COMMUNICATING PATHWAYS BETWEEN MAJOR HEPATIC ARTERIES. MYTH OR REALITY?

Abstract

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Background. The resources of anastomoses between major hepatic arteries are underestimated and do not used by HPB surgeons. It is supposed that this is only theoretical knowledge Aim. To show the importance of this knowledge to practical purposes Material and Methods. Analysis of 10 cases of liver survival due to communicating interlobar artery after major pancreatic and gastric resections and hepatic artery embolization, accompanied by dearterialization of one of the liver lobes. Monitoring of liver arterial supply intraoperatively was carried out by US Doppler of liver parenchyma, and after surgery - by CT angiography (CTA) and angiography. Results and Discussion. Distal pancreatectomy with celiac (CA) and gastroduodenal artery resection (Michels IV), total duodenopancreatectomy with CA resection (Michels III), pancreaticoduodenectomy with common hepatic artery resection (Michels IX), total gastrectomy with resection of right hepatic artery originated from the CA (Michels I), total duodenopancreatectomy with resection of the left hepatic and embolization of the right hepatic artery and embolysatioembolization of the right hepatic arteries for multiple gunshot injuries (Michels I) and for huge hepatocellular carcinoma (Michels I) were performed without vascular reconstructions and ischemic sequelae within short- and long- term postoperative period. Postsurgical CTAs have shown that arterial supply to the liver lobes lacking their main arteries is provided through the anastomoses between major hepatic arteries. Conclusions. The knowledge about the capability of anastomoses between major hepatic arteries allows to resect or embolise the main feeding lobar hepatic artery without reconstruction. In so doing intraoperative monitoring of blood supply must be used, which depending on circumstances can be ultrasound Doppler or angiography.