• Journal of Trauma and Injury
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• 제19권1호
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• pp.59-66
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• 2006

Purpose: Acute liver failure after massive partial hepatectomy is critical condition with high mortality. To prevent postoperative liver failure from being induced by a massive partial hepatectomy, many doctors do a minimal resection on the single lobe of the liver that might cause postoperative bleeding from the remaining ruptured parenchyma. The objective of this study was to assess clinical experience with postoperative hepatic arterial embolization to control bleeding from the remaining ruptured liver during the postoperative period. Methods: This retrospective 4-year study was conducted from May 2002 to April 2006 and included consecutive patients who had sustained massive hepatic injuries and who had undergone a laparotomy, followed by postoperative hepatic arterial angiographic embolization to control bleeding. Data on the injury characteristics, the operative treatment and embolization, and the amount of transfused packed red cells (PRBC) were gathered and analyzed. In addition, data on the overall complications and survival rate were collected and analyzed. Results: Every case showed severe liver injury, higher liver injury scaling grade IV. Only ten cases involved a ruptured bilateral liver lobe. A lobectomy was done in 6 cases, a left lobectomy was done in 3 cases, and a primary suture closure of the liver was done in 2 cases. Suture closure was also done on the remaining ruptured liver parenchyma in cases of lobectomies. The postoperative hepatic arterial embolizations were done by using the super-selection technique. There were some cases of arterio-venous malformations and anomalous vessel branches. The average amount of transfused PRBC during 24 hours after embolization was $2.36{\pm}1.75$, which statistically significantly lower than that before embolization. Among the 11 cases, 9 patients survived, and 2 died. There was no specific complications induced by the embolization. Conclusion: In cases of postoperative bleeding in severe hepatic injury, if there is still a large amount of bleeding, postoperative hepatic arterial embolization might be a good therapeutic option.

• Korean Journal of Radiology
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• 제22권7호
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• pp.1110-1123
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• 2021

Owing to improvements in surgical techniques and medical care, living-donor liver transplantation has become an established treatment modality in patients with end-stage liver disease. However, various vascular or non-vascular complications may occur during or after transplantation. Herein, we review how interventional radiologic techniques can be used to treat these complications.

• Anatomy and Cell Biology
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• 제56권2호
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• pp.276-279
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• 2023

The arterial support of the liver is most commonly from the celiac trunk via the proper hepatic artery (PHA). The PHA divides into left and right branches: the right hepatic artery (RHA) supplies the right and caudate lobes while the left hepatic artery (LHA) supplies the left and quadrate lobes. Aberrant hepatic arteries are relatively common, and the most frequent contributors are the superior mesenteric artery and left gastric artery. Herein we present findings from postmortem dissection of an abdominal cavity that revealed a rare combination of reported variations. Specifically, this subject had three extrahepatic arteries - a replaced LHA (rLHA), a PHA, and a replaced RHA (rRHA). The rLHA originated from the left gastric and the rRHA originated from the superior mesenteric artery. Knowledge of these variations is important for surgical and radiological procedures to avoid complications during treatment and improve patient outcomes.

• Journal of Gastric Cancer
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• 제21권1호
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• pp.74-83
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• 2021

Purpose: No consensus exists on whether to preserve or ligate an aberrant left hepatic artery (ALHA), which is the most commonly encountered hepatic arterial variation during gastric surgery. Therefore, we aimed to evaluate the clinical effects of ALHA ligation by analyzing the perioperative outcomes. Materials and Methods: We retrospectively reviewed the data of 5,310 patients who underwent subtotal/total gastrectomy for gastric cancer. Patients in whom the ALHA was ligated (n=486) were categorized into 2 groups according to peak aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels: moderate-to-severe (MS) elevation (≥5 times the upper limit of normal [ULN]; MS group, n=42) and no-to-mild (NM) elevation (<5 times the ULN; NM group, n=444). The groups were matched 1:3 using propensity score-matching analysis to minimize confounding factors that can affect the perioperative outcomes. Results: The mean operation time (P=0.646) and blood loss amount (P=0.937) were similar between the 2 groups. The length of hospital stay was longer in the MS group (13.0 vs. 7.8 days, P=0.022). No postoperative mortality occurred. The incidence of grade ≥ IIIa postoperative complications (19.0% vs. 5.1%, P=0.001), especially pulmonary complications (11.9% vs. 2.5%, P=0.003), was significantly higher in the MS group. This group also showed a higher Comprehensive Complication Index (29.0 vs. 13.9, P<0.001). Conclusions: Among patients with a ligated ALHA, those with peak AST/ALT ≥5 times the ULN showed worse perioperative outcomes in terms of hospital stay and severity of complications. More precise perioperative decision-making tools are needed to better determine whether to preserve or ligate an ALHA.

• Journal of Trauma and Injury
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• 제19권2호
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• pp.196-200
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• 2006

We report a case of celiac artery dissection after abdominal blunt trauma. A 29-year-old man visited the emergency room for acute left periumbilical pain after abdominal blunt trauma from his child. Computed tomography showed a wedge-shaped splenic infarction with splenic artery thrombus. He was hospitalized for careful observation, and after two days, follow-up computed tomographic angiography showed a progressed celiac artery dissection that involved common hepatic artery and an increased extent of splenic infarction. He underwent conventional angiography, and a self-expandable stent was placed between the celiac axis and the common hepatic artery. After two days, follow-up computed tomographic angiography showed good hepatic arterial blood flow via the stent and no progression of splenic infarction. After ten days, he was discharged without complications.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.454-457
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• 2006

Purpose: The anastomosis of hepatic artery to recipient vessel has a major role in a liver transplantation, so its occlusion is the most important cause of failure of liver transplantations. We made the study to reveal the peculiarities in pediatric liver transplantations compared with adult cases. Methods: From January 1999 to September 2005, we performed 99 cases of pediatric liver transplantation. The mean age at operation was 4.17 years of age. The hepatic vein and portal vein are anastomosed by the general surgeons and then the hepatic artery is anastomosed by the plastic surgeons. The Doppler ultrasonography and computed tomography were used for postoperative checkup for hepatic artery patency. Results: There were no immediate complications, but hepatic arterial occlusion was developed in 3 cases (2.8%). In pediatric patients, the anastomosis of hepatic artery is more difficult than adults because of the rapid respiratory and pulse rate, the small vascular diameter, and the large gap of diameter difference between the recipient and the donor vessels. Conclusion: We could confirm that pediatric liver transplantations are relatively safe but long learning curve was needed.

• Journal of Chest Surgery
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• 제27권6호
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• pp.435-443
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• 1994

Surgical procedures to relieve congenital right ventricular outflow tract[RVOT] obstruction of heart were performed on 125 patients from September 1985 to August 1992. There were 65 males and 60 females. Ages ranged from 7 months to 33 years with a mean age of 8 years. All the patients were divided into three main groups[I, II, III] depending on the presence or absence of cyanosis and combined anomalies. The patient were classified into two groups; A and B according to the outcome after surgical repair. Group A included the patients who had a good postoperative outcome with or without mild complications such as wound disruption, or hydrothorax. Group B included the patients who had a poor outcome including hospital death and significant postoperative complications such as heart failure, low output syndrome, respiratory failure, hepatic failure and others. And the results were summarized as follows. 1. There were no significant differences in age, body surface area and aortic dimension among the group I, II, and III, but there were significant differences among groups in pulmonary arterial dimension, ACT[aortic cross clamping time], TBT [total bypass time], preoperative and postoperative ratio of systolic pressure of right and left ventricles [pre PRV/RV and post PRV/LV], and the size of Hegar dilator which passed through the RVOT postoperatively [p<0.05]. 2. In the group A and B, there were significant differences in pulmonary arterial dimension [group A:1.6$\pm$0.5 cm, group B:1.9$\pm$0.6 cm], ACT [group A:102.3$\pm$ 46.0 minute, group B:76.1$\pm$46.1 minute], TBT [group A:133.9$\pm$56.6 minute, group B:94.9$\pm$51.9 minute], pre PRV/LV [group A:1.06$\pm$0.24, group B:0.8$\pm$0.32], post PRV/LV [group A:0.58$\pm$0.18, group B:0.43$\pm$0.16].It has been concluded that postoperative prognosis of RVOT obstruction was influenced by pulmonary arterial dimension, ACT, TBT, severity of RVOT obstruction [pre PRV/LV] and post PRV/LV.

• 대한핵의학회지
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• 제20권2호
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• pp.61-71
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• 1986

An iodized oil such as Ethiodol or Lipiodol was selectively retained in the tumor vessels of the large hepatomas as well as in the small daughter hepatomas for long periods following the intra-arterial hepatic injection of such contrast material. The specific aim of the study is to deliver a high internal radiation dose to hepatocellular carcinoma (HCC) in an attempt to control the disease. We were able to replace a small fraction of the stable iodine (I-127) of the 37% iodine in Lipiodol by the $I^{-131}$ with 100% exchange efficiency. $I^{-131}$ labeled Lipiodol was injected through the super-selected tumor feeding artery under superselection or into the proper hepatic arterial level of patients who have malignant hepatomas confirmed by aspiration cytology serum AFP and various imaging modalities. Clinical traial was performed on 43 cases during recent 6 months and follow-up observation was carried out. No severe complications or other adverse reactions were encountered until nowdays. $I^{-131}-Lipiodol$ was stable in vivo and no significant activity was noted in the thyroid, stomach, blood and urine after the injection. Only small fraction of radioisotope activity was noticed in the both side of lungs. Tumor to normal liver radio was very high. Therefore, $I^{-131}-Lipiodol$ (or P-32-Lipiodol) will be effective delivering high internal radiation dose to the tumor while delivering small radiation doses to normal tissues. Labeling, tumor dose calculation and preliminary findings will be presented.

• Journal of Trauma and Injury
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• 제26권1호
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• pp.22-25
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• 2013

Severe blunt abdominal trauma frequently involves the liver. The development of nonsurgical treatment of liver trauma has led to more frequent appearance of unusual complications. A hepatic arterioportal fistula (APF) is a rare complication of liver trauma. We present a case of traumatic APF in a patient with liver trauma. A 31-year-old male visited our emergency department with pain in the right upper abdomen following a traffic accident. Initial physical exam and abdominal computed tomography (CT) revealed liver laceration with hemoperitoneum. An abdominal CT obtained on day 11 revealed early opacification of the right portal vein on the arterial phase. After we had come to suspect an APF of the liver, its presence was confirmed on angiography. It was subsequently managed by using transcatheter coil embolization. In patients with portal hypertension and no evidence or history of cirrhosis, one should consider an APF as a potential etiology if history of liver biopsy or penetrating trauma exists. In a patient with liver trauma, serial abdominal CT is important for early detection and treatment of an APF.

• 중환자간호학회지
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• 제10권2호
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• pp.24-33
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• 2017

Purpose: This study aimed to investigate the differences in exudate and bleeding incidence and the changes in back pain and discomfort based on the weight of a sand bag applied to the femoral puncture site after hepatic transcatheter arterial chemoembolization. Methods: This quasi-experimental study comprised 82 patients randomly divided into three different groups. Experimental group 1 patients had a 600g sandbag, experimental group 2 patients an 800g sandbag, and control group patients a 1900g sandbag, on femoral access sites post procedure. The three groups of patients were assessed on level of exudate and bleeding and asked about back pain and discomfort at 30, 60, 120, 180 and 240 minutes after the procedure. Results: There were no significant differences in exudate and bleeding between the three groups before and after application of the sandbag post procedure. Both back pain and discomfort were significantly lower in the experimental groups than in the control group. Conclusion: There was no significant effect on bleeding and exudation due to the weight of the sandbag. The lowest level of back pain and discomfort was found in the group with the lightest weight (600 g). Therefore, the use of lighter-weight sandbags to prevent post procedure vascular complications is proposed.