Hv. Nghiem et al., Impact of double helical CT and three-dimensional CT arteriography on surgical planning for hepatic transplantation, ABDOM IMAG, 24(3), 1999, pp. 278-284
Background: To assess the impact of preliver transplant double helical comp
uted tomography (DHCT) and three-dimensional computed tomograhpy arteriogra
phy (3D-CTA) on surgical planning for hepatic transplantation.
Methods: Vascular findings detected on DHCT/3D-CTAs of 80 patients were sho
wn to the transplant surgeon in a blinded fashion. These findings included
hepatic arterial anatomy, diameters of the major vessels that supplied the
liver, celiac axis stenosis, splenic artery (SA) aneurysms, and portal vein
thrombosis (PVT), The surgeon was asked to state the "planned" surgical ap
proach for each case based on scan findings. These results were subsequentl
y compared with what "actually" occurred at transplantation by review of su
rgical records.
Results: Fifty-five patients had conventional and 25 patients had nonconven
tional hepatic arterial anatomy. Three patients had PVT, three patients had
celiac axis stenosis, and three patients had SA aneurysms. Correlation bet
ween the "actual surgical technique" and the "planned surgical approach" wa
s seen in 50/55 (91%) patients with conventional and in 23/25 (92%) patient
s with nonconventional anatomy. Five patients requiring aortohepatic interp
osition grafts for arterial anastomoses had either severe celiac axis steno
ses or arterial inflow vessels that were 3 mm or smaller. Three patients wi
th PVT underwent successful surgical resection of the thrombosed segment an
d standard PV anastomoses as planned. Patients with complete replacement of
hepatic arterial supply to the superior mesenteric artery required alterat
ion of the sequence of the vascular anastomoses. Patients with SA aneurysms
had surgical ligation of the splenic artery.
Conclusions: DHCT/3D-CTA provides noninvasive means to identify findings th
at have significant impact on surgical planning for hepatic transplantation
including celiac axis stenosis, diameter of inflow arterial vessel less th
an or equal to 3 mm, complete replacement of hepatic arterial supply, PVT,
and SA aneurysms.