Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8425-8440
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8425
Dealing with hepatic artery traumas: A clinical literature review
Osman Nuri Dilek, Arif Atay
Osman Nuri Dilek, Department of General Surgery, Division of Hepatopancreatobiliary Surgery, İzmir Katip Celebi University School of Medicine, İzmir 35150, Turkey
Arif Atay, Department of Surgery, İzmir Katip Celebi University School of Medicine, İzmir 35150, Turkey
Author contributions: Dilek ON wrote the majority of paper, critically revised the manuscript, and also coordinated the writing and correspondence of the paper; Atar A collected data and performed analysis and interpretation of data.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest in connection with this paper.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Osman Nuri Dilek, FACS, Professor, Department of General Surgery, Division of Hepatopancreatobiliary Surgery, İzmir Katip Celebi University School of Medicine, Basin Sitesi, İzmir 35150, Turkey. osmannuridilek@gmail.com
Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: March 30, 2021
Revised: April 5, 2021
Accepted: August 11, 2021
Article in press: August 11, 2021
Published online: October 6, 2021
Abstract
BACKGROUND

The hepatic artery (HA) is one of the most threatened vascular structures during hepatopancreatobiliary (HPB) surgeries and interventional procedures. It can be affected by many clinical pictures, especially tumors, due to its anatomical position and neighborhood.

AIM

To reveal the evolution and recent developments in the management of HA traumas in the light of the literature.

METHODS

In this article, 100 years of MEDLINE (PubMed) literature and articles including cases and series of HA injuries were reviewed, and the types of injury occurrence, treatment, and related complications and their management were compiled.

RESULTS

The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies, among the most common operations. HA anatomy shows anomalies in approximately 15%-25% of the cases, further increasing this risk. The incidence of HA injury is not precisely known. Approaches that have evolved in recent years in managing patients with HA injury (laceration, transection, ligation, resection) with severe morbidity and mortality risk are reviewed in light of the current literature.

CONCLUSION

In conclusion, complications and deaths due to HA injury are less common today. The risk of complications increases in patients with hemodynamic instability, jaundice, cholangitis, and sepsis. Revealing the variations in the preoperative radiological evaluation will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to maintain with primary anastomosis, arterial transpositions, or grafts. In cases where bile duct injury develops, patients should be directed to HPB surgery centers, considering the possibility of accompanying HA injury. Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.

Keywords: Hepatic artery, Injury, Anomaly, Ligation, Resection, Reconstruction

Core Tip: The hepatic artery (HA) is one of the most threatened vascular structures during hepatopancreatobiliary surgeries and interventional procedures. Complications and deaths due to HA injury are less common today. The risk of complications increases in patients with hemodynamic instability, jaundice, and cholangitis. Revealing the variations in the preoperative radiological evaluation will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to be maintained with primary anastomosis, arterial transpositions, or grafts. In cases where bile duct injury develops, patients should be directed to hepatopancreatobiliary surgery centers, considering the possibility of accompanying HA injury. Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.