Proper hepatic

The ability of the liver to act as a depot for vitamin Bi2 (B28, G13) enables us to use this vitamin as an index of proper hepatic function. Hepatic disorders lead to an increased Bi2-binding in the serum (J5, R3), suggesting that the blood assumes a greater role in the conservation of B12. We have reported that patients with liver disease excreted invariably less than 10 fig of Bi2> 8 hours after a 50-[ig intramuscular load dose of the vitamin. In contrast, normal subjects excreted 24-40 pg, i.e., 50-80% of the vitamin in the same test (B14). These results were correlated with various chemical determinations indicative of hepatic disorders (Bl). In Table 16 the clinical diagnosis and the various liver-... 

In the porta hepatis, the proper hepatic artery divides into the right branch (from which the cystic artery emerges) and the left branch (from which a middle hepatic artery occasionally emerges). The branches of the hepatic artery run close to the portal veins and may even (rarely) coil round them in places. An arterial sphincter is located prior to the further division of the hepatic artery into smaller branches. There are anastomoses between the arterial branches and the hepatic vein. By way of an arteriolar sphincter (46), the interlobular arteries branch into intralobular arterioles, supplying the lobules of the liver with arterial blood. The arterial blood enters the sinusoids either through terminal branches or through arterioportal anastomoses and mixes with the portal blood. The pressure in the hepatic arterioles is 30-40 mm Hg. (36, 46, 61)... 

As an alternative to percutaneous injection therapy, there is a possibility to develop new local-interventional treatment strategies by selectively exploring the tumourfeeding branch of the proper hepatic artery. 

Quite often the hepatic artery has an incomplete set of branches because one or the other of its usual branches arises from a source other than the proper hepatic artery from the celiac trunk. Such a vessel if from an outside source is spoken of as aberrant ... 

An aberrant hepatic artery refers to a branch that does not arise from its usual source (i.e. proper hepatic artery from the celiac trunk). This type of artery may be a substitute for the usual hepatic artery that is absent, in which case it is referred to as an aberrant replaced hepatic artery. In other cases there may be an additional artery to the one normally present hence the term aberrant accessory artery. 

Fig. 20.3a,b. Hepatic arterial anatomy according to Hiatt. aMIP reconstruction of Hiatt s type 1 anatomy i.e., conventional anatomy with the common hepatic artery arising from the celiac axis to the gastroduodenal and proper hepatic arteries. The proper hepatic artery divides distally into right and left branches, b MIP reconstruction of Hiatt s type 3 anatomy i.e., a replaced right hepatic artery originating from the superior mesenteric artery... 

Type 1 the common HA arising from the celiac axis to form the gastroduodenal and proper hepatic arteries the proper HA dividing distally into right and left branches... 

Additionally, group 1 of this classification takes into account the proper variations of the common hepatic artery, and reminds the surgeons to take care of the small branches that originate directly from the proper hepatic artery, such as the segment IV artery, which is so important to preserve during split liver transplantation (Chaib et al. 2005 Saylisoy et al. 2005) (Fig. 20.5). 

The hepatic and splenic arteries typically arise from the celiac axis, which has its origin at the T12/ LI level of the abdominal aorta. The three main branches of the celiac include the splenic, left gastric, and common hepatic arteries. The splenic artery is typically large and tortuous and supplies small branches to the pancreas. The common hepatic branches into the gastroduodenal and proper hepatic arteries. There is significant variant anatomy of the hepatic arteries Aat the interventionist should be aware of. The most common variation is the replaced right hepatic artery, which arises from the superior mesenteric artery (SMA). This occurs in 12%-15% of the population. Other less frequent variations include the replaced left hepatic from the left gastric artery (11%) and the completely replaced common hepatic from the SMA (2%). 

As long as there is no celiac, proper hepatic, or SMA origin occlusion, the GDA can be sacrificed. If the GDA is required to maintain perfusion of the liver or, if flow into the SMA is dependent upon the celiac, then direct coiling of GDA pseudoaneurysms is preferable. This can he accomplished with stent placement over the aneurysm neck and microcoil deposition through the interstices via a microcatheter. A small-caliher stent graft such as a Jostent could theoretically be used in this situation. However, use of this device is still not approved by the FDA. Appel et al. described the placement of a 26-mm stent graft for humanitarian treatment of a traumatic pseudoaneurysm of the SMA [34]. 

Liver failure Avoid TACE in patients with Child-Pugh C liver disease. Do not perform TACE from proper hepatic artery. Select right or left. May be irreversible and fatal... 

Kogure K, Kuwano H, Fujimaki N, et al. (2000) Relation among portal segmentation, proper hepatic vein, and external notch of the caudate lobe in the human liver. Ann Surg 231 223-228... 

Figure 10.9 IPSO amount in organs 1 hour after hepatic arterial injection with a W/OAV emulsion consisting of I-IPSO microdroplets that are 10 or 60 pm in diameter. The emulsion was injected into the proper hepatic artery of the rabbits after laparotomy under general anesthesia. The IPSO amount was calculated by measuring the radioactivity of the sample taken from the hver (each 4 lobe), lung (each 5 lobe), spleen, and blood.

In the conventional arterial anatomy of the liver, the common hepatic artery originates from the celiac trunk (Fig. 4.2.2). From the common hepatic artery arise the left gastric, gastroduodenal and proper hepatic arteries. The hepatic artery divides at the hepatic hilum into the right and left branches. The middle hepatic artery supplies the medial seg-... 

Fig. 4.2.2. Volume-rendered CT image of conventional hepatic arterial anatomy. The common hepatic artery (t) originates from the celiac axis and, after the origin of the gastroduodenal artery (5), becomes the proper hepatic artery (2). The proper hepatic artery divides into the left (3) and right (4) hepatic artery...

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