Hepatic artery reconstruction with double-needle microsuture in living-donor liver transplantation

Abstract

In living-donor liver transplantation (LDLT), reconstruction of the hepatic artery is challenging because the recipient artery is located deep in the abdominal cavity and the operating field is limited. Also, the hepatic artery of the graft is short and the recipient artery is occasionally damaged. To overcome these difficulties, we developed a double-needle microsuture technique for artery reconstruction. A total of 161 adult patients received 163 LDLTs using this new technique. The first suture was placed at the most difficult point in the artery to be visualized through the microscope. Each stitch was placed from the inner side of the arterial wall to the outer side. The posterior stitch was tied pulling toward the back. The subsequent sutures were advanced anteriorly on either side adjacent to the previous suture. Hepatic artery thrombosis occurred in 4 patients (2.5%), only 2 (1.2%) of which were associated with arterial reconstruction. Intimal dissection developed in the recipient artery in 2 patients (1.2%). Three (50%) of these 6 complications occurred more than 10 days after LDLT. In conclusion, this suturing technique allows for safe intimal adaptation even when the arterial tunica intima is separated from the tunica media, because all stitches are carried from inside of the vessel to the outside, contributing to more satisfactory results.

Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

“…Figure 1 (12,28,42,51,52,71,73,76,77) for the arterial anastomosis (3.1%) versus centers using loupe magnification (2.1%, p = 0.6) (25,37,53,54,74).…”

Hepatic Arterial Complications after Liver Transplantation: A Single-Center Experience

“…Some studies reported the advantage of the back wall method (15,16). Using back wall support suture under microsurgical reconstruction, they could minimize the artificial injuries of hepatic arteries and improve the survival rate of the post liver transplantation by reducing hepatic artery thrombus (15)(16)(17).…”

“…Some reports have provided the convenience and usefulness about hepatic artery anastomosis by using microsuture with double-arm needle (17). Initially, we must distress ourselves about the amount safe anastomosis of pressure hepatic arteries with previous single arm needle suture, having no idea of the new instrument and surgical product.…”

Partial Portal Arterialization for Hepatic Arterial Thrombosis After Living-Donor Liver Transplant

“…Hironori Hayashi, 1 Hiroyuki Takamura, 1 Takashi Tani, 2 Isamu Makino, 1 Hisatoshi Nakagawara, 1 after a living-donor liver transplant. This study sought to review our experience with partial portal arterialization for a hepatic arterial thrombosis, focusing on technical aspects and clinical benefits.…”

“…Because of the small vascular diameter, arterial reconstruction is a major technical problem in living-donor liver transplant, and some technical refinements have been reported. [1][2][3] However, in some cases, a hepatic arterial thrombosis still occurs after living-donor liver transplant. Although possible therapies for an acute hepatic arterial thrombosis include revascularization to salvage the graft, or retransplant, these may be difficult to do owing to technical aspects in certain cases and donor shortages.…”