Fatal arterial hemorrhage after pancreaticoduodenectomy: How do we simultaneously accomplish complete hemostasis and hepatic arterial flow?

Figure 3 Actual finding of arterioportal shunting. The ileocecal vein and artery were anastomosed in a side-to-side fashion. In a patient in whom the initial endovascular treatment failed (patient 14), hemostasis was completed by additional transcatheter arterial embolization, and liver infarction subsequently occurred. Therefore, an arterioportal shunt was surgically created to oxygenate the portal vein flow. In this case, arterioportal shunting minimized progression to fatal liver infarction due to hepatic ischemia and refractory liver abscess due to biliary ischemia. PV: Portal vein.