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Hepatic artery reconstruction with double‐needle microsuture in living‐donor liver transplantation
Author(s) -
Okazaki Mutsumi,
Asato Hirotaka,
Takushima Akihiko,
Nakatsuka Takashi,
Sarukawa Shunji,
Inoue Keita,
Harii Kiyonori,
Sugawara Yasuhiko,
Makuuchi Masatoshi
Publication year - 2006
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20550
Subject(s) - medicine , artery , living donor liver transplantation , dissection (medical) , liver transplantation , fibrous joint , anastomosis , tunica media , surgery , transplantation , gastroduodenal artery , thrombosis , radiology , carotid arteries
In living‐donor liver transplantation (LDLT), reconstruction of the hepatic artery is challenging because the recipient artery is located deep in the abdominal cavity and the operating field is limited. Also, the hepatic artery of the graft is short and the recipient artery is occasionally damaged. To overcome these difficulties, we developed a double‐needle microsuture technique for artery reconstruction. A total of 161 adult patients received 163 LDLTs using this new technique. The first suture was placed at the most difficult point in the artery to be visualized through the microscope. Each stitch was placed from the inner side of the arterial wall to the outer side. The posterior stitch was tied pulling toward the back. The subsequent sutures were advanced anteriorly on either side adjacent to the previous suture. Hepatic artery thrombosis occurred in 4 patients (2.5%), only 2 (1.2%) of which were associated with arterial reconstruction. Intimal dissection developed in the recipient artery in 2 patients (1.2%). Three (50%) of these 6 complications occurred more than 10 days after LDLT. In conclusion, this suturing technique allows for safe intimal adaptation even when the arterial tunica intima is separated from the tunica media, because all stitches are carried from inside of the vessel to the outside, contributing to more satisfactory results. Liver Transpl 12:46–50, 2006 . © 2005 AASLD.