An experimental evaluation of the order of revascularization after interrupting hepatic afferent blood flow

The purpose of this study was to investigate the influence of the order of revascularization on hepatic metabolic function after interruption of hepatic afferent blood flow to reconstruct the portal vein and the hepatic artery. Hepatic ischemia was induced in male rabbits by clamping the afferent hepatic blood supply. In the cases in which portal blood flow was released after 15 min of hepatic ischemia and hepatic arterial blood flow was released 15 min later, hepatic metabolic function, which was assessed by arterial ketone body ratio, plasma lactate, and hepatic energy charge levels, recovered immediately. When hepatic arterial blood flow was released in the reverse order, the recovery of hepatic function was delayed. In the cases in which portal and hepatic arterial blood flow were released simultaneously after 30 min of hepatic ischemia, hepatic function did not recover even 180 min after reperfusion. In contrast, the venous bypass was established during portal clamping, restoration of hepatic function was accelerated, and there was no significant difference in restoration between the methods of releasing portal blood flow first or releasing hepatic arterial blood flow first. In the method of simultaneous releasing, however, it was most delayed, probably due to the prolonged ischemic time. These results suggest that releasing first the portal or hepatic arterial blood flow with the establishment of venous bypass during the portal clamping would be the best order of revascularization for hepatic function when reconstructing the portal vein and the hepatic artery.