title: Portal vein arterialization: a salvage procedure for a totally de-arterialized liver. The Paul Brousse Hospital experience.
abstract: BACKGROUND
  Portal vein arterialization (PVA) has been used as a salvage inflow technique when hepatic artery (HA) reconstruction is deemed impossible in liver transplantation (LT) or hepatopancreatobiliary (HPB) surgery. Outcomes and the management of possible complications have not been well described.
  
  
  METHODS
  The present study analysed outcomes in 16 patients who underwent PVA during the period from February 2005 to January 2011 for HA thrombosis post-LT (n = 7) or after liver resection (n = 1), during curative resection for locally advanced HPB cancers (requiring HA interruption) (n = 7) and for HA resection without reconstruction (n = 1). In addition, a literature review was conducted.
  
  
  RESULTS
  Nine patients were women. The median age of the patients was 58 years (range: 30-72 years). Recovery of intrahepatic arterial signals and PVA shunt patency were documented using Doppler ultrasound until the last follow-up (or until shunt thrombosis in some cases). Of five postoperative deaths, two occurred as a result of haemorrhagic shock, one as a result of liver ischaemia and one as a result of sepsis. The fifth patient died at home of unknown cause. Three patients (19%) had major bleeding related to portal hypertension (PHT). Of these, two underwent re-exploration and one underwent successful shunt embolization to control the bleeding. Four patients (25%) had early shunt thrombosis, two of whom underwent a second PVA. After a median follow-up of 13 months (range: 1-60 months), 10 patients (63%) remained alive with normal liver function and one submitted to retransplantation.
  
  
  CONCLUSIONS
  Portal vein arterialization results in acceptable rates of survival in relation to spontaneous outcomes in patients with completely de-arterialized livers. The management of complications (especially PHT) after the procedure is challenging. Portal vein arterialization may represent a salvage option or a bridge to liver retransplantation and thus may make curative resection in locally advanced HPB cancers with vascular involvement feasible.
authors: Department of Surgery, Medanta Institute of Liver Transplantation and Regenerative Medicine, Delhi, India.
authors: Prashant
authors: P
authors: Bhangui
authors: Chady
authors: C
authors: Salloum
authors: Chetana
authors: C
authors: Lim
authors: Paola
authors: P
authors: Andreani
authors: Arie
authors: A
authors: Ariche
authors: René
authors: R
authors: Adam
authors: Denis
authors: D
authors: Castaing
authors: Tech
authors: T
authors: Kerba
authors: Daniel
authors: D
authors: Azoulay
mesh_terms: D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005602:France; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D016879:Salvage Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality