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.

Risk factors and treatments for hepatic arterial complications in pediatric living donor liver transplantation

“…In such cases, the recipient splenic artery, right gastroepiploic artery, or jejunal artery of the Roux-en-Y limb can be used safely for hepatic arterial reconstruction [9,[19][20][21][22][23]. On the other hand, hepatic arterial reconstruction using an interposition graft can be selected when the native recipient artery around the hepatic arterial anastomotic position cannot be used [24][25][26]. However, there are strong arguments suggest- The graft survival of the recipients with and without hepatic arterial complication (HAC).…”

“…The log-rank test showed that the accumulated graft survival rate of recipients without HAC was significantly higher than that of recipients with HAC (P < 0.001) Table 5 Treatment and outcome of recipients with hepatic artery complications (HAC) ing that use of an arterial conduit is a risk factor for HAC [3]. Hepatic arterial reconstruction using an interposition graft necessitates two micro-vascular anastomoses, increasing the complexity and duration of the procedure, and increasing the risk of HAC [24][25][26]. Thus, hepatic arterial reconstruction using an interposition graft should be avoided whenever possible.…”

Hepatic artery aneurysm arising from an interposition vein graft four years after auxiliary partial orthotopic liver transplantation

“…Retrospectively, we can conclude that we should not have used an interposition vein graft for arterial reconstruction in this case. Inferior mesenteric arteries [5], radial arteries [6], and sigmoid arteries [7] have all been suggested as candidates for interposition grafts for arterial reconstruction in liver transplantation.…”

The extra‐anatomical jump graft reconstruction of the right hepatic artery after resection of a biliary tract malignancy with a common hepatic artery aneurysm: a case report

“…Extra-anatomical reconstructions are often performed during LDLT, and involve the anastomoses of the graft's hepatic artery and the recipient's other arteries such as the gastroduodenal artery (GDA), the right gastroepiploic artery (RGEA), or the right gastric artery (RGA). There have been reports of other arteries being used in LDLT, such as the splenic artery, the sigmoid artery, and the mesenteric artery [6][7][8][9]. In this case, we could not use the GDA, RGEA, or RGA because of coiling for HAIC.…”