Skip to main content

Advertisement

SpringerLink
Log in

Double Arterial Anastomosis in Liver Transplantation: Is Two Better than One?

  • How I do it
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Arterial revascularization during liver transplantation is normally achieved by anastomosing the graft hepatic artery to the largest artery available at the recipient pedicle—either the common hepatic artery (CHA) or an accessory right hepatic artery (RHA) originating from the superior mesenteric artery (SMA). When a small caliber RHA is present, the artery is ligated and a single anastomosis with the CHA is performed. In the absence of a vascular reconstruction of the graft, the gastroduodenal artery is usually ligated as well. In this article, we describe a new type of arterial anastomosis in the case of a small accessory RHA and/or severe graft hepatic artery atherosclerosis that is commonly seen in elderly donors. To our knowledge, these are the first cases reported in the literature. This technique can be easily performed without increasing the arterial revascularization time or increasing the risk of complications associated with arteriosclerotic arteries. A 12-month follow-up revealed excellent function of the liver grafts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pakosz-Golanowsha M, Lubikowski J, Post M, Jarosz K, Zasada-Cedro K, Milkiewicz P, Wójcicki M. The arterial anastomosis in liver transplantation: complications, treatment and outcome. Hepatogastroenterology. 2010 Nov-Dec;57(104):1477–82.

    PubMed  Google Scholar 

  2. Maluf D, Clark BD, Cotterell AH, Posner MP, Fisher RA.Massive hepatic artery atherosclerosis of an otherwise suitable donor liver: a case report. Transplant Proc. 2004 Jun;36(5):1438–41.

    Article  PubMed  CAS  Google Scholar 

  3. Stange BJ, Glanemann M, Nuessler NC, Settmacher U, Steinmüller T, Neuhaus P. Hepatic artery thrombosis after adult liver transplantation. Liver Transpl. 2003 Jun;9(6):612–20.

    Article  PubMed  Google Scholar 

  4. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966 Sep;112(3):337–47.

    Article  PubMed  CAS  Google Scholar 

  5. Silva MA, Jambulingam PS, Gunson BK, Mayer D, Buckels JA, Mirza DF, Bramhall SR. Hepatic artery thrombosis following orthotopic liver transplantation: a 10-year experience from a single centre in the United Kingdom. Liver Transpl. 2006 Jan;12(1):146–51.

    Article  PubMed  Google Scholar 

  6. Omori S, Ishizaki Y, Sugo H, Yoshimoto J, Imamura H, Yamataka A, Kawasaki S. Direct measurement of hepatic blood flow during living donor liver transplantation in children. J Pediatr Surg. 2010 Mar;45(3):545–8.

    Article  PubMed  Google Scholar 

  7. Aoki T, Imamura H, Kaneko J, Sakamoto Y, Matsuyama Y, Kokudo N, Sugawara Y, Makuuchi M. Intraoperative direct measurement of hepatic arterial buffer response in patients with or without cirrhosis. Liver Transpl. 2005 Jun;11(6):684–91.

    Article  PubMed  Google Scholar 

  8. Panaro F, Bouyabrine H, Carabalona JP, Marchand JP, Jaber S, Navarro F. Hepatic artery kinking during liver transplantation: survey and prospective intraoperative flow measurement. J Gastrointest Surg. 2012 Aug;16(8):1524–30.

    Article  PubMed  Google Scholar 

  9. Panaro F, Gallix B, Bouyabrine H, Ramos J, Addeo P, Testa G, Carabalona JP, Pageaux G, Domergue J, Navarro F. Liver transplantation and spontaneous neovascularization after arterial thrombosis: "the neovascularized liver". Transpl Int. 2011 Sep;24(9):949–57.

    Article  PubMed  Google Scholar 

  10. Ishigami K. Does variant hepatic artery anatomy in a liver transplant recipient increase the risk of hepatic artery complications after transplantation?. AJR Am J Roentgenol, 2004 Dec;183(6):1577–84.

    Article  PubMed  Google Scholar 

  11. Kornasiewicz O, Dudek K, Lewandowski Z, Grat ZM, Scibisz A, Nyckowski P, Krawczyk M. Low incidence of hepatic artery thrombosis after hepatic artery reconstruction during liver transplantation. Transplant Proc. 2009 Oct;41(8):3138–40.

    Article  PubMed  CAS  Google Scholar 

  12. Yaprak O, Demirbas T, Duran C, Dayangac M, Akyildiz M, Tokat Y, Yuzer Y. Living donor liver hilar variations: surgical approaches and implications. Hepatobiliary Pancreat Dis Int. 2011 Oct;10(5):474–9.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors of this manuscript have no conflicts of interest to disclose.

Funding

The authors have declared no funding.

Author information

Authors and Affiliations

  1. Department of General and Liver Transplant Surgery, Hôpital Saint Eloi, University of Montpellier, School of Medicine, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France

    Fabrizio Panaro, John Chauvat, Jean-Pierre Carabalona, Hassan Bouyabrine, Jean-Pierre Marchand & Francis Navarro

  2. Department of Abdominal Imaging, Hôpital Saint Eloi, University of Montpellier, School of Medicine, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France

    Stephanie Nougaret

  3. Department of Surgery, Liver Transplant Unit, Montpellier University Hospital, College of Medicine, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France

    Fabrizio Panaro

Authors
  1. Fabrizio Panaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John Chauvat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Pierre Carabalona
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephanie Nougaret
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hassan Bouyabrine
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean-Pierre Marchand
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francis Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabrizio Panaro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Panaro, F., Chauvat, J., Carabalona, JP. et al. Double Arterial Anastomosis in Liver Transplantation: Is Two Better than One?. J Gastrointest Surg 17, 1512–1515 (2013). https://doi.org/10.1007/s11605-013-2154-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2154-0

Keywords

Search

Navigation