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Hepatic artery injury during portacaval shunt surgery
Insights
Hepatic artery injury during portacaval shunts can lead to fatal liver necrosis. Prompt diagnosis via SGOT monitoring and arteriography is crucial for cirrhotic patients.
Area of Science:
- Vascular Surgery
- Hepatology
- Interventional Radiology
Background:
- Portacaval shunt surgery is performed for advanced liver disease.
- The proper hepatic artery is critical for liver blood supply, especially in cirrhotic livers.
Observation:
- Three patients experienced proper hepatic artery injury during portacaval shunt operations.
- Two patients developed hepatic artery occlusion, necrosis, and died within days.
- One patient had an incidental aneurysm found on postoperative angiography.
Findings:
- Hepatic artery occlusion in cirrhotic patients is often fatal due to liver dependency on arterial flow.
- Rapid SGOT increase postoperatively suggests hepatic complications.
- Arteriography can confirm hepatic artery injury and related complications.
Implications:
- Proper hepatic artery injury is a serious complication of portacaval shunt surgery.
- Early detection of hepatic artery complications is vital for patient outcomes.
- Arteriography is essential for diagnosing vascular complications post-shunt surgery.
Abstract:
The angiographic and clinical findings are presented in three patients in whom the proper hepatic artery was injured during a portacaval shunt operation. In two of the patients, hepatic artery occlusion, hepatic necrosis, and death occurred within several days. In the third, an elongated, lobular aneurysm, clearly related to the operation, was an incidental finding on a postoperative angiogram. Because of the dependency of the cirrhotic liver on hepatic artery blood flow, hepatic artery occlusion in advanced cirrhotic patients is usually fatal and may be the cause of progressive and rapid onset of the hepatic coma in the postoperative period. The complications should be suspected when the SGOT increases rapidly in the postoperative period and can be confirmed by arteriography.