Hepatic Artery Kinking during Liver Transplantation

Abstract

Our survey confirms that no consensus is currently available regarding the most effective method for avoiding AK. Kinking occurs most probably when the liver is released in its final position. The utilization of an interposition method could ensure the maintenance of a correct HAF.

Early Hepatic Artery Thrombosis After Liver Transplantation: What is the Impact of the Arterial Reconstruction Type?

“…Two technical approaches are described for arterial reconstruction in clinical practice [24, 25]: either keeping a long graft artery offering a better lumen diameter [7, 26]; or splitting the graft artery to obtain a more anatomical, non‐redundant conduit [12, 18]. The first conservative approach should facilitate the management of potential post‐LT arterial complications, whereas the latter results in a smaller lumen diameter and potential difficulties in case of reoperation for arterial complications.…”

“…Although many methods have been described to prevent HA kinking, such as omental flap or interposition of hemostatic sealants [25, 28], a long graft artery seems to be more exposed to kinking or at least to leukocytes/platelets aggregation, which contributes to reduced arterial flow and thrombus formation. To our knowledge, there is no evidence that using a long graft artery could improve the management of potential post‐LT arterial complications.…”

“…Although many methods have been described to prevent HA kinking, such as omental flap or interposition of hemostatic sealants [25,28], a long graft artery seems to be Fig. 3 Types of arterial reconstruction more exposed to kinking or at least to leukocytes/platelets aggregation, which contributes to reduced arterial flow and thrombus formation.…”

Omental Flap for Hepatic Artery Coverage During Liver Transplantation

“…All transplantations were routinely performed by an experienced surgeon (>50 liver transplantations) with × 2.5 magnification loupes for the small sutures (artery and bile duct). 12 At the end of the anastomosis, we perform an omental flap by cutting the great omentum with a LigaSure device (LigaSure™, Covidien Energy (Ireland)) or with scissors after simple ligatures (3/0 Vicryl™; Ethicon, Johnson & Johnson International (Belgium)). Additional hemostasis is made with bipolar forceps.…”

Understanding Local Hemodynamic Changes After Liver Transplant: Different Entities or Simply Different Sides to the Same Coin?

“…42 When kinking is identified, surgeons usually opt for "hepatic artery antikinking methods," which include the use of surgical celluloid or omentum patches to correct the kinking. 43 Preventing anastomotic kinking is a key factor in the prevention of HAT, which, as previously mentioned, can greatly compromise graft survival and is a leading cause of retransplantation.…”