Transplant hepatic artery: patch arterial anastomosis

Case contributed by Dr Gilcrease-Garcia

Presentation

Status post orthotopic liver transplantation, follow up evaluation.

Patient Data

Age: 60
Gender: Male

Expected arterial anatomy following orthotopic liver transplantation. Familiarity with specific surgical techniques employed may be helpful in understanding the reconstructed anatomy.

The site of anastomosis using a Carrel patch technique, whereby a "patch" of redundant vessel from donor artery origin is used to facilitate anastomosis. In this case, the donor celiac trunk patch is anastomosed to the recipient common hepatic/GDA branch point.

Case Discussion

The approach to vascular anastomosis in orthotopic liver transplantation varies, due to variability in donor and recipient anatomies, as well as specific difficulties encountered during the operation (e.g. thrombosis, damage to vessels).

During native liver removal, the donor common hepatic artery is dissected back to the celiac origin, and the entire celiac axis may be extracted in order to provide flexible options for re-anastomosis. During arterial reconstruction, the donor vessel celiac trunk is connected to the recipient common hepatic artery, although the precise location and technique vary according to anatomic requirements. For example, portions of the splenic or gastroduodenal artery (GDA) origins may be included in the anastomosis in order to enlarge recipient vessels in cases of size discrepancy. In some cases, interposition of iliac "jump" grafts may be used to connect donor and recipient systems.

In this case, the donor artery was trimmed to the splenic artery takeoff to create a celiac trunk patch, and the recipient common hepatic artery was incised at the GDA takeoff, and the two arteries were connected in "end-to-side" fashion.

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Case information

rID: 54640
Case created: 19th Jul 2017
Last edited: 27th Sep 2017
Inclusion in quiz mode: Included

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