From the Department of General Surgery and Transplantation, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy.
From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Exp Clin Transplant. 2021 Dec;19(12):1345-1347. doi: 10.6002/ect.2021.0302. Epub 2021 Nov 10.
We report a rare variant of the hepatic arterial supply observed during liver procurement from a 71-year-old female donor for whom an ischemic stroke caused brain death. Preoperative computed tomography showed a partially obliterated celiac trunk and an atypical arterial branch that coursed in a retropancreatic plane away from its origin at the superior mesenteric artery to anastomose with the common hepatic artery at the origin of the proper hepatic artery. The gastroduodenal artery and the dorsal pancreatic artery are the 2 conventional anastomotic arcades between the celiac trunk and the superior mesenteric artery. However, another potential anastomotic route is a rare physiological phenomenon known as the arc of Bühler, which, if present, connects the superior mesenteric artery with the celiac trunk or one of its branches. Although the arc of Bühler is known to occur in less than 3% of the general population, it could serve as a crucial anastomotic option in the case of median arcuate ligament syndrome or atheromatous obliteration of the celiac trunk. In our case, we were able to dissect and preserve the entire anastomotic arc from the donor. For arterial reconstruction during liver transplant, we anastomosed the arc of Bühler to the recipient's hepatic artery at the origin of the gastroduodenal artery. The postoperative course was uneventful, and the recipient was in good health at the 6-month follow-up. The arc of Bühler, when present, is an important anastomotic option in hepatobiliary surgery to avoid potential damage to the arterial supply of the liver.
我们报告了一例在为一名 71 岁女性供肝者进行肝切除时观察到的肝动脉供应的罕见变异，该供肝者因缺血性脑卒中导致脑死亡。术前计算机断层扫描显示腹腔干部分闭塞，以及一条非典型的动脉分支，该分支沿胰后平面走行，远离其起源于肠系膜上动脉的部位，与肝固有动脉的起点处的肝总动脉吻合。胃十二指肠动脉和胰背动脉是腹腔干和肠系膜上动脉之间的两个常规吻合弓。然而，另一个潜在的吻合途径是一种罕见的生理现象，称为布勒氏弓，若存在，则连接肠系膜上动脉和腹腔干或其分支。虽然布勒氏弓在普通人群中的发生率低于 3%，但在正中弓状韧带综合征或腹腔干粥样硬化闭塞的情况下，它可以作为一个重要的吻合选择。在我们的病例中，我们能够从供体中解剖并保留整个吻合弓。在肝移植时进行动脉重建，我们将布勒氏弓吻合到受体胃十二指肠动脉起点处的肝动脉。术后过程顺利，受体在 6 个月的随访时身体状况良好。当布勒氏弓存在时，它是肝胆外科中一个重要的吻合选择，可以避免肝脏动脉供应的潜在损伤。
