After hepatic artery embolization, preserved flow (≥4 segmental hepatic artery) lowered the risk of hepatic complications regardless of the portal venous flow. This is the conclusion presented by Won Seok Choi, Chang Jin Yoon (both Seoul National University Bundang Hospital, Seongnam, Korea), and colleagues in the Journal of Vascular and Interventional Radiology (JVIR).
The investigators set out to determine the association between hepatic ischaemic complications and hepatic artery collaterals and portal venous impairment after hepatic artery embolization for postoperative haemorrhage.
Between October 2003 and November 2019, 42 patients underwent hepatic artery embolization for postoperative haemorrhage. Hepatic artery collaterals were classified according to hepatic artery visualisation after embolization (grade 1, none; grade 2, 1–4 segmental hepatic artery; grade 3, ≥4 segmental hepatic artery). Transhepatic portal vein stent placement was performed in the same session in five patients (11.9%) with poor hepatic artery collaterals (grade 1 or2) and compromised portal venous flow (>70% stenosis). Hepatic ischaemic complications were analysed for relevance to hepatic artery collaterals and portal venous compromise.
Following hepatic artery embolization, hepatic artery flow was preserved (grade 3) through intra- and/or extrahepatic collaterals in 23 patients (54.8%), and hepatic complications did not occur regardless of portal venous flow status (0%). Of the 19 patients with poor (grade 1 or 2) hepatic artery collaterals (45.2%), segmental hepatic infarction occurred in two out of 15 patients with preserved portal venous flow (10 naïve and five stented; 13.3%). The remaining four patients with poor hepatic artery collaterals and untreated compromised portal venous flow experienced multi-segmental hepatic infarction (n=three) or hepatic failure (n=one) (100%; p<0.005).
“Transhepatic portal venous stent placement seems to be an effective intervention for the prevention of hepatic complications in cases of poor hepatic artery collaterals and compromised portal venous flow,” Choi et al conclude.