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ID: 517 (Conflict of Interest: K)

Stand der Pfortaderarterialisation in der hepatobiliären Chirurgie – Eine systematische Übersichtsarbeit

A.Majlesara, M.Golriz, O.Ghamarnejad, A.Mehrabi
Universitätsklinikum Heidelberg, Heidelberg

Einleitung

Hepatic artery (HA) reconstruction during liver resection can be impossible due to arterial infiltration or anatomical limitations. Portal vein arterialization (PVA) is discussed to improve the hepatic oxygenation and provide a new chance for the patients with dearterialized liver. The aim of this study is to review the clinical application of PVA in hepatobiliary surgeries. 

Material und Methoden

A systematic review was performed according to the PRISMA guidelines. PubMed, Embase, and Web of Science databases were searched using the keywords: portal vein arterialization; arterioportal shunt; liver resection; hepatectomy. Experimental studies, review articles, letters, and also articles published in languages other than English were not included. 

Ergebnisse

A total of 20 studies, involving 57 patients, were included. According to the anatomical location, hilar lesions (38 patients, 70.4%) were the most common indication of the surgery. The reasons for performing PVA were excision of lesions abutting HA (32 patients, 56.1%), HA ligation (11 patients, 19.3%), HA thrombosis (six patients, 10.5%), iatrogenic injury (four patients, 7.0%), and failure of HA reconstruction (four patients, 7.0%). An end-to-side anastomosis between celiac trunk branches and portal vein (PV) is the main performing technique for PVA (35 patients, 59.3%). An anastomosis between mesenterial artery and vein (20 patients 33.9%), and also end-to-side anastomosis between the splenic artery and PV (three patients 5.1 %) are the other PVA methods. The most common complication of PVA is portal hypertension (12 of 57, 21.1%). 35 patients (61.4 %) survived during the follow-up period of 1 to 87 months in different studies. 

Schlussfolgerung

PVA may provide a chance of cure for patients with the unresectable lesions. To prevent portal hypertension and liver injuries due to thrombosis or over-arterialization, calibrating and timely closure of PVA should be considered.