PMID- 11884939
OWN - NLM
STAT- MEDLINE
DCOM- 20020321
LR  - 20190713
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 73
IP  - 3
DP  - 2002 Feb 15
TI  - Arteroportal fistulas between the accessory right hepatic, gastroduodenal and 
      superior mesenteric arteries and portal vein: a difficult technical problem to 
      overcome in liver transplantation.
PG  - 417-9
AB  - BACKGROUND: Fistulous communications between the accessory right hepatic (ARHA), 
      gastroduodenal (GD), and superior mesenteric (SMA) arteries and the portal vein 
      (PV) may represent a contraindication for liver transplantation (LT). MATERIAL: A 
      patient with HCV-related liver cirrhosis and progressive liver decompensation 
      underwent preoperative LT work-up. Doppler ultrasound (DU), Angiography and MRI 
      revealed arteroportal fistulas (APF) and diversion of mesenteric-splenoportal 
      flow through spontaneous splenorenal shunts (SSRS) in the systemic circulation. 
      The patient was transplanted and the ARHA and GDA were distally sectioned; the HA 
      was anastomosed to the donor HA; the superior mesenteric vein (SMV) was detached 
      from the splenopancreatic venous bed by sectioning and ligating the Henle trunk, 
      by ligating an posterior-inferior pancreatic vein and, finally, by positioning an 
      iliac vein interposition graft between the SMV and the donor PV. The 
      postanastomotic SMV trunk and recipient PV were ligated below and above the 
      pancreatic head, respectively. RESULTS: Reperfusion and late liver function were 
      good. DU and MRI studies showed an effective portal flow and the maintenance of a 
      normal splenopancreatic vein outflow through the SSRS. DISCUSSION: APF represent 
      a serious clinical problem, particularly in patients who need LT. The persistence 
      of arterial flow into the PV is dangerous for the long-term liver function. A 
      particular surgical strategy, strictly tailored to the hemodynamic conditions, 
      has to be planned. CONCLUSIONS: Extrahepatic multiple APF would no longer to 
      represent a contraindication to LT, although this claim needs to be confirmed in 
      the light of further experience and a longer-term follow-up.
FAU - Gerunda, Giorgio E
AU  - Gerunda GE
AD  - Department of Surgical and Medical Sciences, III Surgical Clinic, Policlinico 
      Universitario, Via Giustiniani 2, 35128 Padova, Italy.
FAU - Merenda, Roberto
AU  - Merenda R
FAU - Neri, Daniele
AU  - Neri D
FAU - Barbazza, Franco
AU  - Barbazza F
FAU - Angeli, Paolo
AU  - Angeli P
FAU - Sacerdoti, David
AU  - Sacerdoti D
FAU - Miotto, Diego
AU  - Miotto D
FAU - Valmasoni, Michele
AU  - Valmasoni M
FAU - Zangrandi, Fabio
AU  - Zangrandi F
FAU - Gangemi, Antonio
AU  - Gangemi A
FAU - Faccioli, Alvise Maffei
AU  - Faccioli AM
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
SB  - IM
MH  - Arteriovenous Fistula/*surgery
MH  - Contraindications
MH  - Hepatic Artery/*abnormalities
MH  - Humans
MH  - Liver Transplantation/*methods
MH  - Male
MH  - Mesenteric Artery, Superior/*abnormalities
MH  - Middle Aged
MH  - Portal Vein/*abnormalities
EDAT- 2002/03/09 10:00
MHDA- 2002/03/22 10:01
CRDT- 2002/03/09 10:00
PHST- 2002/03/09 10:00 [pubmed]
PHST- 2002/03/22 10:01 [medline]
PHST- 2002/03/09 10:00 [entrez]
AID - 10.1097/00007890-200202150-00016 [doi]
PST - ppublish
SO  - Transplantation. 2002 Feb 15;73(3):417-9. doi: 10.1097/00007890-200202150-00016.