Clinical application of arterialization of portal vein in living related donor partial liver transplantation

Abstract

Arterialization of the portal vein was employed during hepatic arterial reconstruction in our first few clinical experiences of partial liver transplantation using liver grafts obtained from living related donors. This procedure reduced the time required for revascularization of the grafts to about 25 min, and could in fact reduce the ischemic phase of the grafts. Repeated practice of the clinical transplantation technique has shortened the time needed to complete vascular reconstruction, eliminating the need for this procedure in most of our subsequent cases. In many clinical cases, however, there may be emergency situations which require vascular reconstruction, resulting in a prolongation of ischemic phase and the deterioration of the cellular viability of the graft. In such situations, arterialization of the portal vein can be a useful way to prevent the prolongation of the ischemic phase and to rescue the graft.

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“…Not surprisingly, every group that introduced PVA in his armamentarium started to use the technique more and more widening the indications. The broad spectrum of indications to PVA is reported in a recent paper from the group of Paul Brousse [2].…”

“…First introduced in 1992 like a method to replace a damaged hepatic artery during major hepatobiliary surgery [3], PVA is becoming now a method to rescue the grafts in the field of liver transplantation, when an arterial thrombosis occur and there are no alternative ways to restore the arterial flow [2]. During these experiences it appeared evident that the Arterialization is not just useful to replace the hepatic artery flow, but also to reverse the necrosis that very often is linked to the thrombosis.…”

“…d) To reverse massive necrosis [2] or severe toxic injury of the liver [7] would lead to think about a possible role in AHF. Anyway because of the polarization of surgeons and hepatologists toward the transplant, this possible therapeutical approach to AHF remains still in the shadow.…”

“…Regarding the technical aspects, previous reports [2] show that it's preferable to use medium size arterial inflow vessels, to ensure good oxygenation and to increase the chance of patency. In our patient we took in account the marked coagulopathy, that make advisable to use a site that do not require extensive dissection to perform the shunt, through a short midline incision that doesn't require an interposition graft and can be performed in a short time.…”

“…In our patient we took in account the marked coagulopathy, that make advisable to use a site that do not require extensive dissection to perform the shunt, through a short midline incision that doesn't require an interposition graft and can be performed in a short time. This approach has also has the advantage to leave intact the hepatic hylum and major vessels in case of future operations and easily reversed by embolization or in any case after eventual recovery [2] or the onset of complications due to portal hypertension.…”