The Arcuate Ligament Syndrome in Liver Transplantation

Fukuzawa, Kengo; Schwartz, Myron; Katz, Eliezer; Mor, Eitan; Emre, Sukru; Acarlı, Koray; Miller, Charles M.

doi:10.1097/00007890-199307000-00043

Cited by 26 publications

(20 citation statements)

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“…In fact, there are several living donors with median arcuate ligament syndrome reported in the literature that had uneventful liver resections (13,14). Our patient had a nearly complete celiac artery occlusion during expiration, and although he was asymptomatic, we decided to transect the lateral crura to prevent any compromise to the hepatic arterial flow or accentuation of the effects of celiac axis compression, as had been observed previously in liver transplant recipients (15,16). The access to the supraceliac aorta we used in this patient is our standard technique in liver transplantation whenever there is a need for complex arterial reconstruction or conduits to the abdominal aorta.…”

Section: Discussionmentioning

confidence: 90%

Rescue of a Living Donor with Liver Transplantation

Ringe

Xiao

Sass

et al. 2008

American Journal of Transplantation

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Postoperative liver failure is a rare complication after living donor liver resection. This is a case report of a 22-year-old healthy donor who was rescued with liver transplantation 11 days after right hemihepatectomy. Nine months later the patient is alive, and has fully recovered from his multiple organ failure. According to a review of the literature, there are four additional living liver donors, who received a liver transplant. Our own patient is the only survivor, so far. This case demonstrates that even in supposedly healthy living donors postoperative complications cannot be completely prevented. Although liver failure is rare in these patients, timely transplantation may need to be considered as the only life-saving treatment.

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Section: Discussionmentioning

confidence: 90%

Rescue of a Living Donor with Liver Transplantation

Ringe

Xiao

Sass

et al. 2008

American Journal of Transplantation

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“…Fukuzawa et al reported 1.6% to 10% incidence rate of MALS amongst liver transplantation recipients, based on the number of patients in whom hepatic artery pulse could only be restored by dissection of MAL or aortic arch bridging. [ 2 , 5 , 11 ] Gruber et al [ 12 ] adopted Doppler B ultrasonography to examine 362 patients, and found that 1.7% patients had MALS. Higher incidence rate was observed in earlier reports; in our opinion, this reflects the development of the understanding of MALS over the decades.…”

Section: Discussionmentioning

confidence: 99%

Median arcuate ligament syndrome and arterial anastomotic bleeding inducing hepatic artery thrombosis after liver transplantation

et al. 2018

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Rationale:Median arcuate ligament (MAL) may compress the coeliac trunk inducing median arcuate ligament syndrome (MALS). MALS is a risk factor for hepatic artery thrombosis (HAT) in liver transplant recipients.Patient concerns:A thin female complained about upper abdominal pain for two months.Diagnoses:The patient was diagnosed as primary biliary cirrhosis.Interventions:The patient received two liver transplantations. During the first liver transplantation, the hepatic artery (HA) pulsations were normal. Doppler B ultrasonography showed normal blood flow in the HA in the first week. A 4 cm hematoma was detected in the first porta hepatis. On the ninth day, the hematoma had increased to 9 cm along with development of HAT. Exploratory laparotomy was performed. Bleeding at the site of arterial anastomosis was considered to be the reason for the hematoma. Doppler imaging revealed no blood flow in the liver. Computed tomography angiography demonstrated MALS. Salvage liver transplantation combined with dissection of MAL was performed. The maximum velocity of HA increased to 87 cm/s.Outcomes:The patient was discharged from the hospital 17 days after the second transplantation. At discharge, the liver function was normal and Doppler showed good blood flow in the HA.Lessons:MALS can cause HAT after liver transplantation. Before the liver transplantation, we should use Doppler B ultrasonography and sagittal CT imaging to judge whether the patient is with MALS. Also, before arterial anastomosis in liver transplantation is conducted, we should observe the impacts on the HA caused by pre-blocking gastroduodenal artery, which determines if we are supposed to do MAL dissection or bridge HA with aorta.

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“…This reinforces the decision concerning the indication for modification of arterial reconstruction. Often an inadequate arterial inflow was observed only after reperfusion -especially in patients with celiac artery stenoses caused by arcuate ligament compression [1,10,11]. These were treated by resection of the arcuate ligament or by infrarenal graft interposition, resulting in a doubling of the flow rate in the hepatic artery [12].…”

Section: Discussionmentioning

confidence: 99%