Posterior-wall-first microvascular anastomotic technique

Harris, Gerald D.; Finseth, Frederick; Buncke, Harry J.

doi:10.1016/0007-1226(81)90096-5

Cited by 61 publications

(33 citation statements)

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“…When the donor's arterial branch was long enough to turn over, the anterior suture was performed first. Otherwise, the posterior wall was sutured with an inside‐outward procedure using double needles; thereafter, the anterior wall was sutured without turning the anastomotic site over 12. After reconstruction, the intrahepatic arterial signals in each segment were examined using Doppler ultrasonography; the other branches were ligated after confirming pulsatile back‐bleeding from the nonanastomosed cut stumps13 (k).…”

Section: Methodsmentioning

confidence: 99%

Hepatic arterial anatomy for right liver procurement from living donors

et al. 2004

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Living donor liver transplantation (LDLT) using right liver grafts is now widely performed. Anatomic classifications of the hepatic artery for right liver procurement, however, are limited. In this study, celiac and mesenteric angiograms of 223 consecutive living donors in a single institution were evaluated. Details of the arterial anastomosis and results were reviewed in 72 patients who underwent primary LDLT using right liver grafts. There was a 6% incidence of hepatic arterial bifurcations that might provide multiple orifices in a right liver graft. Only one right liver graft (1%) had multiple arterial orifices. Single arterial anastomosis without interposition was possible in all patients with right liver grafts and none of them were complicated with hepatic arterial thrombosis. Single arterial anastomosis, therefore, has a high probability of success in right liver graft implantation. L iving donor liver transplantation (LDLT) is a preferable treatment for adults with end-stage liver disease due to the limited number of available cadaveric donors. 1 Fundamental to the application of this technique is an understanding of hepatic vascular anatomy. 2 Michels first reported 10 basic types of hepatic arterial supply. 3 Since then, common and rare hepatic artery variants have been reported. Most of these studies, however, focused only on replaced or accessory arterial branches that are helpful for whole-liver harvesting and transplantation. Without information regarding bifurcation of the right hepatic artery (RHA), the classification is of little help for right liver harvesting.Recently, Marcos et al proposed the use of interposition arterial grafts in right liver graft because double hepatic arteries were common in their series. 7 Their report conflicted with our experience because, in our series, no patients underwent double hepatic artery reconstruction in right liver LDLT. To clarify this inconsistency, we evaluated celiac and mesenteric angiograms of 223 consecutive living donors in a single institution. The aim of the study was to determine a useful anatomic classification of the hepatic arteries for LDLT using right liver grafts. Materials and Methods DonorsFrom January 1996 until May 2003, 223 consecutive living donors underwent hepatectomy at the University of Tokyo Hospital. They comprised 126 men and 97 women with a median age of 34 years (range, 18 -63 years). Details regarding selection criteria and evaluation are described elsewhere. 8 Only one case was rejected due to arterial anatomy. 9 All of the donors were related to the recipients. The relation of the donors to the patients was 84 parents, 65 children, 37 siblings, 22 spouses, 9 nephews, and 4 uncles and two cousins. The type of graft was determined by volumetric analysis and not by vascular anatomy. The graft estimate was determined by computed tomography (CT). A graft-volume-to-recipient-standard-liver-volume ratio 10 of 40% was the lower limit. Candidates in whom the right liver comprised more than 70% of the whole liver were rejected as ...

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Section: Methodsmentioning

confidence: 99%

Hepatic arterial anatomy for right liver procurement from living donors

et al. 2004

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“…In the conventional method of microvascular anastomosis, the arteries were held with a double clamp with 2 stay sutures, which must be rotated for posterior wall anastomosis 4. A posterior‐wall‐first anastomotic technique5, 6 has significant advantages for hepatic artery reconstruction in LDLT. In the technique, microsutures are placed in the back wall of the vessel first, and turning over of the microclamp is eliminated.…”

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confidence: 99%

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

et al. 2005

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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.

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“…In 1981, Harris et al reported the posterior wall first suturing in finger replantation. 7 Yamamoto et al reported this procedure eliminated the necessities of reversing microclamps in LDLT. 5 And Okazaki et al reported a new posterior first technique in LDLT using a 4 mm length 9-0 nylon suture with double needles which allowed to placement of the each sutures from the inside to outside.…”

Section: Discussionmentioning

confidence: 97%

A modified technique for hepatic artery reconstruction in living donor liver transplantation

et al. 2010

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Reconstruction of the hepatic artery (HA) is challenging, because there are technical difficulties. Especially, it is difficult to repair the posterior wall. In 2006, we reported an experimental study of the posterior wall first continuous suturing combined with the interrupted suturing and we also confirmed the safety of this procedure. In this article, we report our clinical experiences using this procedure for the HA reconstruction in living-donor liver transplantation. First, we repaired the posterior wall of the HA with continuous suturing. Then, the anterior wall is repaired with the interrupted suturing using a nylon suture with double needle. Between 2006 and 2009, we performed 13 HA reconstructions using our procedure. In all patients, the HA reconstruction was completed easily and uneventfully without oozing from the posterior wall or postoperative HA thrombosis. Our procedure has the benefits of both continuous and interrupted suturing. We believe that it is useful for reconstruction of the HA in living-donor liver transplantation.

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Posterior-wall-first microvascular anastomotic technique

Cited by 61 publications

References 0 publications

Hepatic arterial anatomy for right liver procurement from living donors

Hepatic arterial anatomy for right liver procurement from living donors

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

A modified technique for hepatic artery reconstruction in living donor liver transplantation

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