title: Preoperative segmental embolization of the proper hepatic artery prior to pylorus-preserving pancreaticoduodenectomy: A case report.
abstract: BACKGROUND
  Radical resection of bile duct carcinoma may require resection of hepatic arteries. Preoperative segmental embolization of the hepatic artery for resection of hilar cholangiocarcinoma has been reported. We report a patient with bile duct carcinoma infiltrating the proper hepatic artery.
  
  
  METHODS
  A 66-year old male with jaundice was diagnosed with mid-distal bile duct carcinoma. A replaced left hepatic artery originated from the left gastric artery. Pylorus-preserving pancreaticoduodenectomy (PPPD) with combined resection of hepatic artery was planned. To promote the development of collateral blood flow after excision of the hepatic artery, preoperative segmental embolization of the proper hepatic artery was performed. The patient underwent PPPD with concurrent resection of the common hepatic, right hepatic, and middle hepatic arteries without arterial reconstruction. He received adjuvant chemotherapy with gemcitabine for six months and is alive three years after surgery without tumor recurrence.
  
  
  CONCLUSIONS
  The growth of collateral vessels after selective embolization of the proper hepatic artery has been used for hilar lesions and bile duct lesions. Resection of the hepatic artery without the need for complex arterial reconstruction, allowing a radical resection, may have contributed to this patient's relatively unremarkable recovery and long-term survival. Retroperitoneal mobilization of the pancreatic head and duodenum must be limited as important collaterals may originate in that area.
  
  
  CONCLUSIONS
  Preoperative segmental embolization of the hepatic artery before PPPD for a patient with a replaced left hepatic artery encouraged the growth of collateral blood supply, allowing radical resection including the vessels and obviated the need for arterial reconstruction.
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan. Electronic address: tcvtag@jichi.ac.jp.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Taguchi
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Sata
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kaneda
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Koizumi
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hyodo
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Department of Pathology, Jichi Medical University, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Kawata
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
keywords: Arterial resection; Bile duct carcinoma; Preoperative embolization; Pylorus-preserving pancreaticoduodenectomy; Replaced left hepatic artery