Rescue for rare complications of the hepatic artery in living donor liver transplantation using grafts of autologous inferior mesenteric artery

Abstract

This report describes two rescued cases with rare complications of the hepatic artery in livingdonor liver transplantation (LDLT). In both cases a segment of the autologous inferior mesenteric artery (IMA) was successfully used as an arterial graft for re-vascularization under microsurgery. The first case was that of a pseudoaneurysm of the hepatic artery, which caused massive gastrointestinal bleeding. The hepatic arteries of the pre-and post-aneurysm were divided, and the arterial graft from the recipient's IMA was interposed for reconstruction. The second case was that of an intimal dissection of the recipient's hepatic artery. Because the dissection extended to the root of the common hepatic artery, the autologous IMA was interposed between the donor's hepatic artery and the proximal stump of the recipient's splenic artery. Reconstruction using the arterial graft of the autologous IMA is feasible for re-vascularization of the hepatic artery in liver transplantation.

Evaluation of the hepatic artery anastomosis by intraoperative sonography with high‐frequency transducer in right‐lobe graft living donor liver transplantation

“…HA dissection has been regarded as a rare complication after LT. There have been anecdotal reports about this complication, [10][11][12][13][14] which is thought to be caused by clamp injury or honeycomb-like intimal deformity of the recipient's HA. 9,10 In our series, the dissection invariably occurred at the recipient HA in all 4 patients.…”

Dissection of the Hepatic Artery and the Celiac Trunk After a Liver Transplant: Description of a Complication and Endovascular Management

“…3,4 An insufficient recipient's hepatic artery may require anastomosis, that is, to the splenic artery directly, 4 or by using an autologous interpolate (eg, a segment of the inferior mesenteric artery). 5 If this is not technically feasible, the donor artery can be anastomosed to intestinal branches, such as a jejunal arcade of a Roux-en-Y limb. 3 Hepatic artery dissection occurring postoperatively after an orthotopic liver transplant is rare, and only several cases have been described worldwide.…”

“…3 Hepatic artery dissection occurring postoperatively after an orthotopic liver transplant is rare, and only several cases have been described worldwide. [5][6][7] Kim and associates reported the first series of hepatic artery dissection in a living-donor liver transplant. 7 Adami and associates described the development of a hepatic artery dissection from a pseudoaneurysm, extending into the graft bifurcation requiring retransplant.…”

Microsurgical hepatic artery reconstruction during living-donor liver transplantation by using head-mounted surgical binocular system

“…For both anastomotic techniques, Varioscope could provide sufficient magnification at an appropriate working distance. Although vascular interposition grafts for hepatic artery reconstruction were not used in this series, they may be occasionally required when a suitable recipient’s artery is not available for reconstruction [12,13]. The utility of the Varioscope in such cases remains to be tested.…”