Intraoperative ultrasound for assessment of collateral liver arterial blood supply after acute blockade of hepatic blood flow

Egorov VI, Sorokin AS, Perekhodov SN, et al. . Intraoperative ultrasound for assessment of collateral liver arterial blood supply after acute blockade of hepatic blood flow. Pirogov Russian Journal of Surgery. 2025;(4):12‑22. (In Russ., In Engl.)
https://doi.org/10.17116/hirurgia202504112

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

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Abstract:

OBJECTIVE

To analyze the role of intraoperative ultrasound in assessment of collateral liver arterial blood supply after acute blockade of hepatic blood flow.

MATERIAL AND METHODS

Intraoperative analysis of hemodynamic changes in liver blood supply after temporary arterial blockade of hepatic blood flow was carried out in 135 patients who underwent total resection of pancreatic, liver, and gastric cancers. In addition to analysis of ischemic complications, we studied arterial architecture, pulsation of hepatoduodenal ligament, linear arterial blood flow velocity in liver parenchyma and hepatoduodenal ligament before and after hepatic blood flow blockade, as well as diameters of the main celiac-mesenteric arteries before surgery. These parameters were compared in groups of DP CAR and other interventions.

RESULTS

There were no ischemic liver events after DP CAR and hepatic blood flow blockade. After hepatic blood flow blockade in the overall group, hepatoduodenal ligament pulsation disappeared in 8% of cases, while linear arterial blood flow velocity decreased by more than 50%. Pulsatile blood flow was preserved in 77% of cases. Despite significant decrease in linear arterial blood flow velocity and even disappearance of hepatoduodenal ligament pulsation, arterial blood flow in liver parenchyma never ceased. None patient had arterial blood flow in liver parenchyma< 20 cm/s. When dividing the groups into DP CAR and non-DP CAR, we found no significant differences in age- and gender-adjusted distribution, Michels vascular architecture and linear arterial blood flow velocity decrease. Pulse disappearance significantly depended on diameter of gastroduodenal artery (GDA) and largely on the ratio of its diameter to the diameter of the common hepatic artery (CHA). IF CHA/GDA diameter ≈ 2, the probability of hepatoduodenal ligament pulse disappearance increased by more than 5 times.

CONCLUSION

High adaptive capacity of collateral arterial blood supply to the liver is revealed after CHA or celiac artery blockade. Intraoperative ultrasound is a highly reliable method for analysis of blood supply. Linear blood flow velocity in parenchymal arteries ≥20 cm/s is sufficient to prevent ischemic liver damage.

Keywords:

intraoperative ultrasound of liver blood flow

DP-CAR

collateral hepatic blood flow

liver arteries

resection of celiac axis

Authors:

Egorov V.I.

Ilyinskaya Hospital

ORCID: 0000-0002-8805-7604

Sorokin A.S.

Plekhanov Russian University of Economics

ORCID: 0000-0002-9328-7017

Perekhodov S.N.

Russin University of Medicine

ORCID: 0000-0001-7166-0290

Grigorievsky M.V.

Russin University of Medicine

ORCID: 0000-0002-9596-8107

Zelter P.

Meir hospital

ORCID: 0000-0003-1346-5942

Zhurenkova T.V.

Loginov Moscow Clinical Scientific Center

ORCID: 0009-0000-7325-099X

Zhurina Yu.A.

Medswiss Medical Center

ORCID: 0000-0002-2309-7330

Petukhova M.V.

Moscow City Clinical Hospital No. 52

ORCID: 0009-0007-1146-060X

Received:

03.12.2024

Accepted:

29.01.2025

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