title: Preexcisional artery reconstruction: a new strategy in multiple hepatic artery reconstruction for reducing ischemic injury of the liver.
abstract: Multiple reconstructions of the hepatic arteries (HA) after cancer resection presents a surgical challenge, not only because it is technically demanding, but also because attention must be paid to potential ischemic injury to the liver caused by the prolonged ischemia. We present a novel "preexcisional artery reconstruction" method for minimizing ischemic injury of the liver. A 65-year-old woman presented with cholangiocarcinoma invading the HA. Pancreatoduodenectomy, resection, and multiple reconstruction of the HA were performed. First, the left hepatic artery (LHA) was reconstructed prior to the tumor resection. During this procedure, blood supply was maintained to most of the liver via the right hepatic artery (RHA). Then, resection of the tumor en bloc with the HA was performed, followed by reconstruction of the RHA. During this procedure, blood supply was maintained via the already-reconstructed LHA, thereby limiting the ischemic area. Use of this method allowed the ischemia time and region to be divided and minimized, thereby leading to a reduced risk of ischemia-related complications. We believe that this method may be one of the useful approaches in multiple HA reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. tiida-tky@umin.ac.jp
authors.forename: Takuya
authors.initials: T
authors.lastname: Iida
authors.forename: Makoto
authors.initials: M
authors.lastname: Mihara
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control*; D008099:Liver / Q000098:blood supply*; D016577:Pancreaticoduodenectomy