Anatomical basis for pancreas transplantation via isolated splenic artery perfusion:A literature review

The variability of vascular anatomy of the pancreas underlines the difficulty of its transplantation.Research regarding the consistency of anatomical variations shows splenic arterial dominance in most cases.This can significantly improve transplantation success.A systematic literature review was performed according to the quality standards described in the AMSTAR measurement tool and the PRISMA guidelines.We valuated existing literature regarding the vascularization and blood perfusion patterns of the pancreas in terms of dominance and variability.The collected data was independently analyzed by two researchers.Variance of vascular anatomy was seen to be underreported in literature,though significant findings have been included and discussed in this study,providing valuable insight into the dynamics of pancreatic perfusion and feasibility of transplantation on several different supplying arteries.The splenic artery(SA)has a high percentage of consistency in all found studies(over 90%).High frequency of anastomoses between arterial pools supplying the pancreas can mediate sufficient blood supply through a dominant vessel,such as the SA,which is present in most cases.Pancreatic transplantation with isolated SA blood supply can provide sufficient arterial perfusion of the pancreas for stable transplant viability due to high anatomical consistency of the SA and vast communications with other arterial systems.

Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy

Aim:There are some previous reports concerning the relationship between prognosis of patients treated with sorafenib and parameters of computed tomography(CT)and magnetic resonance imaging(MRI).This study presents monocentric experience with sorafenib in the treatment of hepatocellular carcinoma(HCC)patients and will try to identify predictive factors for survival based on the correlation of results from imaging and survival.Methods:A total of 38 HCC patients treated from April 2009 to December 2010 with sorafenib were included in this study.HCCs were classified as good arterial supply and poor arterial supply according to the enhancement intensity on CT scan or MRI.Clinical data were collected and survival time was analyzed by Kaplan-Meier method.A Cox’s regression model was performed to reveal predictive factors for survival.Results:Among the 38 patients treated with sorafenib,mean age was 53.3±11.1 years and 35(92.1%)were males.Tumors in 17 patients were classified as good arterial supply,while the remaining 21 patients belonged to poor arterial supply.The median survival time(MST)was 10.7 months[95%confidence interval(CI),8.7-12.7]and the 1-year overall survival(OS)was 41.0%.The MST and 1-year OS in patients with a good arterial supply of tumors were 12 months(range:4-20 months)and 52.9%,compared with that of 7 months(range:1-16 months)and 23.8%in patients with a poor arterial supply of tumors(P=0.002).Patients who had tumors at Barcelona Clinic Liver Cancer(BCLC)stage B had longer MST and higher OS than those who had tumors at BCLC stage C,but there was no statistical difference between these two stages.On multivariate analysis,only arterial supply of the tumors remained statistically predictive for OS(hazard ratios 0.22,95%CI,0.07-0.67,P=0.008).Conclusion:Arterial blood supply is an independent predictor for survival in patients treated with sorafenib,and patients with a good arterial supply of tumors benefit more than those with a poor arterial supply of tumors.

Study of Relationship Between the Blood Supply of the Extrahepatic Bile Duct and Duct Supply Branches from Gastroduodenal Artery on Imaging and Anatomy

Background： Liver transplantation has become the treatment of choice for patients with end-stage acute or chronic hepatic disease. Bile duct complications are common events after liver transplantation. The aim of this study was to evaluate the blood supply of the human bile duct and identify the underlying mechanisms of bile duct complications after liver transplantation. Methods： The duct supply branches from gastroduodenal artery and blood supply of extrahepatic bile duct system were re-evaluated through selective hepatic angiography from 600 patients. In addition, 33 cadavers were injected with latex casting material into the common hepatic artery, then the extrahepatic bile duct and the branches from the common hepatic artery were carefully dissected to visualize the gastroduodenal artery and its branching to the extrahepatic bile duct. Results： The bile duct artery arose from the branch of the gastroduodenal artery in 8.1% （49/600）. Of these 49 individuals, the bile duct artery was supplied by the gastroduodenal artery （61.22%, 30/49）, the proper hepatic artery （14.29%, 7/49）, or both the gastroduodenal artery and the proper hepatic artery （24.49%, 12/49）. In our study of 33 cadavers, the percentage that the bile duct artery arose from the gastroduodenal artery was 27.27%. The blood supply to the bile extrahepatic bile ducts was divided into different segments and formed longitudinal and arterial network anastomosed on the walls of the duct. Conclusions： There is a close relationship between the duct supply branches from gastroduodenal artery and the blood supplying patterns of the extrahepatic bile duct system. In liver transplant surgery, the initial part of the gastroduodenal artery is preferred to be preserved in the donor liver. It is of great significance to improve the success rate of operation and reduce complications.