Portal vein arterialization as a salvage procedure in hepatopancreatobiliary surgery: a systematic review

Portal vein arterialization as a salvage procedure in hepatopancreatobiliary surgery: a systematic review

Can J Surg 2021;64(2):E173-E182 | PDF | Appendix

Ali Majlesara, MD; Omid Ghamarnejad, MD; Elias Khajeh, MD, MPH; Mohammad Golriz, MD; Negin Gharabaghi, PhD; Katrin Hoffmann, MD; De-Hua Chang, MD; Markus W. Büchler, MD, PhD; Arianeb Mehrabi, MD, PhD

Abstract

Background: Portal vein arterialization (PVA) is a possible option when hepatic artery reconstruction is impossible during liver resection. The aim of this study was to review the literature on the clinical application of PVA in hepatopancreatobiliary (HPB) surgery.

Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the PubMed, Embase and Web of Science databases until December 2019. Experimental (animal) studies, review articles and letters were excluded.

Results: Twenty studies involving 57 patients were included. Cholangiocarcinoma was the most common indication for surgery (40 patients [74%]). An end-to-side anastomosis between a celiac trunk branch and the portal vein was the main PVA technique (35 patients [59%]). Portal hypertension was the most common longterm complication (12 patients [21%] after a mean of 4.1 mo). The median followup period was 12 (range 1–87) months. The 1-, 3- and 5-year survival rates were 64%, 27% and 20%, respectively.

Conclusion: Portal vein arterialization can be considered as a rescue option to improve the outcome in patients with acute liver de-arterialization when arterial reconstruction is not possible. To prevent portal hypertension and liver injuries due to thrombosis or overarterialization, vessel calibre adjustment and timely closure of the anastomosis should be considered. Further prospective experimental and clinical studies are needed to investigate the potential of this procedure in patients whose liver is suddenly de-arterialized during HPB procedures.

Résumé

Contexte : L’artérialisation de la veine porte (AVP) est une option envisageable lorsqu’il est impossible de reconstruire l’artère hépatique au moment d’une résection du foie. Le but de cette étude était de faire le point sur la littérature concernant l’application clinique de l’AVP en cours de chirurgie hépatopancréatobiliaire (HPB).

Méthodes : Nous avons procédé à une revue systématique selon les directives PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Nous avons interrogé systématiquement les bases de données PubMed, Embase et Web of Science jusqu’à décembre 2019. Les études expérimentales (chez l’animal), les articles de synthèse et les lettres ont été exclus.

Résultats : Vingt études regroupant 57 patients ont été incluses. Le cholangiocarcinome était la plus fréquente indication de la chirurgie (40 patients [74 %]). L’anastomose terminolatérale d’une branche du tronc cæliaque avec la veine porte a été la principale technique d’AVP (35 patients [59 %]). L’hypertension portale a été la plus fréquente complication (12 patients [21 %] après une moyenne de 4,1 mois). Le suivi médian a été de 12 mois (éventail, 1–87 mois). Les taux de survie moyens à 1, 3 et 5 ans ont été de 64 %, 27 % et 20 %, respectivement.

Conclusion : L’artérialisation de la veine porte peut être considérée comme une option de dernier ressort pour améliorer l’état des patients victimes d’une désartérialisation hépatique aiguë lorsque la reconstruction artérielle est impossible. Pour prévenir l’hypertension portale et les lésions au foie dues à la thrombose ou à l’hyperartérialisation, il faut veiller à ajuster le calibre vasculaire et fermer rapidement l’anastomose. D’autres études expérimentales et cliniques prospectives s’imposent afin d’analyser le potentiel de cette intervention chez les patients dont le foie se trouve subitement désartérialisé durant une chirurgie HPB.


Accepted Mar. 17, 2020

Affiliations: From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang).

Competing interests: None declared.

Contributors: A. Mehrabi, K. Hoffmann, D.-H. Chang and M.W. Büchler conceived the study. A. Majlesara, O. Ghamarnejad, E. Khajeh, M. Golriz and N. Gharabaghi conducted the literature search and analyzed the data. A. Majlesara, O. Ghamarnejad, E. Khajeh and N. Gharabaghi drafted the manuscript, which A. Mehrabi, M. Golriz, K. Hoffmann, D.-H. Chang and M.W. Büchler critically revised. All authors gave final approval of the article to be published.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

DOI: 10.1503/cjs.012419

Correspondence to: A. Mehrabi, Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany, arianeb.mehrabi@med.uni-heidelberg.de