Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer.
OBJECTIVE
To assess preliminary results of preoperative embolization of the common hepatic artery in preparation for distal pancreatectomy with en bloc resection of the celiac and common hepatic arteries for carcinoma of the body of the pancreas involving these arteries.


METHODS
Four patients underwent the embolization with coils 1-7 (median: 5) days before surgery. A detachable coil was used to obtain the best position of the first coil as an anchor in 3 patients.


RESULTS
Immediately after embolization, collateral pathways developed from the superior mesenteric artery via the pancreatoduodenal arcades to the proper hepatic and gastroduodenal arteries in all 4 patients; however, they were relatively poor in one patient. There were no complications after embolization. The pulsation of the proper hepatic and gastroduodenal arteries was well palpable during surgery, although it had been compromised sometimes in previous cases without embolization. There were no ischemia-related complications in the 2 patients who underwent radical surgery.


CONCLUSIONS
Preoperative embolization of the common hepatic artery is a safe technique and has the potential to enlarge the collateral pathways by the time of distal pancreatectomy with en bloc resection of the celiac artery and prevent postoperative fatal ischemia-related complications.
Kondo
S
S
Department of Surgery II, Hokkaido University School of Medicine, Sapporo, Japan. kondows@med.hokudai.ac.jp
Katoh
H
H
Shimizu
T
T
Omi
M
M
Hirano
S
S
Ambo
Y
Y
Okushiba
S
S
Morikawa
T
T
D000368:Aged; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011300:Preoperative Care; D015427:Reperfusion Injury / Q000517:prevention & control