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Peter L Abt - One of the best experts on this subject based on the ideXlab platform.
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en bloc hilar dissection of the Right Hepatic Artery in continuity with the bile duct a technique to reduce biliary complications after adult living donor liver transplantation
Journal of Gastrointestinal Surgery, 2016Co-Authors: Samir Abugazala, Kim M Olthoff, David S Goldberg, Abraham Shaked, Peter L AbtAbstract:Objective Techniques that preserve the Right Hepatic Artery and the common bile duct in continuity during the dissection may be associated with lower rates of biliary complications in living-donor liver transplants. This study sought to determine whether en bloc hilar dissections were associated with fewer biliary complications in living-donor liver transplants.
Nigel Heaton - One of the best experts on this subject based on the ideXlab platform.
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use of an aberrant Right Hepatic Artery arising from the superior mesenteric Artery of the recipient for arterial reconstruction in liver transplantation
Annals of Transplantation, 2010Co-Authors: Robert P Sutcliffe, Mohamed Rela, Evangelos Lolis, Andreas Prachalias, Parthi Srinivasan, Nigel HeatonAbstract:Background Our aim was to report a single centre experience of using a recipient's aberrant Right Hepatic Artery (RHA) from the superior mesenteric Artery (SMA) to establish inflow into liver allografts. Material/methods All patients who had arterial reconstruction with an aberrant RHA were identified from a prospective database (1989-2004). Indications and outcomes were evaluated, with particular reference to arterial complications. Results An aberrant RHA was used in 27/2518 recipients (1%), including 6 paediatric recipients. Indications were replaced CHA (4), hypoplastic CHA (7), atheroma (12), previous conduit (1) and poor post-anastomotic flow (3). After a median of 42 months, arterial complications occurred in 2 paediatric recipients (Hepatic Artery thrombosis 1; arterial stenosis 1). Four patients developed anastomotic biliary strictures, and one paediatric recipient developed ischaemic cholangiopathy after Hepatic Artery thrombosis. Two patients underwent retransplantation (one patient with arterial stenosis). 1-year and 5-year patient survival rates were 85% and 81%. There were 6 deaths unrelated to vascular complications. Conclusions In adult liver transplant recipients with an unsuitable common Hepatic Artery, an aberrant Right Hepatic Artery may be used to establish arterial inflow. This technique may be associated with a higher rate of vascular complications in paediatric recipients, and should be used cautiously in this group.
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accessory Right Hepatic Artery arising from the left implications for split liver transplantation
Transplantation, 1998Co-Authors: Mohamed Rela, John Mccall, J Karani, Nigel HeatonAbstract:Background. Variant arterial anatomy must be recognized and appropriately managed during split liver transplantation to ensure complete vascular supply to both grafts. We described an accessory posterior Right Hepatic Artery, arising from the left and passing behind the portal vein bifurcation. Methods. Thirty-seven consecutive livers were examined during ex vivo liver-splitting procedures. An abnormal Right accessory Artery arising from the left Hepatic Artery was identified high in the porta hepatis. The anatomical variant is described and illustrated by methylene blue injection and arteriography. Results. The anomaly was encountered in 2 of 37 split liver procedures. The two Right lobes with the abnormal Artery were discarded. Conclusion. Care should be taken during dissection behind the portal vein bifurcation to exclude an accessory segmental Right Hepatic Artery. If present, the liver may not be suitable for splitting without compromising the Right lobe, unless the left Hepatic Artery can be divided distal to the origin of the accessory vessel.
Seyfettin Koklu - One of the best experts on this subject based on the ideXlab platform.
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unusual cause of common bile duct dilatation in asymptomatic elderly patient Right Hepatic Artery syndrome
Annals of Hepatology, 2012Co-Authors: Adnan Tas, Seyfettin KokluAbstract:Obstructive jaundice by vascular compression is extremely rare. Luttwak and Schwartz first described jaundice due to an obstruction of the common Hepatic duct by an aberrant Artery.1 Compression of extraHepatic bile duct (EBD) by Right Hepatic Artery was defined as Right Hepatic Artery syndrome. We present here a rare case of asymptomatic biliary obstruction due to compression of the common bile duct by Right Hepatic Artery. A 74-year-old female presented with slight epigastric pain. Her past medical history and physical examination were unremarkable. On laboratory examination, alkaline phosphatase, gamma-glutamyl transpeptidase, total biluribin, aspartate aminotransferase and alanine aminotransferase were normal. Ultrasonography revealed moderate dilatation of common bile duct and intraHepatic ducts. Abdominal computerized tomography (CT) showed compression from the dorsum and stenosis of the EBD by the Right Hepatic Artery, but did not reveal a mass or lymph node swelling around EBD. Proximal and distal choleduct was 9.7 mm and 6.8 mm, respectively (Figures 1A, 1B). MRCP showed a stenotic lesion at the level of the upper common Hepatic duct. Hepatic Artery was normal at CT angiography. Since she was asymptomatic, we decided on regularly follow-up in the out-patient. Compression of the EBD by the Right Hepatic Artery has been reported as a Right Hepatic Artery syndrome. Anatomic variations of biliary tract are found frequently. Among these variations, some reports have described anatomically variable vasculature of the Hepatic Artery.2 Koops represented that the finding of 604 selective angiographies showed normal anatomy of the Hepatic Artery in 79.1% and the anomalous arterial patterns in the remaining.3 Because of previous cases were symptomatic, almost all were operated.4,5 Our case was asymptomatic, hence we advice to regular follow-up as out-patient.
Surekha D Shetty - One of the best experts on this subject based on the ideXlab platform.
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Accessory Right Hepatic Artery Compensating Rudimentary Right Branch of
2015Co-Authors: Www. Ijhsr. Org Issn, Naveen Kumar, Satheesha B Nayak, Jyothsna Patil, Surekha D Shetty, Swamy Ravindra S, Ra Shetty, Anitha GuruAbstract:Replaced Right Hepatic Artery and accessory Right Hepatic Artery (ARHA) are the rare form of variant Hepatic arterial system. During routine dissection of abdominal cavity, we observed an ARHA arising from the proximal part of superior mesenteric Artery. This anomalous Artery was found to be compensating the nutritional source of the Right lobe of the liver which might have been deprived due to rudimentary Right branch of Hepatic Artery proper. In addition to this, the AHA was also supplying the gall bladder and cystic duct through its cystic branches. Presence of ARHA in addition to original Right branch of the Hepatic Artery proper may get unnoticed by the surgeons or therapeutic radiologists leading to serious complications following its iatrogenic injury. Therefore, ascertaining the presence or absence of ARHA is prerequisite before planning and executing surgical or radiological interventions in this region
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accessory Right Hepatic Artery compensating rudimentary Right branch of Hepatic Artery proper a case report
International Journal of Health Sciences and Research, 2014Co-Authors: Naveen Kumar, Ravindra S Swamy, Prakashchandra Shetty, Satheesha B Nayak, Jyothsna Patil, Surekha D Shetty, Anitha GuruAbstract:Replaced Right Hepatic Artery and accessory Right Hepatic Artery (ARHA) are the rare form of variant Hepatic arterial system. During routine dissection of abdominal cavity, we observed an ARHA arising from the proximal part of superior mesenteric Artery. This anomalous Artery was found to be compensating the nutritional source of the Right lobe of the liver which might have been deprived due to rudimentary Right branch of Hepatic Artery proper. In addition to this, the AHA was also supplying the gall bladder and cystic duct through its cystic branches. Presence of ARHA in addition to original Right branch of the Hepatic Artery proper may get unnoticed by the surgeons or therapeutic radiologists leading to serious complications following its iatrogenic injury. Therefore, ascertaining the presence or absence of ARHA is prerequisite before planning and executing surgical or radiological interventions in this region.
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hepatosplenic trunk associated with tortuous course of Right Hepatic Artery forming caterpillar hump
North American Journal of Medical Sciences, 2012Co-Authors: Satheesha Nayak Badagabettu, Naveen Kumar, Srinivasa Rao Sirasanagandla, Surekha D ShettyAbstract:Celiac trunk usually trifurcates and supplies the organs in the supracolic compartment. The vascular variations are common in this region. There are reports on the variant course of Right Hepatic Artery (RHA). The tortuous RHA forming a caterpillar hump is a rare finding and also its providing origin to gastroduodenal Artery (GDA) is an important observation. During routine dissection of abdomen of approximately 60-year-old male cadaver, concurrent arterial variations were observed. The celiac trunk bifurcated into splenic and common Hepatic arteries. The left gastric Artery arose from the abdominal aorta. The common Hepatic Artery was tortuous and divided into Right and left Hepatic arteries in front of portal vein. The RHA gave origin to GDA and then made a characteristic loop around the bile duct with the convexity to the Right side. Knowledge of arterial variations of celiac trunk and its branches is useful in planning and executing the radiological interventions and surgeries in the supracolic abdominal compartment.
Samir Abugazala - One of the best experts on this subject based on the ideXlab platform.
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en bloc hilar dissection of the Right Hepatic Artery in continuity with the bile duct a technique to reduce biliary complications after adult living donor liver transplantation
Journal of Gastrointestinal Surgery, 2016Co-Authors: Samir Abugazala, Kim M Olthoff, David S Goldberg, Abraham Shaked, Peter L AbtAbstract:Objective Techniques that preserve the Right Hepatic Artery and the common bile duct in continuity during the dissection may be associated with lower rates of biliary complications in living-donor liver transplants. This study sought to determine whether en bloc hilar dissections were associated with fewer biliary complications in living-donor liver transplants.
