Reconstrução arterial no transplante hepático: a melhor reconstrução para variação da artéria hepática direita

Andraus, Wellington; Haddad, Luciana Bertocco de Paiva; Ducatti, Liliana; Martino, Rodrigo; Santos, Vinicius Rocha; D’Albuquerque, Luiz Augusto Carneiro

doi:10.1590/s0102-67202013000100014

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…Of those, 27 presented SMA originating the right hepatic artery, while the other four presented right hepatic artery from SMA, as well as the left hepatic artery originating from the left gastric artery. In this context, the detailed knowledge of these variations in SMA involving hepatic arterial anatomy is of great interest to surgeons who develop procedures in this area, especially liver transplants, since besides representing an ideal opportunity for their anatomical surgical study, their identification and correct handling are fundamental for the good outcome of the procedure 1 , 4 , 22 , 29 .…”

Section: Discussionmentioning

confidence: 99%

Anatomical Variations of the Superior Mesenteric Artery and Its Clinical and Surgical Implications in Humans

SILVA¹,

Barbosa²,

Silva³

et al. 2020

ABCD, arq. bras. cir. dig.

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Introduction: Superior mesenteric artery (SMA) usually arises from the abdominal aorta, just below the celiac trunk and it supplies the midgut-derived embryonic structures. Anatomical variations in this vessel contribute to problems in the formation and/or absorption of this part of the intestine and its absence has been recognized as the cause of congenital duodenojejunal atresia. Objective: To analyze SMA anatomical variations in humans and the possible associated clinical and surgical implications. Methods: This is a systematic review of papers indexed in PubMed, SciELO, Springerlink, Science Direct, Lilacs, and Latindex databases. The search was performed by two independent reviewers between September and December 2018. Original studies involving SMA variations in humans were included. SMA presence/absence, level, place of origin and its terminal branches were considered. Results: At the end of the search, 18 studies were selected, characterized as for the sample, method to evaluate the anatomical structure and main results. The most common type of variation was when SMA originated from the right hepatic artery (6.13%). Two studies (11.11%) evidenced the inferior mesenteric artery originating from the SMA, whereas other two (11.11%) found the SMA sharing the same origin of the celiac trunk. Conclusion: SMA variations are not uncommon findings and their reports evidenced through the scientific literature demonstrate a great role for the development of important clinical conditions, making knowledge about this subject relevant to surgeons and professionals working in this area.

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Section: Discussionmentioning

confidence: 99%

Anatomical Variations of the Superior Mesenteric Artery and Its Clinical and Surgical Implications in Humans

SILVA¹,

Barbosa²,

Silva³

et al. 2020

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

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“…It is known that changes present at different stages of embryonic development lead to large variations in vasculature. In liver transplantation, in particular, detailed knowledge of the graft anatomy is essential to achieve its full arterialization and must be precisely identified at the time of organ captation 1 , 4 , 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Studies of hepatic arterial anatomy using case series of liver transplants show great diversity in the grafts, warning need for caution in surgical dissections, aiming effective arterialization and, consequently, success of the procedure in the receptor 1 , 3 , 9 , 11 , 13 .…”

Section: Discussionmentioning

confidence: 99%

“…These modifications are especially important in the context of orthotopic liver transplantation, since, besides being ideal opportunity for its surgical anatomical study, their precise identification is crucial to the success of procedure 1 , 3 , 4 , 14 . According to the literature, the incidence of anatomic variations of hepatic artery range from 20-50% in different series 1 , 4 .…”

Section: Introductionmentioning

confidence: 99%

“…According to the literature, the incidence of anatomic variations of hepatic artery range from 20-50% in different series 1 , 4 .…”

Section: Introductionmentioning

confidence: 99%

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Anatomic Variations of Hepatic Artery: A Study in 479 Liver Transplantations

Fonseca-Neto

Lima

Rabêlo

et al. 2017

ABCD, arq. bras. cir. dig.

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Background:The incidence of anatomic variations of hepatic artery ranges from 20-50% in different series. Variations are especially important in the context of liver orthotopic transplantation, since, besides being an ideal opportunity for surgical anatomical study, their precise identification is crucial to the success of the procedure. Aim:To identify the anatomical variations in the hepatic arterial system in hepatic transplantation. Methods: 479 medical records of transplanted adult patients in the 13-year period were retrospectively analyzed, and collected data on hepatic arterial anatomy of the deceased donor. Results:It was identified normal hepatic arterial anatomy in 416 donors (86.84%). The other 63 patients (13.15%) showed some variation. According to the Michels classification, the most frequently observed abnormalities were: right hepatic artery branch of superior mesenteric artery (Type III, n=27, 5.63%); left hepatic artery branch of the left gastric artery (Type II, n=13, 2.71%); right hepatic artery arising from the superior mesenteric artery associated with the left hepatic artery arising from the left gastric artery (Type IV, n=4, 0.83%). Similarly, in relation to Hiatt classification, the most prevalent changes were: right hepatic accessory artery or substitute of the superior mesenteric artery (Type III, n=28, 6.05%)), followed by liver ancillary left artery or replacement of gastric artery left (Type II, n=16, 3.34. Fourteen donors (2.92%) showed no anatomical abnormalities defined in classifications, the highest frequency being hepatomesenteric trunk identified in five (01.04%). Conclusion:Detailed knowledge of the variations of hepatic arterial anatomy is of utmost importance to surgeons who perform approaches in this area, particularly in liver transplantation, since their identification and proper management are critical to the success of the procedure.

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Comparison of reconstruction methods used during liver transplantation in case of a graft with replaced or accessory right hepatic artery: A retrospective study

Wouters

Blondeau

Bos

et al. 2022

J Hepato Biliary Pancreat

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Variations in graft arterial anatomy can increase the risk of postoperative hepatic arterial thrombosis (HAT), especially in presence of a replaced or accessory right hepatic artery (RHA). We retrospectively analyzed 223 cases of liver transplantations with the presence of an RHA on the graft. Patient outcomes were compared according to the four different reconstruction methods used: (i) the re‐implantation of the RHA into the splenic or gastroduodenal artery (n = 106); (ii) the interposition of the superior mesenteric artery (SMA) (n = 83); (iii) dual anastomosis (n = 24); (iv) use of an aortic patch including the origins of both the SMA and the coeliac trunk (n = 10). A competing risk analysis and Inverse Probability Weighting (IPW) were used. We found that the interposition of the SMA method was associated with a significantly lower incidence of HAT, at 4.8% compared to the re‐implantation method at 17.9%, dual anastomosis at 12.5%, and aortic patch at 20%, p = .03. In the competing risk analysis with IPW, the only risk factor for RHA thrombosis was the type of reconstruction. Taking the SMA interposition group as the reference, the sub‐hazard ratio (sHR) was 5.05 (CI 95 [1.72; 14.78], p < .01) for the re‐implantation group, sHR = 2.37 (CI 95 [0.51; 11.09], p = .27) for the dual anastomosis group and sHR = 2.24 (CI 95 [0.35; 14.33], p = .40) for the aortic patch group. There were no differences for intraoperative transfusion, hospitalization duration (p = .37) or incidence of severe complications (p = .1). The long‐term graft (p = .69) and patient (p = .52) survival was not different. In conclusion, the SMA interposition method was associated with a lower incidence of RHA thrombosis.

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Reconstrução arterial no transplante hepático: a melhor reconstrução para variação da artéria hepática direita

Abstract: The proposed technique proved to be an interesting alternative for the reconstruction of right hepatic artery variation in liver transplantation.

Cited by 14 publications

References 23 publications

Anatomical Variations of the Superior Mesenteric Artery and Its Clinical and Surgical Implications in Humans

Anatomical Variations of the Superior Mesenteric Artery and Its Clinical and Surgical Implications in Humans

Anatomic Variations of Hepatic Artery: A Study in 479 Liver Transplantations

Comparison of reconstruction methods used during liver transplantation in case of a graft with replaced or accessory right hepatic artery: A retrospective study

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