• Journal of International Society for Simulation Surgery
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• 제1권2호
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• pp.87-89
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• 2014

An aberrant left hepatic artery is one of the most common variants of hepatic arteries, and its prevalence has been reported 6.5-30%. During D2 lymph node dissection for gastric cancer, an aberrant left hepatic artery arising from left gastric artery is ligated which may lead to hepatic damage. In this case report, a 66-year-old male patient underwent total gastrectomy with D2 lymph node dissection during which the aberrant left hepatic artery was ligated. Post-operative liver function tests revealed elevated liver enzymes, and ischemic changes in the left lateral hepatic section was seen on the CT scan. On retrospective review of preoperative CT images, a replaced left hepatic artery from left gastric artery could have been identified. The information on the presence of aberrant LHA and its supplying area is clinically important when planning curative gastrectomy for gastric cancer, because extended lymph node dissection requires division of the left gastric artery and this may lead to severe liver damage. By using preoperative CT scan, detection of aberrant left hepatic artery could be done.

• Anatomy and Cell Biology
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• 제56권2호
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• pp.276-279
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• 2023

The arterial support of the liver is most commonly from the celiac trunk via the proper hepatic artery (PHA). The PHA divides into left and right branches: the right hepatic artery (RHA) supplies the right and caudate lobes while the left hepatic artery (LHA) supplies the left and quadrate lobes. Aberrant hepatic arteries are relatively common, and the most frequent contributors are the superior mesenteric artery and left gastric artery. Herein we present findings from postmortem dissection of an abdominal cavity that revealed a rare combination of reported variations. Specifically, this subject had three extrahepatic arteries - a replaced LHA (rLHA), a PHA, and a replaced RHA (rRHA). The rLHA originated from the left gastric and the rRHA originated from the superior mesenteric artery. Knowledge of these variations is important for surgical and radiological procedures to avoid complications during treatment and improve patient outcomes.

• Journal of Gastric Cancer
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• 제21권1호
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• pp.74-83
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• 2021

Purpose: No consensus exists on whether to preserve or ligate an aberrant left hepatic artery (ALHA), which is the most commonly encountered hepatic arterial variation during gastric surgery. Therefore, we aimed to evaluate the clinical effects of ALHA ligation by analyzing the perioperative outcomes. Materials and Methods: We retrospectively reviewed the data of 5,310 patients who underwent subtotal/total gastrectomy for gastric cancer. Patients in whom the ALHA was ligated (n=486) were categorized into 2 groups according to peak aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels: moderate-to-severe (MS) elevation (≥5 times the upper limit of normal [ULN]; MS group, n=42) and no-to-mild (NM) elevation (<5 times the ULN; NM group, n=444). The groups were matched 1:3 using propensity score-matching analysis to minimize confounding factors that can affect the perioperative outcomes. Results: The mean operation time (P=0.646) and blood loss amount (P=0.937) were similar between the 2 groups. The length of hospital stay was longer in the MS group (13.0 vs. 7.8 days, P=0.022). No postoperative mortality occurred. The incidence of grade ≥ IIIa postoperative complications (19.0% vs. 5.1%, P=0.001), especially pulmonary complications (11.9% vs. 2.5%, P=0.003), was significantly higher in the MS group. This group also showed a higher Comprehensive Complication Index (29.0 vs. 13.9, P<0.001). Conclusions: Among patients with a ligated ALHA, those with peak AST/ALT ≥5 times the ULN showed worse perioperative outcomes in terms of hospital stay and severity of complications. More precise perioperative decision-making tools are needed to better determine whether to preserve or ligate an ALHA.

• Journal of Gastric Cancer
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• 제16권2호
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• pp.72-77
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• 2016

Purpose: During laparoscopic gastrectomy, an aberrant left hepatic artery (ALHA) arising from the left gastric artery (LGA) is occasionally encountered. The aim of this study was to define when an ALHA should be preserved during laparoscopic gastrectomy. Materials and Methods: From August 2009 to December 2014, 1,340 patients with early gastric cancer underwent laparoscopic distal gastrectomy. One hundred fifty patients presented with an ALHA; of the ALHA was ligated in 116 patients and preserved in 34 patients. Patient characteristics, postoperative outcomes and perioperative liver function tests were reviewed retrospectively. Correlations between the diameter of the LGA measured on preoperative abdominal computed tomography and postoperative liver enzyme levels were analyzed. Results: Pearson's correlation analysis showed a positive correlation between the diameter of the LGA and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on postoperative day 1 in the ALHA-ligated group (P=0.039, P=0.026, respectively). Linear regression analysis estimated the diameter of the LGA to be 5.1 mm and 4.9 mm when AST and ALT levels were twice the normal limit on postoperative day 1. Conclusions: We suggest preserving the ALHA arising from a large LGA, having diameter greater than 5 mm, during laparoscopic gastrectomy to prevent immediate postoperative hepatic dysfunction.

• 한국산학기술학회논문지
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• 제20권3호
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• pp.188-193
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• 2019

경동맥 화학색전술은 널리 이용되며 빠르게 발전하고 있는 간세포암의 비수술적 치료법이다. 만족할만한 치료결과를 얻기 위해서는 환자의 해부학적 특성을 이해하고 종양 공급 동맥을 찾아내서 올바른 치료 계획을 세워야 한다. 본 연구에서는 간세포암의 경동맥 화학색전술 중에 방해요인으로 작용한 후천성 동정맥 기형의 증례를 보고하고자 한다. 72세 남자가 2일전부터 지속된 복통으로 내원하였다. 만성 B형 간염환자로 10년 전 간세포암에 대한 고식적 경동맥 화학색전술을 시행 받고 완치된 과거력이 있었다. 전산화 단층 촬영상 간우엽의 8분절에 결절성 간세포암이 발견되었으며 우간동맥은 상장간막동맥에서 기시하는 기형을 가지고 있었으며 종양 주변에 과혈관성 종양 구조가 관찰되었다. 1차 경동맥 화학색전술을 실시하였을 때 좌간동맥에서 기시하는 종양 공급동맥을 찾아 이를 약물방출미세구와 Adriamycin 50mg을 이용하여 화학색전하였다. 우간동맥조영술을 시행하였을 때 동정맥 기형이 관찰되었으며 간세포암은 관찰되지 않았다. 1개월 후 시행한 전산화 단층 촬영상 괴사된 종양과 남은 병변이 관찰되어 2차 경동맥 화학색전술을 시행하였다. 우간동맥을 통하여 미세유도철사와 카테터를 이용하여 동정맥 기형을 지나쳐 초선택하였고 시행한 조영술에서 남은 간세포암의 병변이 조영됨을 확인할 수 있었다. 이를 약물방출미세구와 Adriamycin을 이용하여 화학색전하였다. 시술 후 혈관 조영술에서 간세포암이 조영되지 않는 것을 확인하였고, 그 후 환자는 특별한 합병증 없이 퇴원하였다. 저자들은 매우 드물게 발생하는 간세포암 주변의 후천성 동정맥 기형을 발견하였고, 방해요인으로 작용한 동정맥 기형을 넘어 초선택적 경동맥화학색전술을 시행하여 간세포암을 치료하였다.