Hepatic artery reconstruction in orthotopic liver transplantation
- VernacularTitle:原位肝移植肝动脉重建临床分析
- Author:
Gang WU
;
Yongfeng LIU
;
Shurong LIU
;
Jialin ZHANG
;
Guichen LI
;
Xuchun CHEN
- Publication Type:Journal Article
- Keywords:
Liver transplantation;
Angioplasty;
Doppler ultrasonography;
Postoperative complications
- From:
Chinese Journal of General Surgery
2008;23(7):487-489
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize experience for hepatic artery reconstruction in orthotopic liver transplantation(OLT).Method A retrospective analysis was made for 183 cases of orthotopic liver transplantation performed in our institute from May 1995 to december 2006.All the arterial reconstructions were performed with 6-0 polypropylene sutures in an interrupted fashion under a 3.5 magnification surgical loupe.Donor hepatic arteries were anastomosed at the origin of the celiac artery with a Carrel's patch or at the level of splenic artery confluence.Extra-anatomic arterial reconstruction was based on recipient aorta using donor iliac artery graft.OLT with routine anatomic arterial construction served as control.Heparin or low-molecule-weight heparin as a prophylactic anticoagulation therapy was maintained during and after operation if prothrombin time is less than eighteen seconds.Follow-up Doppler ultrasonography was used daily in the early postoperative period.Results Overall incidence of hepatic artery complications was 3.28%.Hepatic artery thrombosis(HAT)was observed in 5 cases.Hepatic artery stenosis(HAS)occurred in 1 patient.Routine anatomic arterial construction was performed in 89.07%(163)of cases,and HAT developed in 3(1.84%)cases.Extra-anatomic arterial reconstruction was carried out in 10.93%(20)of the patients;the presence of HAT was identified in 3(15.0%)cases(X2=9.73,P＜0.01).Thrombolysis,balloon angioplasty,and vascular stenting via hepatic artery were performed.One patient suffering from identified hepatic artery thrombosis died of liver failure 19 days post-op.The other 5 patients were cured successfully with patent blood flow by interventional therapy.Mortality related to hepatic artery complication was 16.7%.Conclusion HAT and HAS may be minimized by using gastroduodenal branch-patch anastomosis and postoperative anticoagulation.Close follow-up by Doppler ultrasonography helps to make a prompt diagnosis and reduce HAT-and HAS related graft loss.
