Hepatic artery injury during portacaval shunt surgery.

The angiographic and clinical findings are presented in three patients in whom the proper hepatic artery was injured during a portacaval shunt operation. In two of the patients, hepatic artery occlusion, hepatic necrosis, and death occurred within several days. In the third, an elongated, lobular aneurysm, clearly related to the operation, was an incidental finding on a postoperative angiogram. Because of the dependency of the cirrhotic liver on hepatic artery blood flow, hepatic artery occlusion in advanced cirrhotic patients is usually fatal and may be the cause of progressive and rapid onset of the hepatic coma in the postoperative period. The complications should be suspected when the SGOT increases rapidly in the postoperative period and can be confirmed by arteriography.