title: Proper hepatic artery reconstruction with gastroduodenal artery transposition during pancreaticoduodenectomy.
abstract: BACKGROUND
  Vascular injuries to hepatic arterial blood flow present a challenge in reconstruction. The location and extent of the injury dictate intraoperative decision making, with repair being performed expeditiously to preserve hepatic function. Formal arterial repair either primarily or with interposition or transposition grafts is indicated in the majority of patients. Special consideration should be made in patients with underlying liver disease and those undergoing biliary reconstructions. This latter group of patients is at high risk of complications following the injury secondary to bile duct ischemia.
  
  
  METHODS
  A case of proper hepatic artery (PHA) transection repaired with gastroduodenal artery (GDA) transposition is presented with a relevant review of limited literature available on the subject.
  
  
  RESULTS
  During an elective pancreaticoduodenectomy the PHA was inadvertently transected just distal to the origin of the GDA. As the GDA had not been transected at this stage of the operation, it was available for transposition. This was performed, restoring arterial blood flow to the liver and the bile duct. The patient did well postoperatively with no evidence of biliary or pancreatic leak or hepatic dysfunction at both discharge and follow-up clinic visit.
  
  
  CONCLUSIONS
  Injuries to hepatic artery injury are uncommon in experienced hands. This case report is only the second instance of such injury requiring reconstruction in 434 cases of single operator experience pancreaticoduodenectomies. We present arterial transposition of GDA as a feasible method to ensure adequate arterial supply to the hepatobiliary system.
authors.affiliation: 1Hines VA Medical Center, Maywood, IL, USA.
authors.forename: Gaurav V
authors.initials: GV
authors.lastname: Kulkarni
authors.forename: Michael
authors.initials: M
authors.lastname: Malinowski
authors.forename: Richard
authors.initials: R
authors.lastname: Hershberger
authors.forename: Gerard V
authors.initials: GV
authors.lastname: Aranha
mesh_terms: D000714:Anastomosis, Surgical; D004386:Duodenum / Q000601:surgery*; D017558:Elective Surgical Procedures; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019651:Plastic Surgery Procedures; D013270:Stomach / Q000098:blood supply*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*
keywords: gastroduodenal artery transposition; hepatic artery injury; iatrogenic vascular injury