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Volume: 6 Issue: 4 November 2008 - Supplement - 1

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ALTERNATIVE HEPATIC ARTERY RECONSTRUCTION IN A PATIENT WITH LIVER TRANSPLANT: A CASE REPORT

Despite improvements in the surgical techniques used for liver transplants, hepatic artery thrombosis remains the most common vascular complication. Among other factors, a precise, initial, tension-free, vascular anastomotic technique remains a key factor for preventing hepatic artery thromboses. Here, we describe a patient in whom the gap between the graft artery and the recipient hepatic artery was observed intraoperatively as being short; the gap was subsequently managed successfully with an alternate modified radial artery reconstruction technique. A 23-year-old man with hepatic alveolar hydatid cyst underwent a living-donor liver transplant. After determining the gap between the graft left hepatic artery and the recipient proper hepatic artery, we made a search for an alternative source for the vascular graft. However, neither the arterial graft from the donor nor from the patient was viable. We decided to create an interposition graft anastomosis using a radial artery. The left radial artery was subsequently harvested. Seeing that the diameter of the lumen of the radial artery was less than 2 mm, it was double bended, the edges were longitudinally incised parallel to each other, and both arterial segments were sutured together with continuous 7-0 monofilament nonabsorbable suture material. We therefore created a modified arterial interposition graft that was of better quality and wider than the original. An end-to-end anastomosis was done between the donor right hepatic artery and recipient’s proper hepatic artery using a modified radial artery interposition graft. We used a continuous back-wall first technique and anterior interrupted stitches. Arterial blood flow was established successfully. The patient recovered without complications with normal liver function. In conclusion, using a modified radial artery interposition graft as a method for a hepatic artery anastomosis is a safe and significant option for patients and surgeons.



Volume : 6
Issue : 4
Pages : 119


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Department of General Surgery and Transplantation, Baskent University Faculty of Medicine, Ankara, Turkey