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Appropriate blood flow for arterio-portal shunt in acute hypoxic liver failure
O Suzuki1, T Takahashi, H Kitagami
1Second Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Insights
Maintaining adequate liver blood flow is crucial after hepatic artery interruption. Arterio-portal shunts (APS) with flow equal to the original common hepatic artery (CHA) best prevent liver hypoxia and hepatocyte damage.
Area of Science:
- Hepatology
- Vascular Surgery
- Surgical Physiology
Background:
- Hepatic arterial interruption can cause fatal liver hypoxia if collateral circulation is absent.
- Arterio-portal shunts (APS) are a potential strategy to maintain liver perfusion.
- Determining optimal APS blood flow is critical for preventing liver ischemia.
Purpose of the Study:
- To investigate the appropriate blood flow rate for arterio-portal shunts (APS) to prevent liver hypoxia.
- To evaluate the hemodynamic, biochemical, and pathological effects of different APS blood flow rates in dogs.
Main Methods:
- Dogs underwent division of all hepatic arteries and creation of three types of APS with varying blood flow rates (half, equal, twice the original common hepatic artery (CHA) flow).
- Control group had no shunt.
- Postoperative hemodynamic, biochemical (serum alanine aminotransferase), and histopathological assessments were performed at 1 and 48 hours.
Main Results:
- APS significantly increased portal blood flow and oxygen saturation without raising portal venous pressure.
- Group II (equal CHA flow) showed significantly lower alanine aminotransferase levels compared to no-shunt and half-flow groups.
- Only Group II maintained preoperative energy charge and showed no hepatocyte degeneration.
Conclusions:
- Arterio-portal shunt (APS) blood flow equal to the original common hepatic artery (CHA) flow is optimal for preventing liver hypoxia.
- This flow rate preserves hepatocyte integrity and energy metabolism following hepatic arterial interruption.
Abstract:
Hepatic arterial interruption inevitably leads to fatal liver hypoxia when all the collateral arteries to the liver have been eradicated. To prevent such hypoxia, we aimed to determine the appropriate flow of arterial blood in the arterio-portal shunt (APS). After division of all the arteries to the liver, we created three types of APSs between the common hepatic artery (CHA) and the portal vein in dogs, using catheters which were adjusted to pass blood flows of approximately half (group I), equal to (group II) and twice (group III) the CHA blood flow before shunting, except in the control (no-shunt) group. Postoperatively, at 1 and 48 h, we examined the hemodynamics of the liver biochemically and pathologically. After shunting, portal blood flow and oxygen saturation markedly increased, whereas portal venous pressure did not rise significantly. The serum alanine aminotransferase level was significantly higher in the no-shunt group and group I than in group II. Only in group II was the preoperative energy charge maintained, and light- and electron-microscopic examinations revealed no degeneration of the hepatocytes. APS blood flow similar to the original CHA (as in group II) is most appropriate for preventing liver hypoxia.