Partial portal vein arterialization maintains regeneration after critical major hepatectomy: experimental study

Portal vein arterialization (PVA) is often referred to as a salvage procedure for insufficient arterial or portal inflow. Its main role focuses on two domains, liver transplantation and extensive surgery for malignancies of liver, biliary tract and pancreas. It ha been applied in treatment of fulminant hepatic failure due to intoxications and as a bridging procedure for transplantation or re-transplant. Radical resections with arterial reconstruction are a major challenge for surgeons especially in prolonging survival in advanced malignancies of the liver or biliary tract. This study revisited the benefits of this procedure to test the hypothesis of supporting a failing liver during critical period of regeneration following major hepatectomy with insufficient arterial inflow. The endpoints were to identify the histopathological and biochemical evidence of regeneration. The experimental design: 24 adult dogs of both sexes were included. They were divided into 3 groups: G1 (n = 7): animals subjected to 65% hepatectomy (control), G2 (n = 8): animals subjected to 65% hepatectomy & hepatic artery ligation, G3 (n = 8): animals subjected to 65% hepatectomy & partial portal vein arterialization (PPVA). Blood samples were taken for assessment of liver functions and blood gas analysis. Liver biopsy was assessed for morphological and histopathological changes of regeneration. Gross specimens were used to calculate the liver regeneration rate. Results showed the presence of mitotic activity and regeneration in groups with PPVA comparable to controls. No evidence of regeneration observed in G2. Shunt patency was confirmed by increase in PO2 levels of arterialized portal vein. A significant increase in the regeneration rate in groups with arterialized portal vein 1 week post procedure was noted.