An Alternative Method of Arterial Reconstruction After Hepatic Arterial Thrombosis Following Living-Related Liver Transplantation

Ikegami, Toshihiko; Kawasaki, Seiji; Hashikura, Yasuhiko; Miwa, Shiro; Kubota, Tatsuya; Mita, Atsuyoshi; Iijima, Satoshi; Terada, Masaru; Miyagawa, Shinichi; Furuta, S

doi:10.1097/00007890-200005150-00036

Cited by 43 publications

(27 citation statements)

References 9 publications

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“…42 Many revascularization procedures were recommended to manage HAT, e.g., thrombectomy alone, creation of a new anastomosis between a more proximal part of the recipient artery and the donor artery, introduction of an interposition graft, or using different intraabdominal arteries. 8,32,33,41 However, these efforts may salvage the graft, most patients with HAT in the early posttransplant period need urgent retransplantation. But even if they have undergone retransplantation, the survival rates are lower than those who do not develop this complication.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical reconstruction of hepatic artery during living donor liver transplantation

et al. 2005

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Living donor liver transplantation (LDLT) has become a well-recognized treatment modality for patients with end-stage liver disease. Arterial reconstruction during LDLT is perhaps the most important aspect of the grafting procedure. Although microsurgical hepatic artery reconstruction has become the essential technique in LDLT, it poses significant challenges even to experienced microsurgeons. In this report, the experiences of 155 microsurgical reconstructions of the hepatic artery in 150 LDLTs were reviewed, and the problems that were encountered and the solutions are discussed. From June 1999-March 2004 150 LDLTs were performed on 148 recipients at Ege University Organ Transplantation and Research Center. Hepatic arterial thrombosis was encountered in 3 patients. Microsurgical technique has overcome the difficulties in LDLT. This has increased liver transplantations in the presence of limited cadaver grafts and has decreased the patient mortality in the waiting list.

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Section: Discussionmentioning

confidence: 99%

Microsurgical reconstruction of hepatic artery during living donor liver transplantation

et al. 2005

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“…So these early experiences have been accumulated, several techniques have attempted to improve the success rate. Recently many centers have designed new technique in order to reduce the arterial damage and complication which happens in operation (12)(13)(14). Other methods such as the fish-mouth method, funnelization method, or end-to-side anastomosis were not used in this study; sometimes it is dangerous to use the conventional twist reconstruction technique, because it may require turning over a damaged, short artery, some reports support a back wall support suture technique with double needle suture instead of conventional rotating method.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Arterial Complications after Liver Transplantation: A Single-Center Experience

Lee

Choi

Chung

et al. 2011

Korean J Transplant

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Background: We wanted to explore performing hepatic arterial reconstruction in living donor liver transplantation (LDLT) using right lobe liver grafts and cadaveric liver transplantation (CLT) in a single center.Methods: Thirty five LDLTs were performed from April 2005 to August 2009. The back wall support suture without twisting was used in most cases. A single RHA was anastomosed to the RHA in 24 patients, to the proper HA in 2 patients, to the RAHA in 4 patients, to the LHA in 2 patients and to an aberrant RHA arising from the SMA in 3 patients. The diameter of the donor RHA was between 1.5 mm and 3.0 mm (mean: 2.5 mm). In the 34 patients who underwent CLT, most of the arterial anastomoses were usually performed using two cuffs at the recipient HA and the GDA bifurcation and a branching point on the donor CHA with running and intermittent stay suture.Results: The total incidence of HA complication was 4.34% (3/69): 1 HAT (2.85%) occurred in a case of LDLT and 2 HAS (5.88%) occurred in a case of CLT. HAT occurred in 1 recipient on the 1st day following LDLT and 2 HAS occurred in CLT recipients at one and two months, respectively, following LDLT.Conclusions: HA complications occurred as a mild type of late complication and these complications might not be fatal in CLT. A low incidence of HAT can be achieved with using non-twisting method-guided microsurgical techniques for creating hepatic arterial anastomosis in LDLT. When early HAT occurs, early surgical reconstruction is mandatory for preventing the loss of the graft. Back wall sutures with only single needle suture might be a feasible method for HA microsurgical reconstruction.

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“…Reestablishment of arterial inflow through the splenic artery 14 or gastroepiploic artery 15 have been described. Autologous saphenous vein 16 and sigmoid artery 17 interposition grafts have also been used.…”

Section: Discussionmentioning

confidence: 99%

Use of autologous radial artery for revascularization of hepatic artery thrombosis after orthotopic liver transplantation: Case report and review of indications and options for urgent hepatic artery reconstruction

Rogers

Chavin

Kratz

et al. 2001

Liver Transplantation

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Hepatic artery thrombosis (HAT) is the most common vascular complication after orthotopic liver transplantation (OLT) and has traditionally been managed with re-OLT. However, several reports have shown that urgent revascularization is frequently an effective means of graft salvage. This most often involves hepatic artery (HA) thrombectomy and thrombolysis, with reestablishment of arterial inflow through a donor iliac artery conduit based on the supraceliac or infrarenal aorta. We report a 46-year-old man who developed HAT 13 days after OLT after angiographic splenic artery embolization to reduce splenic artery steal. A suitable donor iliac artery was not available for arterial reconstruction and could not be obtained from neighboring transplant centers. The patient underwent urgent HA thrombectomy, intrahepatic arterial thrombolysis, and revascularization using an autologous radial artery (RA) conduit based on the supraceliac aorta. The patient is alive more than 1 year after revascularization, with normal liver function and documented flow in the arterial conduit by Doppler ultrasound and arteriography. He has not developed late biliary complications or adverse sequelae of RA harvest. Autologous RA can be safely and successfully used as an aortic-based arterial conduit in urgent revascularization of HAT after OLT. RA should be considered for use in HA revascularization if an adequate donor iliac artery is not available and other potential conduits are not usable or desirable. The availability of autologous RA expands the armamentarium of vascular conduits that can be used in HA revascularization and may help minimize re-OLT for otherwise potentially salvageable liver allografts. (Liver Transpl 2001;7:913-917.) H epatic artery (HA) thrombosis (HAT) is the most common vascular complication in orthotopic liver transplantation (OLT), with an incidence of 2% to 5% in adults and 10% to 33% in children. 1 Although interruption of HA flow is frequently well tolerated in a native liver because of the presence of collateral arterial blood supply, it is often a morbid and life-threatening event after OLT because of the lack of collateral vessels. Although it has been speculated that as many as one third of all early cases of HAT after OLT may be asymptomatic, 2 many episodes of HAT result in either acute hepatic necrosis and liver failure or late biloma and hepatic abscess formation. Traditionally, HAT has been considered an indication for urgent re-OLT, and most cases are still managed in this way. Although re-OLT has significantly reduced the morbidity and mortality attributable to HAT, this option has become limited by the decreasing availability of organs for transplantation. Over the past decade, several reports have shown the effectiveness of urgent revascularization for early HAT. [2][3][4][5][6] Although HA thrombectomy with primary reanastomosis is well described, revascularization usually requires the use of a donor iliac artery as a vascular conduit between the aorta and allograft HA.We report a novel approach ...

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An Alternative Method of Arterial Reconstruction After Hepatic Arterial Thrombosis Following Living-Related Liver Transplantation

Cited by 43 publications

References 9 publications

Microsurgical reconstruction of hepatic artery during living donor liver transplantation

Microsurgical reconstruction of hepatic artery during living donor liver transplantation

Hepatic Arterial Complications after Liver Transplantation: A Single-Center Experience

Use of autologous radial artery for revascularization of hepatic artery thrombosis after orthotopic liver transplantation: Case report and review of indications and options for urgent hepatic artery reconstruction

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