Comparison of Two Techniques of Arterial Anastomosis During Adult Cadaveric Liver Transplantation

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doi:10.1016/j.transproceed.2007.05.008 Copyright © 2007 Elsevier Inc. All rights reserved.

Liver

Comparison of Two Techniques of Arterial Anastomosis During Adult Cadaveric Liver Transplantation

D. Lorenzin, a, , G.L. Adania, C. Comuzzia, M. Sainz-Barrigaa, E. Benzonia, V. Bresadolaa, A. Risalitia, U. Baccarania and D. De a aDepartment of Surgery & Transplantation, University of Udine, Italy. Available online 8 August 2007.

Abstract Arterial complications are a major source of morbidity and mortality after orthotopic liver transplantation (OLT). The incidence of hepatic artery thrombosis (HAT) ranges from 1.6% to 8%, with a mortality rate that ranges from 11% to 35%. We have described herein a technique of arterial anastomosis aiming to perform the anastomosis as straight as possible to avoid any kinking, redundancy, or malposition of the artery when the liver is released in its final position. We compared this technique with the traditional technique of arterial anastomosis using an aortic Carrel patch, namely, 198 OLT (group A) with the traditional technique and 117 OLT (group with the modified technique. An aorto-hepatic bypass was necessary in 25% of the cases in group A and in 21% of the cases in group B (P = .33). Vascular anomalies were present in 20% of cases in group A and in 27.5% in group B (P = .14). Fourteen cases (7%) of HAT developed in group A versus 0 cases in group B (P = .003). In group B, we experienced 2 (1.7%) late arterial stenoses that were successfully treated using percutaneous transluminal angioplasty. The 14 cases of HAT occurring in group A were successfully managed using immediate surgical revascularization with graft salvage in 6 cases (43%), whereas the remaining 8 cases needed urgent retransplantation. We suggest that a technique of arterial anastomosis aimed at avoiding kinking, redundancy, or malposition of the artery may be a viable option to reduce the risk of HAT after OLT.

Address reprint requests to Dario Lorenzin, MD, Department of Surgery & Transplantation, University of Udine, Italy.

Transplantation Proceedings Volume 39, Issue 6, July-August 2007, Pages 1879-1880