Portal vein arterialization for iatrogenic embolization of the hepatic artery. An old but still useful technique?

Introduction: Portal Vein Arterialization is a rare procedure for total de-arterialized livers to ensure arterial inflow to the liver.

Presentation Of Case: A 55-year-old male patient underwent pancreatoduodenectomy for chronic pancreatitis. One month after discharge the patient was re-admitted because of bleeding from a pseudoaneurysm of the ligated gastroduodenal artery. During radiological intervention a coil dislocated and a complete occlusion of the hepatic artery occurred. Extraction of the coil was not possible, therefore, the patient was transferred to our hospital for surgical revascularization. We performed a side-to-side running anastomosis between a branch of a mesenteric artery and the corresponding vein to supply arterial blood to the liver. The postoperative course was uneventful. Radiologic examinations showed a patent arterio-portal shunt.

Discussion: Portal vein arterialization might be a lifesaving procedure in complication management.

Conclusion: PVA is an old surgical method, which could be helpful to reduce the failure-to-rescue rate.