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

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.

Controlled flow reduction of an iliacoportal shunt graft for portal vein arterialization in a pediatric patient

“…Portal vein arterialization has been described as a rescue option when hepatic artery reconstruction is not possible for oncologic or technical reasons in adults [ 1 , 2 ] and in children with liver transplantation [ 4 ]. The majority of the hepatic blood supply, approximately 75%, originates from the portal vein, while the remaining blood supply is provided by the hepatic arteries, which are also the main oxygen suppliers of the biliary tract [ 2 ]. The primary goal of portal vein arterialization is to avoid biliary and liver ischemia and necrosis and, therefore, liver failure and death [ 1 ].…”

“…Portal vein arterialization is thus not a long-term solution but serves as a temporary solution until arterial hepatopetal collaterals develop. The hepatopetal collaterals form due to the enlargement of preexisting arteries [ 2 ]. Some authors recommend reevaluating arterial collaterals 4–6 weeks after the surgery and using angiography to occlude the portal vein arterialization [ 8 ].…”

“…Some authors recommend reevaluating arterial collaterals 4–6 weeks after the surgery and using angiography to occlude the portal vein arterialization [ 8 ]. While it is also recommended to close the portal vein arterialization completely if portal hypertension occurs postoperatively [ 8 ], no long time studies support this and the benefit and ideal time for portal vein arterialization closure remain uncertain [ 2 ]. We favored partial closure to maximize time for arterial collaterals to develop and thus avoid biliary and liver necrosis.…”

“…Portal vein arterialization represents a rarely performed surgical salvage technique aiming to establish hepatic and biliary blood flow [ 1 , 2 ]. The hepatic arteries are the main oxygen supplier to the biliary tract and also supply a quarter of the blood carried to the liver; thus, portal vein arterialization serves to avoid biliary and liver ischemia and necrosis [ 1 , 2 ]. Indications for portal vein arterialization are acute de-arterialization of the liver (hepatic artery injury or obstruction) and failure to reconstruct the hepatic artery [ 2 ].…”

“…The hepatic arteries are the main oxygen supplier to the biliary tract and also supply a quarter of the blood carried to the liver; thus, portal vein arterialization serves to avoid biliary and liver ischemia and necrosis [ 1 , 2 ]. Indications for portal vein arterialization are acute de-arterialization of the liver (hepatic artery injury or obstruction) and failure to reconstruct the hepatic artery [ 2 ]. Portal vein arterialization increases blood flow in the portal vein and may cause portal hypertension [ 1 ].…”