Treatment for accidental occlusion of the hepatic artery after hepatic resection: Report of two cases

Two patients in whom accidental hepatic artery occlusion (HAO) occurred aft er hepatic resection (Hx) were reported. A 59-year-old female who underwent Hx for hepatocellular carcinoma with underlying liver cirrhosis developed HAO on postoperative day (POD) 14 and died of hepatic failure on POD 23, Th e autopsy findings show;ed multiple necrosis in the remnant liver and an ex traluminal hematoma of the hepatic artery, suggesting an injury caused by P ringle's maneuver. The second case was a 53-year-old male who underwent Hx for cholangiocarcinoma without any underlying liver disease. He developed H AO on POD 6, and radiological studies indicated a pseudoaneurysma formation and severe stenosis of the hepatic artery, It was speculated that the caus e of the HAO was intraluminal injury of the hepatic artery during an angiog raphic study conducted prior to Hx. Partial arterialization of the portal v ein was performed, following which his liver function test results improved . In both cases, measuring the serum hepatocyte growth factor level and the hepatic vein oxygen saturation proved useful, not only for determining the degree of liver injury, but also for predicting the outcome after treatmen ts for HAO. Furthermore, the partial arterialization of the portal vein for HAO after Hx may rescue the normal remnant liver.