Open AccessStrategies for a successful hepatic artery anastomosis in liver transplantation: A review of 51 cases
Author(s) -
Bien Keem Tan,
Hui Chai Fong,
Ek Khoon Tan,
Jeyaraj Prema Raj
Publication year - 2021
Publication title -
annals, academy of medicine, singapore/annals of the academy of medicine, singapore
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.299
H-Index - 60
ISSN - 0304-4602
DOI - 10.47102/annals-acadmedsg.2020635
Subject(s) - medicine , anastomosis , liver transplantation , artery , surgery , transplantation , dissection (medical) , thrombosis , common hepatic artery , radiology
: Hepatic artery reconstruction is a critical aspect of liver transplantation. The microsurgeonfaces several challenges when reconstructing the hepatic artery—the donor hepatic artery stalk is shortand often a poor match for the usually hypertrophic recipient vessels. Previous inflammation impedesvessel dissection, and recipient vessels have a tendency to delaminate with manipulation. We review 51consecutive liver transplantations to highlight these problems and propose strategies for a successfulreconstruction of the hepatic artery.Methods: A prospective study involving all adult patients undergoing liver transplantation at theSingapore General Hospital from January 2015 to December 2018 was undertaken. All hepatic arteryanastomoses were performed by 2 microsurgeons at 10x magnification. Patients were started on astandard immunosuppressive regimen. Postoperative ultrasound scans on days 1, 3, 5, 7, 9 and 14were used to confirm arterial patency.Results: There were 51 patients who underwent liver transplantation during the study period. Of thisnumber, 31 patients received deceased donor grafts and 20 received living donor grafts. A total of 61anastomoses were performed (5 dual anastomosis, 4 radial artery interposition grafts) with 1 case ofhepatic artery thrombosis that was successfully salvaged. The mean (range) postoperative resistiveindex and hepatic artery peak systolic velocity were 0.69 (0.68–0.69) and 1.0m/s (0.88–1.10m/s),respectively.Conclusion: Hepatic artery thrombosis after liver transplantation is poorly tolerated. The challengesof hepatic artery reconstruction in liver transplantation are related to vessel quality and length. The useof microsurgical technique, appropriate recipient vessel selection, minimisation of vessel manipulationwith modified instruments, variation in anastomosis techniques, and use of radial artery interpositionalgrafts are useful strategies to maximise the chances of success.Keywords: Hepatic artery, hepatology, liver transplant, microsurgery, plastic surgery