Successful application of supraceliac aortohepatic conduit using saphenous venous graft in right Lobe living donor liver transplantation

Li, Ping-Chun; Thorat, Ashok; Jeng, Long‐Bin; Yang, Horng Ren; Li, Mingli; Yeh, Chun-Chieh; Chen, Te-Hung; Hsu, Sandy Huey-Jen; Poon, Kin Shing

doi:10.1002/lt.24720

Cited by 13 publications

(14 citation statements)

References 4 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The extra‐anatomic HA revascularization can be achieved by using a recipient right gastric artery, RGEA, left gastric artery, or splenic artery without an interpositional vascular conduit and from the aorta (either supraceliac or infrarenal) using a vascular graft . In our experience, 11 of the patients required a supraceliac aortohepatic conduit using the left great saphenous vein, whereas RGEA was used for HA reconstruction in 3 patients. One patient with an aortohepatic conduit, however, suffered from pseudoaneurysm at the aortic side that caused hematoma and hemodynamic instability.…”

Section: Discussionmentioning

confidence: 91%

“…One recipient with a supraceliac aortic conduit developed a pseudoaneurysm of the saphenous conduit from the aortic side on the second postoperative day and developed an intra‐abdominal hematoma. The patient underwent exploratory laparotomy, and the anastomosis on the aortic side was securely revised . Two patients who underwent HA reconstruction using the RGEA had poor HA flow on the first postoperative day.…”

Section: Resultsmentioning

confidence: 99%

“…An innovative “supraceliac aortohepatic conduit” technique was applied to establish arterial inflow using the recipient's great saphenous vein as the vascular conduit. The technical details have been reported before …”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow

Thorat

Jeng

et al. 2017

Liver Transpl

Self Cite

View full text Add to dashboard Cite

The reconstruction of the hepatic artery (HA) is the most complex step in living donor liver transplantation (LDLT) because of the smaller diameter of the artery and the increased risk of HA-related complications. Because of the smaller diameter of the HA, many centers use a microsurgical technique with interrupted sutures for arterial anastomosis. The aim of our study was to retrospectively investigate the outcomes after HA reconstruction performed under magnifying loupes using the "parachute technique." From August 1, 2002 to August 31, 2016, LDLT was performed in 766 recipients. HA reconstruction for the initial 25 LDLT surgeries was performed using a microsurgery technique (era 1). From May 2007 until the end date, HA reconstruction was performed in 741 recipients by a "parachute technique" under surgical loupes (era 2). HA reconstruction was performed using surgical loupes in 737 adults (male:female, 526:211) and 4 pediatric patients (male:female, 3:1). The average diameter of the donor graft HA was 2.8 mm (range, 1-6.5 mm). The most notable factor in this era was the quick HA anastomosis procedure with a mean time of 10 ± 5 minutes (range, 5-30 minutes). In era 2, 9 (1.21%) patients developed hepatic artery thrombosis (HAT), whereas 2 patients developed nonthrombotic HA-related complications. Extra-anatomic HA reconstruction was performed in 14 patients due to either primary HA anastomosis failure or a poor caliber recipient HA. The use of magnifying surgical loupes to perform HA reconstruction is safe, feasible, and yields a low incidence of HA-related complications. The "parachute technique" for HA reconstruction can achieve a speedy reconstruction without increasing the risk of HAT. Liver Transplantation 23 887-898 2017 AASLD.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow

Thorat

Jeng

et al. 2017

Liver Transpl

Self Cite

View full text Add to dashboard Cite

show abstract

“…The use of supraceliac GSV conduits was also assessed by Li and colleagues in 11 patients, and 100% graft patency was reported. (5) These reports highlight the utility of GSV conduits in patients with arterial dissection. We believe that in the event of an arterial dissection, the selection of the most suitable arterial inflow varies based on patient-related and graft-related factors.…”

Section: To the Editormentioning

confidence: 95%

Reply

Bhatti

Khan

2021

Liver Transpl

View full text Add to dashboard Cite

“…In the recipients with poor caliber HA, an extraanatomical reconstruction of the HA was done. In such situations, a supra-coeliac aorto-hepatic anastomosis using saphenous venous conduit was preferred technique for extra-hepatic source of graft hepatic arterial reconstruction (9). Immediately after the HA reconstruction, the arterial blood flow was measured by doppler flowmeter and any inadequacy was dealt.…”

Section: Technique Of Hepatic Arterial Reconstruction During Ldlt Andmentioning

confidence: 99%

Management of Hepatic Artery Thrombosis after Living Donor Liver Transplantation: Endovascular Thrombolytic Therapy or Surgical Intervention? Role of Hepatic Arterial Urokinase Infusion

Thorat¹,

Jeng²,

Hsu³

et al. 2018

SGO

Self Cite

View full text Add to dashboard Cite

The hepatic artery (HA) related complications after living donor liver transplantation (LDLT) remains an important cause of increased risk of post-transplant mortality. The timing of occurrence of hepatic artery thrombosis (HAT) after transplantation and the timely intervention are the determining factors in the survival of the recipients. Re-exploration and revision of the hepatic artery anastomosis or medical treatment with urokinase therapy are the lifesaving treatment options. We describe our successful outcome after arterial urokinase infusion as an initial therapy for the LDLT recipients with HAT. Materials and Methods: From 10 th September 2002 till 31 st December 2017, a total of 908 LDLT surgeries were performed at China Medical University Hospital. A total of 12 patients that developed HAT in postoperative period were further studied. All the patients that were diagnosed to have HAT within 24 hours were re-explored whereas medical therapy with intraarterial urokinase infusion was the first treatment modality for the HAT developing after 24 hours of LDLT. Results: 12 recipients (1.37%) developed HAT. Computed tomography (CT) angiography was done for all the recipients and arterial Urokinase infusion was given in 10 patients as the initial therapy whereas 2 patients were directly re-explored. All the urokinase treated patients had HAT 24 hours after LDLT. Five of the urokinase therapy patients developed complete re-canalization after urokinase therapy without any morbidity in post-transplant period. After successful re-canalization, there was no evidence of arterial stenosis in subsequent follow up with satisfactory liver graft functions. Remaining five patients underwent re-exploration with revision of hepatic artery anastomosis (n=2) and re-transplantation (n=3). Conclusions: Intra-arterial urokinase therapy is a feasible initial therapy in LDLT recipients with HAT with an acceptable HA recanalization rate that needs no further surgical intervention and can certainly be first choice of treatment in stable HAT patients. However, failure of re-canalization or deterioration of the patient's clinical condition warrants urgent surgical intervention.

show abstract

Successful application of supraceliac aortohepatic conduit using saphenous venous graft in right Lobe living donor liver transplantation

Cited by 13 publications

References 4 publications

Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow

Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow

Reply

Management of Hepatic Artery Thrombosis after Living Donor Liver Transplantation: Endovascular Thrombolytic Therapy or Surgical Intervention? Role of Hepatic Arterial Urokinase Infusion

Contact Info

Product

Resources

About