Dealing with hepatic artery traumas: A clinical literature review

Table 1 Factors affecting the extent of liver damage in hepatic artery injury

Factors affecting the extent of liver damage in hepatic artery trauma
Artery anatomy
Location of injury
Portal vein capasity
Collateral system and variations
Hemodynamic stability
Complications/comorbidities
Duration of HA trauma (injury invasion)
Dimensions of the operation/intervention
Cholangitis (sepsis) ?
Tissue bacteriology
Hyperbilirubinemia

HA: Hepatic artery.

Table 2 Selected and summarized hepatic artery injury, ligation, resection, or embolization series in the literature

Ref.	Cases, n	Etiology	Anomaly	HA injuries (laceration/transection, ligation/embolization)	Treatment options ligation/embolization reconstruction	Morbidity, n	Mortality, 90-d
Edgecombe and Gardner[2]	40	Review of the literature including cholecystectomy aneurysm and EHBT tumor	NA	40 ligation	Ligation? Drainage	LF? LA?	50%-75%
Brittain et al[16]	5	Cholecystectomy	NA	5 injury/ligation	No reconstruction, drainage	1% LA	1%
Alves et al[15]	55	Postcholecystectomy biliary tract stricture series (Bismuth type 3-4-5)	20?	20 rRHA/RHA injury?, 2 HA pseudoaneurism, 4 portal vein injury	43 HJ, 12 right Hx	1% LA, 12% atrophy	NA
Stewart et al[10]	261	Biliary tract injury during LC	NA	84 RHA injury	4 Hx, HJ, drainage	12% LA, 9% LN, 17% bleeding, 7% hemobilia, …	2%
Gaujoux et al[24]	545	PD series	NA	4 injury (Postoperative detection)	4 (Thrombectomy, stenting, reconstruction) 2 left Hx	2% LN, 4% thrombosis, 1% HJ	3%
Tzeng et al[14]	32	Liver trauma (15) + Interventional HA injury (17)	NA	32 injury	32 Embolization (2 fail)	2% LA, drainage	-
Li et al[12]	60	Biliary tract injury during LC	NA	8 RHA injury; 2 PHA injury	5 Reconstruction (2 fail)	3 LN, 3 Hx, 2 LA, 3 others	3%
Turrini et al[53]	471	PD series	47	1 injury? 2 planned resection	2 Reconstruction	-	-
Eshuis et al[9]	758	PD series	143	8 planned resection, 5 injury	3 Reconstruction	3 PF, 4 DGE, 1 LA, 3 Rlp	2%
Okada et al[52]	180	PD series	25	6 preop embolization and planned resection	No-reconstruction	1 POPF	-
El Amrani et al[27]	2278	Systematic analysis for PD (1950-2014)	440	49 injury; 6 embolization (preop)	18 Reconstruction	POPF 15%, DGE 39%,	0%-10%
Landen et al[3]	NA	Systematic review for PD (1990-2016)	3	21 injury (8 PHA, 3 RHA, 3 rRHA, 4 HA thrombosis, 3 HA injury)	5 Reconstruction (1 fail)	14 LA, 3 LF, 6 AL,11 Rlp	5 (24%)
Asano et al[19]	343	PD series	51	1 rRHA injury; 8 rRHA planned resection	No reconstruction; 1 drainage	1 LA	-
Kleive et al[20]	1535	Pancreatectomy series	NA	14 injury (5 SMA, 5 RHA, 2 CHA, 2 Celiac trunk); 22 planned resection	Embolectomy, Hx, re-reconstruction, drainage	4 thrombosis, 2 PPH, 1 POPF, 5 LN, 11 Rlp	2 injured; 1 planned
Elsanousi et al[34]	19	Invasive HCC series	NA	19 HALED	19 HALED1	8 Ascites-controlled, 2 jaundice	1 Pulmonary embolism

¹Ligation for therapeutic purpose.

Three patients died of LA at postoperative 5-7-12 mo. AL: anastomotic leakage; CHA: common HA; DGE: delayed gastric emptying; EHBT: Extrahepatic bile tract; HJ: Hepp-Couinaud hepaticojejunostomy; Hx: Hepatectomy, HALED: Hepatic artery ligation and extrahepatic collateral division; LA: Liver abscess; LC: Laparoscopic cholecystectomy; LF: Liver failure, LHA: Left HA; LN: Liver necrosis; n: Number of cases in series; NA: Not available; PD: Pancreaticoduodenectomy; POPF: Postoperative pancreatic fistula; PHA: Proper hepatic artery; PPH: Post pancreatectomy haemorrhage; Rlp: Relaparotomy; rRHA: Replaced right hepatic artery; SMA: Superior mesenteric artery.