Portal vein arterialization (PVA) has been applied as a salvage procedure in hepatopancreatobiliary surgeries, including
transplantation and liver resection, with revascularization for
malignancies. Here we describe the use PVA as a salvage procedure following
accidental injury of the hepatic artery to the remnant liver occurred during left hepatic trisectionectomy for colorectal liver
metastases (CRLM). A 60-year-old man with
cancer of the sigmoid colon and initially unresectable CRLM received 11 cycles of hepatic arterial infusion
chemotherapy with
5-fluorouracil (1500mg/week), after which CRLM was downstaged to resectable. One month after laparoscopic sigmoidectomy, a left trisectionectomy and wedge resection of segment 6 were performed. The posterior branch of the right hepatic artery, the only feeding artery to the remnant liver, was injured and totally dissected. Because microsurgical reconstruction of the artery was impossible, PVA was used; PVA is the sole known procedure available when hepatic artery reconstruction is impossible. The patient then suffered
portal hypertension, and closure of arterio-portal anastomosis using an interventional technique with angiography was eventually performed on postoperative day 73. Therefore, it is considered that because PVA is associated with severe postoperative
portal hypertension, closure of the arterio-portal shunt should be performed as soon as possible on diagnosing
portal hypertension.