Abraham Rami Tzafriri PhD, Fernando Garcia-Polite PhD, John Keating DVM DACVP, Raffaele Melidone DVM DACVP, Jennifer Knutson BS, Peter Markham MS, Elazer R. Edelman MD PhD, Felix Mahfoud MD. "Morphometric analysis of the human common hepatic artery (CHA) reveals a rich and accessible target for sympathetic liver denervation."
Summary:
Treatment of type 2 diabetes mellitus includes lifestyle modifications and medication regimens that require concerted efforts from both physicians and patients to be effective owing to high rates of noncompliance. Indeed, it has been estimated that non-adherence to antidiabetic drugs ranges from 53 to 65% and may be responsible for uncontrolled glucose levels in about 23% of patients. Development of alternative approaches that are less prone to adherence issues could therefore offer a significant advancement in diabetes care. Given the association of activation of the sympathetic nervous system with altering insulin resistance and the development of type 2 diabetes mellitus, catheter-based sympathetic denervation of the digestive system has been suggested as one such alternative.
This study quantified the distribution of nerves and adjacent anatomies surrounding human common hepatic artery (CHA) as guidance for catheter based denervation.
CHA collected from cadaveric human donors (n=20) were histologically evaluated and periarterial dimensions and distributions of nerves, lymph nodes, pancreas and blood vessels quantified by digital morphometry.
Nerve abundance decreased significantly with distance from the aortic ostium (P<0.0001) and was higher in the Superior/Inferior compared to the Anterior/ Posterior quadrants (P=0.014). In each locational group, nerves were absent from the artery wall, and starting 0.5-1.0 mm from the lumen exhibited a first order dependence on radial distance, fully defined by the median distance. Median subject-averaged nerve distance to the lumen was 2.75 mm, ranging from 2.1-3.1 mm in different arterial segments and quadrants and 2.0-3.5 mm in individuals. Inter-individual variance was high, with certain individuals exhibiting 50th and 75th nerve distances of, respectively, 3.5 and 6.5 mm The pancreas rarely approached within 4 mm of the lumen proximally and 2.5 mm more distally.
The data indicate that the CHA is a rich and accessible target for sympathetic denervation regardless of sex and diabetes, with efficacy and safety most optimally balanced proximally.