We read with considerable interest the article by Majno et al1 in the February issue of the Archives. We agree with the authors' conclusions regarding the importance of maintaining hepatic arterial flow in patients with compromised portal flow, especially when the patient requires biliary reconstruction. We recently encountered 2 similar patients who also required resection and reconstruction of their portal vein. These patients demonstrate that concomitant problems of artery and portal vein flow include not only biliary injury but also acute hepatic failure.
Report of Cases.
Case 1. The first patient was a 50-year-old woman with a nonfunctioning islet cell pancreatic tumor that had invaded her portal vein. She underwent a pancreaticoduodenectomy, during which the common hepatic artery was ligated. The portal vein was concomitantly resected and reconstructed with a polytetrafluoroethylene interposition graft. Immediately postoperatively, she demonstrated evidence of acute hepatic failure. Doppler ultrasound examination revealed the portal vein