The stand of portal vein arterialization in hepatobiliary surgery: a systematic review

Abstract

Introduction: Hepatic artery (HA) reconstruction during liver resection can be impossible due to arterial infiltration or anatomical limitations. Portal vein arterialization (PVA) is discussed to improve the hepatic oxygenation and provide a new chance for the patients with dearterialized liver. The aim of this study is to review the clinical application of PVA in hepatobiliary surgeries. Methods: The systematic review was performed according to the PRISMA guidelines. MEDLINE, Embase, and Web of Science databases were systematicly searched. Experimental studies, review articles, letters, and also articles published in languages other than English were excluded. Results: A total of 20 studies, involving 57 patients, were included. According to the anatomical location, hilar lesions (38 patients, 70.4%) were the most common indication of the surgery. The reasons for performing PVA were excision of lesions abutting HA (32 patients, 56.1%), HA ligation (11 patients, 19.3%), HA thrombosis (six patients, 10.5%), iatrogenic injury (four patients, 7.0%), and failure of HA reconstruction (four patients, 7.0%). An end-to-side anastomosis between celiac trunk branches and portal vein (PV) was the main performing technique for PVA (35 patients, 59.3%). The most common complication of PVA was portal hypertension (12 of 57, 21.1%). Thirty-five patients (61.4 %) survived during the follow-up period of 1 to 87 months. Conclusion: PVA may provide a chance of cure for patients with the unresectable lesions. To prevent portal hypertension and liver injuries due to thrombosis or over-arterialization, calibrating and timely closure of PVA should be considered.