Double arterial anastomosis in liver transplantation: is two better than one?

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.