Extra-Anatomic Jump Graft Arterial Reconstruction Using a Great Saphenous Vein Autograft During Living Donor Liver Transplantation

Baimakhanov, Zhassulan; Magauina, Aidana; Matkerimov, A.Zh.; Kaniev, Shokan; Doskhanov, Maxat; Serikuly, Erbol; Skakbayev, Aidar; Makhanbetkhan, Sh Sh; Baiguissova, Dinara; Seisembaev, Manas; Chormanov, Almat; Baimakhanov, Bolatbek

doi:10.1016/j.transproceed.2019.07.004

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…The available length of GSV conduits can be increased to more than 20 cm, which enables performing a long extra-anatomic jump graft. There are case reports presenting successful application of a supraceliac aorto-hepatic conduit and a right iliac artery-hepatic conduit using a GSV graft during LDLT [ 10 , 11 ]. To protect the GSV graft from potential harvest-associated injury, no-touch technique is preferred.…”

Section: Discussionmentioning

confidence: 99%

Hepatic artery reconstruction using interposition of autologous saphenous vein conduit for living donor liver transplantation: a case report

Moon

Hwang

Jung

et al. 2021

Korean J Transplant

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We have preferentially used the right gastroepiploic artery (RGEA) as an alternative for the recipient hepatic artery (HA) inflow during living donor liver transplantation (LDLT), but it was not always available. We herein present a case of adult LDLT with HA reconstruction using a greater saphenous vein (GSV) conduit because of the absence of the RGEA due to prior subtotal gastrectomy. A 55-year-old male patient diagnosed with hepatitis B virus-associated liver cirrhosis and secondary biliary cirrhosis underwent LDLT using a modified right liver graft. The upper abdominal cavity was heavily adhered due to prior abdominal surgeries, thus we had to sacrifice the common bile duct and the right HA completely. A 6-cm-long GSV segment was harvested from the left ankle and interposed between the recipient gastroduodenal artery and the graft HA. The patient recovered from LDLT and HA complications did not occur. However, 8 years after LDLT, chronic rejection occurred, thus repeated deceased donor liver transplantation was performed. This patient has been doing well for 2 years after retransplantation. In conclusion, we suggest that interposition of an autologous GSV conduit can be an alternative for establishing HA inflow in LDLT when other inflow source is not available.

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Section: Discussionmentioning

confidence: 99%

Hepatic artery reconstruction using interposition of autologous saphenous vein conduit for living donor liver transplantation: a case report

Moon

Hwang

Jung

et al. 2021

Korean J Transplant

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show abstract

“…The available length of the greater saphenous vein conduits can be increased to more than 20 cm, which enables performing a long extra-anatomic jump graft. There are a few case reports presenting successful application of a supraceliac aorto-hepatic conduit and a right iliac artery-hepatic conduit using a greater saphenous vein graft during LDLT [ 14 , 15 ]. These studies suggest that a long greater saphenous vein segment can be used as a vessel substitute allowing aorto-hepatic reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Salvage aorto-hepatic jump graft for hepatic artery thrombosis following living donor liver transplantation: a case report with 10-year follow-up

Choi

Hwang

Ahn

et al. 2021

Korean J Transplant

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Hepatic artery thrombosis (HAT) following living donor liver transplantation (LDLT) is a lethal complication. We present the case of a patient who underwent salvage redo hepatic artery reconstruction using an aorto-hepatic jump graft because of HAT following LDLT. A 64-year-old female patient diagnosed with hepatitis C virus-associated liver cirrhosis and hepatocellular carcinoma underwent salvage LDLT using a modified right liver graft. Partial graft infarct was identified at posttransplant day 4, and by day 9, it had spread. Celiac arteriography showed complete occlusion of the graft hepatic artery. We performed redo hepatic artery reconstruction using a fresh iliofemoral artery homograft 10 days after the LDLT operation because such a vessel homograft was available at our institutional tissue bank. The infrarenal aorta was dissected and an iliofemoral artery graft was anastomosed. Soon after hepatic artery revascularization, liver function progressively improved, and the infarct area at the liver graft was reduced. The patient has been doing well for 10 years without any vascular complications. In conclusion, our experience with this case suggests that salvage redo hepatic artery reconstruction using an aorto-hepatic jump graft is a feasible option to treat HAT following LDLT, as in deceased donor liver transplantation.

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“…Nevertheless, intractable shortage of vessel allograft from deceased donors make it hard to meet the need with a rapid increase of LDLT. Although autologous graft veins have also been applied for reconstruction of hepatic veins in LDLT (26), this strategy may cause additional damage to patients and cost more operation time. In addition, overlong (>20 mm) interposition conduit and endarterectomized vessel allograft are more likely to induce venous congestion.…”

Section: Perioperation Outcomesmentioning

confidence: 99%

Modified Dual Hepatic Vein Anastomosis in Pediatric Living-Donor Liver Transplantation Using Left Lateral Segment Grafts With Two Wide Orifices

et al. 2021

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Background: The anatomic variation of hepatic vein in the left lateral segment (LLS) increases the risk of outflow complication in pediatric living liver transplantation (LDLT). Here, we share a modified method for dual hepatic vein reconstruction in pediatric LDLT using LLS with two wide orifices.Methods: From Sep 2018 to Dec 2019, 434 pediatric LDLTs using LLS were performed in our center. Hepatic veins of grafts were classified into three types with emphasis on the number, size, and location of orifices at the cut surface: a single opening (type I, n = 341, 78.57%); two adjacent orifices (type II, n = 66, 15.21%); two wide orifices with orifices distances <20 mm (type IIIa, n = 15, 3.46%); and two wide orifices with orifices distances >20 mm (type IIIb, n = 12, 2.76%). Rv was defined as the ratio of diameter of V2 and V3 (refer to hepatic vein drained segments II and III). We developed a modified dual hepatic vein anastomosis to reconstruct outflow for type IIIb grafts with Rv ≤1. Briefly, the hepatic vein of segment II was anastomosed to the common stump of middle hepatic vein (MHV) and left hepatic vein (LHV), followed by unification of V3 and the longitudinal incision orifice in inferior venous cave (IVC).Results: During median follow-up of 15.6 months (7.5–22.9 months), no hepatic vein complications occurred.Conclusion: This novel modified dual hepatic vein anastomosis could serve as a feasible surgical option for type IIIb LLS grafts with Rv ≤1 in pediatric LDLT.

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Extra-Anatomic Jump Graft Arterial Reconstruction Using a Great Saphenous Vein Autograft During Living Donor Liver Transplantation

Cited by 4 publications

References 6 publications

Hepatic artery reconstruction using interposition of autologous saphenous vein conduit for living donor liver transplantation: a case report

Hepatic artery reconstruction using interposition of autologous saphenous vein conduit for living donor liver transplantation: a case report

Salvage aorto-hepatic jump graft for hepatic artery thrombosis following living donor liver transplantation: a case report with 10-year follow-up

Modified Dual Hepatic Vein Anastomosis in Pediatric Living-Donor Liver Transplantation Using Left Lateral Segment Grafts With Two Wide Orifices

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