N Yang1, H-B Zhang, J-H Lu, J Zhao, H Si-Ma, N Zhu, G-S Yang. 1. 5th Department of Liver Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Abstract
OBJECTIVE: To explore the surgical techniques of hepatic artery reconstruction in liver transplantation (OLT) and the choice of treatment for hepatic artery thrombosis (HAT). METHODS: We analyzed hepatic artery reconstructions based on 234 cadaveric donor liver transplantations and seven living related liver transplantations from April 2003 to February 2009. Anastomosis time was compared between the groups with respect to vascular caliber. Interventional thrombolysis or early thrombectomy and hepatic artery reconstruction was implemented in three HAT cases. RESULTS: The hepatic artery anastomoses for vessels less than 3 mm in diameter (n = 78) required 33.6 ± 21.3 minutes which were significantly greater compared with those for vessels more than 3 mm in diameter (n = 163; 19.4 ± 7.4 minutes). Among two patients (0.83%) who developed early HAT within the first week after the operation, one was successfully treated by interventional thrombolysis, but the other required an urgent conduit between the aorta and the graft after attempted thrombolysis. Only one patient (0.41%) displayed a delayed HAT without special management, but recovered liver function upon follow-up. DISCUSSION: Early detection and proper revascularization measures can yield satisfactory results after HAT.
OBJECTIVE: To explore the surgical techniques of hepatic artery reconstruction in liver transplantation (OLT) and the choice of treatment for hepatic artery thrombosis (HAT). METHODS: We analyzed hepatic artery reconstructions based on 234 cadaveric donor liver transplantations and seven living related liver transplantations from April 2003 to February 2009. Anastomosis time was compared between the groups with respect to vascular caliber. Interventional thrombolysis or early thrombectomy and hepatic artery reconstruction was implemented in three HAT cases. RESULTS: The hepatic artery anastomoses for vessels less than 3 mm in diameter (n = 78) required 33.6 ± 21.3 minutes which were significantly greater compared with those for vessels more than 3 mm in diameter (n = 163; 19.4 ± 7.4 minutes). Among two patients (0.83%) who developed early HAT within the first week after the operation, one was successfully treated by interventional thrombolysis, but the other required an urgent conduit between the aorta and the graft after attempted thrombolysis. Only one patient (0.41%) displayed a delayed HAT without special management, but recovered liver function upon follow-up. DISCUSSION: Early detection and proper revascularization measures can yield satisfactory results after HAT.