Abstract
A right replaced hepatic artery (RRHA) arising from the superior mesenteric artery (SMA) is the most frequent variation of the hepatic arterial supply requiring backtable reconstruction. There are several widely used techniques for backtable reconstruction of the RRHA to a single conduit. If these reconstructions fail, due to technical reasons or size discrepancies, an alternative method of rearterialization is needed. We describe six cases in which an RRHA was anastomosed to the donor's gastroduodenal artery (GDA) stump utilizing a loupe magnification technique. In four cases the reconstruction was performed at the time of the backtable procedure and in two after reperfusion and failure of the original RRHA to splenic artery (SA) reconstruction. In all cases, the anastomoses remained patent. All patients had Doppler sonography and two had subsequent arteriograms that verified anastomotic patency. This method of reconstruction is more demanding technically but obviates the awkward 90-degree twist of the hepatic artery when an RRHA is anastomosed to the SA stump.
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Colledan M, Feris G, Rossi G, Gridelli B, Fassati LR, Reggiani P, Maggi V, Gatt S, Piazzino A, Gision M, Galmarini D (1990) Bench reconstruction of the graft arterial supply in liver transplantation. Transplant Proc 22: 408–409
Gordon RD, Shaw BW, Iwatsuki S, Todo S, Starzl TE (1985) A simplified technique for revascularization of homografts of the liver with a variant right hepatic artery from the superior mesenteric artery. Surg Gynecol Obstet 160: 475–476
Kalayoglu M, Belzer FO (1987) A new technique for arterialization of the hepatic graft. Surg Gynecol Obstet 164: 565–567
Merion RM, Burtch GD, Ham JM, Turcotte JG, Campbell DA (1989) The hepatic artery in liver transplantation. Transplantation 48: 438–443
Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112: 337–347
Shaw BW, Iwatsuki S, Starzl TE (1984) Alternative methods of arterialization of the hepatic graft. Surg Gynecol Obstet 159: 491–493
Suzuki T, Nakayasu A, Kawabe K, Takeda H, Honjo I (1971) Surgical significance of anatomic variations of the hepatic artery. Am J Surg 122: 505–512
Todo S, Makowka L, Tzakis AG, Marsh JW, Karrer RM, Armancy M, Miller C, Talbert MB, Esquival CV, Gordon RD, Iwatsuki S, Starzl TE (1987) Hepatic artery in liver transplantation. Transplant Proc 19: 2406–2411
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Merhav, H.J., Mieles, L.A., Ye, Y. et al. Alternative procedure for failed reconstruction of a right replaced hepatic artery in liver transplantation. Transpl Int 8, 414–417 (1995). https://doi.org/10.1007/BF00337178
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DOI: https://doi.org/10.1007/BF00337178