The recipient celiac trunk as an alternative to the native hepatic artery for arterial reconstruction in adult liver transplantation

Abstract

During liver transplantation (LT), the recipient hepatic artery (RHA) cannot always be used, and alternatives include aortohepatic conduits and the splenic artery (SA). We report our experience with arterial reconstruction on the recipient celiac trunk (RCT), which has rarely been described. Since January 2013, we have been using the RCT when the RHA could not be used. All cases were discussed in a multidisciplinary LT meeting, and arterial patency or anomalies were systemically viewed with computed tomography (CT) scan. The RCT was used after section-ligation of all celiac trunk collaterals. Until May 2014, the RHA could not be used in 11/139 (8%) patients who underwent LT. Postoperative arterial patency was assessed by serial Doppler ultrasound and CT scan. The advantages and disadvantages of the different arterial conduits were evaluated. The RCT was used in 7/11 (64%) patients. Mean follow-up was 10 (6-15) months. The patency rate was 100%, and 1 patient with associated portal shunting died at day 20 from septic complications. No related gastric or splenic complications were encountered. The RCT could not be used in 4 patients with reconstruction on the SA (n 5 2), infrarenal (n 5 1), and supraceliac aorta (n 5 1). The patency rate was 75%. One patient with SA conduit and portal shunting developed pancreatitis/anastomotic pseudoaneurysm with secondary rupture. An emergency infrarenal conduit was created, which was later embolized because of infected pseudoaneurysms. Although the literature reports a higher risk of thrombosis with aortohepatic conduits, no long-term results are available for the SA conduits, and only 1 report is available for the RCT. In conclusion, this study shows that the RCT is a good alternative to the RHA and can be used in two-thirds of patients with inadequate RHA flow.

Short‐ and long‐term outcomes of arterial reconstruction on recipient splenic artery in adult liver transplantation. Single‐center prospective study 25 years after first description

“…Recently, Dokmak et al [14] proposed the recipient celiac trunk (RCT) as the best alternative to the HA for arterial reconstruction. The main drawbacks they attributed to the SA reconstruction were the risks of bleeding and pancreatitis.…”

“…However, although a few others studies have described short-term outcomes in cases series [11][12][13], there has been no comprehensive long-term report on the outcomes of this technique. Otherwise it has been published recent evidence for an alternative technique using arterial anastomosis directly to the recipient's celiac trunk [14]. The authors report good short-term outcomes in a short series of seven patients performed with this arterial reconstruction technique.…”

Vascular complications after orthotopic liver transplantation

“…Стойкий артериальный спазм, недостаточный диаметр, атеросклеротическое поражение собственной печеночной артерии и неудовлетворительный артериальный поток, наличие в анамнезе эндо-васкулярных вмешательств (эмболизация пече-ночной артерии) или предсуществующий тромбоз могут потребовать альтернативных методов арте-риальной реконструкции. В подобных ситуациях наиболее распространенным решением являет-ся анастомоз, осуществляемый непосредственно между аортой реципиента и чревным стволом донора с использованием аллопротезов, в каче-стве которых, как правило, используют под-вздошные сосуды донора [17,24,25]. Вместе с тем, по мнению большинства авторов, подобные соустья сопровождаются статистически значимо большим процентом ТПА по сравнению с тра-диционным методом артериальной реконструк-ции [1,2,6,10,17].…”

“…Ранее перенесенные операции, спаеч-ный процесс, ожирение осложняют выделение соответствующего участка аортальной стенки. По мнению W. Vanderlan et al (2008), при неудовле-творительном состоянии собственной печеноч-ной артерии реципиента предпочтение следует отдавать анастомозу с селезеночной артерией; S. Dookmak (2015) в подобных случаях рекомендует использовать чревный ствол реципиента [18,25].…”

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“…Donor iliac arteries are used for this procedure. 2,3 Here, we report an alternative method using arterial transposition of the recipient's splenic artery for HA reconstruction.…”