Brief report Reconstruction of the hepatic artery using the gastroduodenal artery Juan M. Sarmiento, M.D. a , Jean M. Panneton, M.D. b , David M. Nagorney, M.D. a,c, * a Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA b Division of Vascular Surgery, Mayo Clinic, Rochester, MN, USA c Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA Manuscript received July 2, 2002; revised manuscript September 6, 2002 Abstract Although injury of the hepatic artery is not common during the performance of biliary and pancreatic resections, the hepatic artery if involved by tumor extension can be injured during its dissection.Several methods for reconstruction of the hepatic artery have been described and although each technique is applicable in a specific situation, autologous tissue conduits are preferable in contaminated operative fields. We report here another transposition technique to reconstruct the proper hepatic artery using the gastroduodenal artery, which may provide a local autologous artery for repair of hepatic artery damage during pancreaticoduodenectomy. © 2003 Excerpta Medica, Inc. All rights reserved. Keywords: Hepatic artery; Vascular reconstruction; Whipple procedure Injury of the hepatic artery is not common during the per- formance of biliary and pancreatic resections. However, the hepatic artery, if involved by tumor extension, can be in- jured during its dissection. Several methods for reconstruc- tion of the hepatic artery have been described: interposition of venous (greater saphenous vein) [1] and prosthetic grafts (Gore-Tex) [2]; transposition of native arteries to the distal stump of the hepatic artery (ie, splenic artery, right gastro- epiploic artery) [3,4], and even primary repair to avoid prosthetics with combined major visceral resections [5]. Although each technique is applicable in a specific situa- tion, autologous tissue conduits are preferable in contami- nated operative fields. We describe here another transposition technique to re- construct the proper hepatic artery using the gastroduodenal artery. Surgical technique Repair of the proper hepatic injury is not always feasible by either single suture closure or segmental resection and primary anastomosis. The gastroduodenal artery is a large direct branch coming from the proper hepatic artery (Fig. 1) and can be used as an autologous conduit for arterial repair. The gastroduodenal artery is dissected for 2.5 to 3 cm distal to its origin and rotated to the distal stump of the hepatic artery (Fig. 1, inset). Minor branches from the gastroduo- denal artery are ligated to mobilize the artery completely. Both the distal stump of the hepatic artery and the gastrodu- odenal artery stumps are spatulated for size matching and a primary anastomosis is constructed with thin monofilament suture (6-0). An intraoperative ultrasonogram is crucial to evaluate the patency of the repair, especially in the presence of a biliary anastomosis. Aspartate aminotransferase are measured postoperatively as a marker for liver ischemia, and ultrasonography should be repeated after a week. Comments Pancreatic and biliary cancers may potentially involve the proper hepatic artery either by direct extension or by lymphatic metastases. Sometimes during radical resection of these malignancies the hepatic artery, the portal vein or both require excision to achieve tumor free margins [1]. Although the hepatic artery provides just 25% to 30% of the circulation to the liver and can often be ligated [6], vascular reconstruction is particularly important in the setting of bile duct reconstruction. After dividing the bile duct, perfusion * Corresponding author. Tel.: +1-507-284-4321; fax: +1-507-284- 5196. E-mail address: nagorney.david@mayo.edu The American Journal of Surgery 185 (2003) 386 –387 0002-9610/03/$ – see front matter © 2003 Excerpta Medica, Inc. All rights reserved. doi:10.1016/S0002-9610(02)01416-2