Use of the Splenic Artery for Arterial Reconstruction in Living Donor Liver Transplantation

Hepatic arterial complications in adult living donor liver transplant recipients: a single‐center experience of 673 cases

“…In detail, the median interval from LDLT was 13 d (2–44) in HAT, 5.5 d in anastomotic bleeding, 29.5 d (13–63) in anastomotic stenosis, and 18 d (4–33) in rupture of anastomotic aneurysm.…”

“…In particular, extra‐anatomical anastomosis is a very important surgical risk factor. Several studies demonstrated the usefulness of extra‐anatomical reconstruction using other arteries, such as recipients’ gastroduodenal artery , splenic artery , and right gastroepiploic artery , instead of unusable hepatic arteries. Besides these extrahepatic arteries, the condition of patients’ vessels sometimes necessitates anastomosis using other arteries as well.…”

Hepatic artery reconstruction after extended resection for borderline resectable pancreatic head cancer: A case report

“…The splenic artery represents one of the most commonly cited types of autologous grafts, being used either by transposition or interposition for both superior mesenteric and hepatic artery (30). Utility of splenic artery in order to provide an adequate arterial hepatic flow was initially investigated in living donor liver transplantation and proved to be a safe and efficient one (31). It seems that the use of this arterial segment is associated with low risks of intraoperative and postoperative complications and was further included in the therapeutic armamentarium of hepatic arterial reconstruction after extended resections for borderline resectable pancreatic cancer (5).…”

Reconstrução arterial no transplante hepático: a melhor reconstrução para variação da artéria hepática direita

“…The authors think that the reconstruction technique using the splenic artery with a superior mesenteric artery Carrel-patch ( Figure 1) has multiple advantages: 1) the caliber of the splenic artery is always bigger than the R/A-RHA, and it has always a good flow, especially in cirrhotic patients 8,24 ; thus a better flow arrives at its ostium and the anastomosis takes place with a bigger arterial caliber; 2) the use of superior mesenteric artery Carrel-patch allows an easier anastomosis without the need for branch caliber reduction; 3) when Carrel-patch is not used, the small caliber of the R/A-RHA creates a challenge for anastomosis because of the consequent disproportion with the caliber of the splenic artery; 4) in anatomical position, the celiac trunk turns posteriorly and the splenic artery is inferior and bottom-up in relation to the celiac trunk. After the aorta is divided and the celiac trunk is rectified, the splenic artery turns to the right, facing the accessory right hepatic branch, leading to a straight position after the anastomosis (Figure 2); 5) the length of the R/A-RHA is always sufficient to allow a short splenic stump anastomosis; 6) the anastomosis with the splenic artery leaves other options to perform the anastomosis at the recipient subject (aortal patch, celiac trunk, left gastric artery patch); 7) the celiac trunk remains in a straight position after the reconstruction to perform the recipient anastomosis; 8) only a short stump length is needed for the splenic artery and the superior mesenteric artery, which allows a simultaneous pancreas procurement because the inferior pancreatic arteries are at distances greater than 1cm from the R/A-RHA in most cases 7 .…”