BACKGROUND: The immediate challenges during microvascular reconstruction of hepatic artery (HAR) during liver transplantation (LT) can be many. Hence, in order to give a cross sectional view of these problems this study over a period of 1 year, showing our routine practice, was taken up. METHODS: From January 2015 to December 2015, a total of 133 LTs were performed in Kaohsiung Chang Gung Memorial Hospital, Taiwan. All hepatic artery (HA) reconstructions were performed by a microvascular surgeon under an operating microscope. RESULTS: In the 133 patients, one artery was anastomosed in 123 (92.5%) patients, two in 9 (6.8%) patients and three in 1 (0.7%) of the patient. Eleven (8.3%) arteries were less than 2 mm in size (1-1.9 mm). There were intimal dissections (IDs) involving either the donor or the recipient arteries of mild to severe nature in 9 (6.8%) patients. Immediately following graft arterial anastomosis, either there was no flow or an intraoperative hepatic artery thrombosis (HAT) was found in nine (7.1%-8 LDLT, 4.8%-1 DDLT) patients. Immediate re-do anastomosis was done in all of these patients who did well in the follow-up. The overall post-operative success rate was 99.2%. One patient (0.8%) developed postoperative HAT due to infection during follow up and died due to sepsis. CONCLUSIONS: Small vessels or HA injury are the frequently encountered problems by a micro vascular surgeon. The other problems could be ID, need to do multiple reconstructions, immediate HAT and ability to re-do the HAR immediately.
BACKGROUND: The immediate challenges during microvascular reconstruction of hepatic artery (HAR) during liver transplantation (LT) can be many. Hence, in order to give a cross sectional view of these problems this study over a period of 1 year, showing our routine practice, was taken up. METHODS: From January 2015 to December 2015, a total of 133 LTs were performed in Kaohsiung Chang Gung Memorial Hospital, Taiwan. All hepatic artery (HA) reconstructions were performed by a microvascular surgeon under an operating microscope. RESULTS: In the 133 patients, one artery was anastomosed in 123 (92.5%) patients, two in 9 (6.8%) patients and three in 1 (0.7%) of the patient. Eleven (8.3%) arteries were less than 2 mm in size (1-1.9 mm). There were intimal dissections (IDs) involving either the donor or the recipient arteries of mild to severe nature in 9 (6.8%) patients. Immediately following graft arterial anastomosis, either there was no flow or an intraoperative hepatic artery thrombosis (HAT) was found in nine (7.1%-8 LDLT, 4.8%-1 DDLT) patients. Immediate re-do anastomosis was done in all of these patients who did well in the follow-up. The overall post-operative success rate was 99.2%. One patient (0.8%) developed postoperative HAT due to infection during follow up and died due to sepsis. CONCLUSIONS: Small vessels or HA injury are the frequently encountered problems by a micro vascular surgeon. The other problems could be ID, need to do multiple reconstructions, immediate HAT and ability to re-do the HAR immediately.
Authors: K Kubota; M Makuuchi; T Takayama; Y Harihara; K Hasegawa; T Aoki; H Asato; H Kawarasaki Journal: Transplantation Date: 2000-08-27 Impact factor: 4.939
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Authors: H Egawa; Y Inomata; S Uemoto; K Asonuma; T Kiuchi; S Fujita; M Hayashi; M A Matamoros; K Itou; K Tanaka Journal: World J Surg Date: 2001-10 Impact factor: 3.352
Authors: K Mori; I Nagata; S Yamagata; H Sasaki; F Nishizawa; Y Takada; F Moriyasu; K Tanaka; Y Yamaoka; K Kumada Journal: Transplantation Date: 1992-08 Impact factor: 4.939
Authors: Paola A Vargas; Haowei Wang; Christina Dalzell; Curtis Argo; Zachary Henry; Feng Su; Matthew J Stotts; Patrick Northup; Jose Oberholzer; Shawn Pelletier; Nicolas Goldaracena Journal: Transplant Direct Date: 2022-04-07