Arterial conduits that use donor iliac arteries represent a reliable technique for graft revascularization in orthotopic liver transplantation. We reviewed 757 consecutive liver transplantations performed between 1989 and 1995 for acute or chronic liver disease in adults and children. Of these, 218 patients received arterial conduits that used donor iliac arteries. The incidence of hepatic artery thrombosis (HAT) for conduits was 4.1% (9 of 218 patients) compared with 4% (22 of 539 patients) for direct arterial anastomosis. Patients in the arterial conduit group included 66% (99 of 159) of the children younger than 5 years of age, 75% (67 of 89) of all patients who underwent retransplantation, and, in particular, 25 patients regrafted for HAT. Arterial conduits provide an effective and reliable method of revascularization in patients at higher risk of arterial thrombosis. The actuarial 3-year patency rate for conduits is 95% and the incidence of HAT is similar to that in standard arterial anastomoses. Copyright 1998 by the American Association for the Study of Liver DiseasesH epatic artery thrombosis (HAT) remains an important cause of graft loss after liver transplantation. 1,2 Because the potential collateral supply to the graft is severed at the time of hepatectomy, the transplanted liver is particularly dependent on the arterial blood flow and HAT leads to retransplantation in up to 75% of patients, with a mortality rate approaching 50%. 3 Arterial conduits that use donor iliac arteries were developed to overcome arterial inflow problems, 4-6 and we have reviewed our experience with the use of this technique. MethodsWe reviewed 757 consecutive orthotopic liver transplantations (OLTs) performed between January 1989 and December 1995 for acute or chronic liver disease in adults and children. Of these, 218 grafts were revascularized by means of donor iliac artery anastomosed to the infrarenal aorta. These conduits were prepared from donor iliac arteries, occasionally from splenic artery, and exceptionally from saphenous vein, the latter being used for the initial living related liver transplantations. The common iliac arteries were retrieved at the end of the donor operation, carefully avoiding excessive traction to reduce the risk of intimal damage, and were stored in University of Wisconsin solution at 4°C.Whenever possible, iliac arteries from the same donors were used to construct the infrarenal conduit. Occasionally, these were unsuitable because of atherosclerosis or intimal damage, and we used the most recently retrieved ABO group-compatible vessels.The vascular grafts were prepared on the back table just before use and subsequently anastomosed to the infrarenal aorta, which was side-clamped by means of either an interrupted or a continuous 5/0 or 6/0 polypropylene suture. The graft was brought to the lesser sac through the transverse mesocolon, behind the stomach and in front of the pancreas. The distal end was subsequently anastomosed to the common hepatic artery or to the celiac trunk of the donor wit...

Objective: The goal of this study was to analyze our 10-year experience in the treatment of aneurysms of the collateral circulation secondary to steno-occlusions of the celiac trunk (CT) or superior mesenteric artery (SMA).Methods: In the last 10 years, 32 celiac-mesenteric aneurysms were detected (25 true aneurysms and seven pseudoaneurysms) in 25 patients with steno-occlusion of the CT or SMA. All cases were diagnosed and treated at our center, with either surgical or endovascular approach. As open surgery, we performed aneurysmectomy and revascularization; as endovascular treatment we performed both the embolization (or graft exclusion) of the aneurysm sac, and embolization of afferent and efferent arteries.Results: Sixteen patients (64%) underwent endovascular treatment, accounting for 66% of aneurysms (21/32). Six patients (24%) and seven associated aneurysms (22%) underwent open surgery. Three asymptomatic patients (12%), representing a total of four aneurysms (12%), were not treated. For endovascular procedures, the technical success rate was 90%, with a 56% clinical success rate. For open surgery, clinical and technical success were achieved in five patients (83%) and six procedures (86%), respectively. Sixty-eight percent of patients (17/25) were treated in an emergency setting, using either endovascular (88%) or open (12%) approaches. Although technical success was achieved in more than 85% of these procedures for both approaches, clinical success was reached less frequently among patients with an acute presentation (P ¼ .041). Regardless of the type of treatment, CT or SMA revascularization during the first procedure did not show an increased rate of clinical success (P ¼ .531). However, we reported four cases of visceral ischemia after an endovascular approach without revascularization, with three open surgical corrections required. The mean follow-up was 41 months (range, 0-136 months).Conclusions: Neither of the approaches described qualifies as a standard optimal choice. We suggest a tailored therapeutic approach based on the clinical condition at the time of diagnosis and specific vascular anatomy.

this data shows that suprarenal clamping, which is necessary for the radical treatment of juxtarenal aortic aneurysms, can be performed with a low risk.

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Preoperative poor renal function, blood transfusions, and the thoracoabdominal extent of the aortic disease were the most important predictors for AKI.