintaining a high sensitivity.This study presents a retrospective review of 129 patients with transplanted hepatic arteries. We illustrate how beyond common clinical metrics such as stenosis and resistive index, a more comprehensive set of waveform data (including flow half-lives and Fourier transformed waveforms) can be integrated into machine learning models to obtain more accurate screening of stenosis and occlusion. We present a novel framework of Extremely Randomized Trees and Shapley values, we allow for explainability at the individual level.The proposed framework identified cases of clinically significant stenosis and occlusion in hepatic arteries with a state-of-the-art specificity of 65%, while maintaining sensitivity at the current standard of 94%. Moreover, through 3 case studies of correct and mispredictions, we demonstrate examples of how specific features can be elucidated to aid in interpreting driving factors in a prediction.This work demonstrated that by utilizing a more complete set of waveform data and machine learning methodologies, it is possible to reduce the rate of false-positive results in using ultrasounds to screen for transplant hepatic artery pathology compared with conventional quantitative measures. An advantage of such techniques is explainability measures at the patient level, which allow for increased radiologists' confidence in the predictions.
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Affiliation(s)
| | - Justin Baraboo
- Department of Biomedical Engineering, Northwestern University, Chicago, IL
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Chui JN, Ziaziaris WA, Mohtashami A, Lim CSH, Wong S, Mittal A, Samra JS. Open repair of an anatomically complex hepatic artery aneurysm with great saphenous vein graft. ANZ J Surg 2023; 93:704-706. [PMID: 35790066 DOI: 10.1111/ans.17899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/02/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Juanita N Chui
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - William A Ziaziaris
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ali Mohtashami
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher S H Lim
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Shen Wong
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, University of Notre Dame Australia, Sydney, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Saiga A, Yokota H, Akutsu A, Ooka Y, Kubota Y, Wada T, Koizumi J, Uno T. Prediction of common hepatic artery catheter insertion based on celiac trunk morphology. Diagn Interv Radiol 2023; 29:161-166. [PMID: 36960583 PMCID: PMC10679584 DOI: 10.5152/dir.2022.21010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 11/03/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed to predict the ability to insert a 4-5 French (Fr) catheter insertion with a guidewire into the common hepatic artery (CHA) based on celiac trunk morphology. METHODS This retrospective study included 64 patients who underwent balloon-occluded transcatheter arterial chemoembolization (n = 56), transcatheter arterial chemotherapy (n = 2), or were fitted with an implantable port system (n = 6) between June 2019 and December 2019 in our institution. The morphology of the celiac trunk was classified into three types (upward, horizontal, and downward) based on celiac angiography. The aortic-celiac trunk angle was measured on sagittal images of preprocedural contrast-enhanced computed tomography (CT). We reviewed whether a 4-5-Fr shepherd's hook catheter could advance beyond the CHA using a 0.035-inch guidewire (Radifocus® Guidewire M; Terumo). Three patients were diagnosed with median arcuate ligament syndrome (MALS) based on the characteristic hook shape of the celiac artery on sagittal images of contrast-enhanced CT. The predictive ability of celiac angiography and preprocedural CT for CHA insertion success was evaluated. In unsuccessful cases, the balloon anchor technique (BAT) was attempted as follows: (1) a 2.7/2.8-Fr microballoon catheter (Attendant Delta; Terumo) was placed beyond the proper hepatic artery, and (2) the balloon was inflated as an anchor for parent catheter advancement. RESULTS Upward, horizontal, and downward celiac trunk types were noted in 42, 9, and 13 patients, respectively. The median CT angle was 122.83° (first quartile-third quartile, 102.88°-136.55°). Insertion in the CHA using the guidewire was successful in 56 of 64 patients (87.50%), and the success rate in the downward type was significantly lower than that in the upward type [42/42 (100%) vs. 7/13 (53.85%), P < 0.001]. The CT angle was significantly larger downward in the unsuccessful group than in the successful group (121.03° vs. 140.70°, P = 0.043). Celiac angiography had a significantly higher area under the curve (AUC) than preprocedural CT (AUC = 0.91 vs. AUC = 0.72, P = 0.040). All three cases of MALS showed unsuccessful CHA insertion. In all eight patients with unsuccessful insertion, the catheter could be advanced using the BAT [8/8 (100%)]. CONCLUSION Celiac angiography and preprocedural CT could predict CHA catheter insertion using a guidewire, and celiac angiography had high predictability. CT could detect MALS, a risk factor for unsuccessful CHA insertion.
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Affiliation(s)
- Atsushi Saiga
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Hospital, Chiba, Japan
| | - Akira Akutsu
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology, Chiba University Hospital, Chiba, Japan
| | - Yoshihiro Kubota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takeshi Wada
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Jun Koizumi
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Hospital, Chiba, Japan
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Pla Sanchez F, Volo Perez G. Ruptured True Left Hepatic Artery Aneurysm After Thyroid Surgery. Eur J Vasc Endovasc Surg 2023; 65:130. [PMID: 36229015 DOI: 10.1016/j.ejvs.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/04/2022] [Accepted: 10/03/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Ferran Pla Sanchez
- Department of Angiology and Vascular Surgery, Dr Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Guido Volo Perez
- Department of Angiology and Vascular Surgery, Dr Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
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48
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Petrovsky AN, Bondarenko YS, Belova VE, Tupikin RS, Popov DA. [Hemobilia as a sign of arterio-biliary fistula]. Khirurgiia (Mosk) 2023:77-82. [PMID: 37850899 DOI: 10.17116/hirurgia202304177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Hepatic artery aneurysms (HAA) are rare (20% of all visceral arteries). Most often, HAAs are asymptomatic and detected at autopsy. However, their ruptures and/or bleeding following pressure ulcers in visceral gastrointestinal organs are a significant clinical and diagnostic problem. We present 2 patients with obstructive jaundice and hemobilia. Diagnostics revealed aneurysm of the right hepatic artery with arterio-biliary fistula. Life-threatening hemobilia is a consequence of HAA rupture into biliary system. Endovascular approach is preferable for HAA without clinical manifestations. Awareness of this disease is important for early detection and active surgical intervention before possible complications.
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Affiliation(s)
- A N Petrovsky
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - Yu S Bondarenko
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - V E Belova
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - R S Tupikin
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - D A Popov
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
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Aly AK, Yarmohammadi H, Bajwa R, Silk M, Hsu M, Moskowitz C, Santos E, Moussa AM. Stent Graft Placement for the Treatment of Hepatic Artery Injury in Patients with Cancer: Primary Patency and Clinical Outcomes. J Vasc Interv Radiol 2023; 34:79-85.e1. [PMID: 36265819 PMCID: PMC10445798 DOI: 10.1016/j.jvir.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the safety, primary patency, and clinical outcomes of hepatic artery stent graft (SG) placement for vascular injuries. MATERIALS AND METHODS Patients treated with hepatic arterial SG placement for vascular injuries between September 2018 and September 2021 were reviewed. Data on demographic characteristics, indication, stent graft characteristics, antiplatelet/anticoagulant use, clinical success rate, complications, and type of follow-up imaging were collected. Follow-up images were reviewed by 2 independent reviewers to assess primary patency. A time-to-event analysis was performed. The median duration of stent graft patency was estimated using Kaplan-Meier curves. A Cox proportional hazard model was used to evaluate factors related to stent graft patency. RESULTS Thirty-five patients were treated with hepatic arterial SG placement, 11 for postoperative bleeds and 24 for hepatic artery infusion pump catheter-related complications. Clinical success was achieved in 32 (91%) patients (95% CI, 77-98). The median primary patency was 87 days (95% CI, 73-293). Stent grafts of ≥6-mm diameter retained patency for a longer duration than that with stent grafts of smaller diameters (6 mm vs 5 mm; hazard ratio, 0.35; 95% CI, 0.14-0.88; P = .026; and 7+ mm vs 5 mm; hazard ratio, 0.27; 95% CI, 0.09-0.83; P = .023). Anticoagulation/antiplatelet regimen was not associated with increased stent graft patency duration (P > .05). Only minor complications were reported in 2 (5.7%) patients. CONCLUSIONS Stent grafts can be used safely and effectively to treat injuries of the hepatic artery. Stent graft diameters of ≥6 mm seem to provide more durable patency.
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Affiliation(s)
- Ahmed K Aly
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Hooman Yarmohammadi
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raazi Bajwa
- Division of Body Imaging, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mikhail Silk
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chaya Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ernesto Santos
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amgad M Moussa
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Min H, Yoon CJ, Lee JH, Choi WS, Yeo JB, Yoon YS, Cho JY, Lee HW, Lee JS. Covered stent placement for gastroduodenal artery stump hemorrhage after pancreaticoduodenectomy: long-term patency and risk factor of stent failure. Br J Radiol 2022; 95:20220022. [PMID: 36000821 PMCID: PMC9793492 DOI: 10.1259/bjr.20220022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate the long-term outcomes of covered stent placement in patients with gastroduodenal artery (GDA) stump hemorrhage after pancreaticoduodenectomy (PD) and to identify risk factors of stent failure. METHODS AND MATERIALS Covered stent was placed in total of 21 patients for GDA stump hemorrhage after PD from September 2012 to March 2021. Technical and clinical success, complications, and stent patency were retrospectively evaluated. Nine relevant variables were analyzed to determine risk factors for stent failure. RESULTS In 20 of 21 patients (95.2%), the GDA stump was completely excluded with covered stent placement. Immediate hemostasis was achieved in the 20 patients and rebleeding from jejunal artery occurred in one patient which was successfully embolized one day after the stent placement. There was no procedure-related complication or early mortality (<30 days). During follow-up period (median 655.5 days), stent thrombosis was found on CT in 10 patients (50.0%, 10/20) without any laboratory or CT abnormalities. One thrombosed stent migrated into the jejunum 20 months after placement. The six-month, one-year, and two-year stent patency were 81.9%, 52.9%, and 37.8%, respectively (median 620 days). The recurrence of primary malignancy was associated with stent failure (HR 5.70; 95% CI 1.18-27.76, p = 0.03). CONCLUSIONS Covered stent placement is an effective and safe management of postoperative GDA stump hemorrhage. Stent failure occurred frequently (50%) but did not cause liver ischemia. Stent failure was associated with recurrence of primary malignancy. ADVANCES IN KNOWLEDGE 1. Covered stent placement is an effective and safe management of postoperative GDA stump hemorrhage.2. Stent failure occurred frequently (50%) but did not cause liver ischemia.3. Stent failure was associated with recurrence of primary malignancy.
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Affiliation(s)
- Hooney Min
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | | | - Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Bum Yeo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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