Partial portal arterialization for the prevention of massive liver necrosis following extended pancreatobiliary surgery: experience of two cases.

Massive liver necrosis, which is a severe and highly fatal complication after extended pancreatobiliary surgery, may occur due to an interruption of the hepatic arterial flow caused by such events as an excision of the hepatic artery invaded by cancer, a ligation of the postoperatively ruptured hepatic artery, or a thrombotic obstruction of the reconstructed hepatic artery. In order to improve this ischemic state of the liver, we have performed a partial arterialization of the portal vein by making an arteriovenous shunt at the mesenteric vascular branches in two cases. Although a sufficient pathophysiological investigation could not be fully conducted, partial portal arterialization was considered to be effective in one patient, while no clinically noticeable adverse effects were revealed in the other patient.