The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases

Gruttadauria, Salvatore; Foglieni, Carlo Scotti; Doria, Cataldo; Luca, Angelo; Lauro, Augusto; Marino, Ignazio R.

doi:10.1034/j.1399-0012.2001.150510.x

Cited by 120 publications

(89 citation statements)

References 8 publications

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“…[3][4][5]8,10,12 Michels 3 reported in 1966 a classification of 10 possible anatomical variants of the extrahepatic arterial distribution that was based on a study of 200 autopsy cases. After Michels 3 initial classification, several authors described their own observations.…”

Section: Discussionmentioning

confidence: 99%

“…These studies are based on angiographic data and autopsy dissections, and mainly derive from surgery and transplantation literature. [4][5][6][7][8][9][10][11][12][13][14] The large sample size of transplanted livers is one of the major interests of this study. Indeed, harvested livers offer an excellent opportunity to describe, in situ, the anatomic variants of the arteries since all extrahepatic arteries need to be carefully identified during this step of the liver transplantation procedure to avoid injuries that jeopardize the viability of the graft once implanted.…”

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confidence: 99%

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Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

et al. 2007

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The aim of this study is to contribute our experience to the knowledge of the anatomic variations of the hepatic arterial supply. The surgical anatomy of the extrahepatic arterial vascularization was investigated prospectively in 1,081 donor cadaveric livers, transplanted at La Fe University Hospital from January 1991 to August 2004. The vascular anatomy of the hepatic grafts was classified according to Michels description (Am J Surg 1966;112:337-347) plus 2 variations. Anatomical variants of the classical pattern were detected in 30% of the livers (n ϭ 320). The most common variant was a replaced left artery arising from the left gastric artery (9.7%) followed by a replaced right hepatic artery arising from the superior mesenteric artery (7.8%). In conclusion, the information about the different hepatic arterial patterns can help in reducing the risks of iatrogenic complications, which in turn may result in better outcomes not only following surgical interventions but also in the context of radiological treatments. Knowledge of hepatic arterial vascularization has a significant relevance for the daily practice of a wide range of practitioners including not only surgeons specialized in the hepato-biliary-pancreatic area, but also general surgeons and radiologists, mainly those who are dedicated to interventional radiologic treatments.In the last few years, substantial improvements have been achieved in the surgical and/or radiological treatment of benign and malignant liver, pancreatic, and biliary diseases. With laparoscopic surgery the need has arisen for exact descriptions of the hepatic vascularization to avoid iatrogenic vascular lesions.In the setting of liver transplantation, the most effective approach to reduce the dropout rate on the waiting lists is to expand the number of available livers. Several strategies including living donors and split livers have been developed for this purpose. These are extremely complex techniques in which the exact knowledge of the arterial anatomy is a required step to plan the best resection as well as to minimize the risks of morbidity.The patterns of hepatic arterial supply are not constant. The usual anatomy of the hepatic arterial vascularization is a common hepatic artery arising from the celiac axis, accounting for 25 to 75% of the cases. 1 In the variant patterns, the hepatic lobes receive arterial flow through branches coming from the superior mesenteric artery, left gastric artery, or, rarely, from other arterial trunks. 2 Since Michels 3 published his first report, several studies have reported not only common and rare hepatic artery variants, but also different classifications. These studies are based on angiographic data and autopsy dissections, and mainly derive from surgery and transplantation literature. [4][5][6][7][8][9][10][11][12][13][14] The large sample size of transplanted livers is one of the major interests of this study. Indeed, harvested livers offer an excellent opportunity to describe, in situ, the anatomic variants of the arteries since all e...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

et al. 2007

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“…[10][11][12] In contrast to clinical studies, anatomic studies show a considerably higher frequency of anatomic variants, with a rate between 40% and 75%. [13][14][15] However, this difference between clinical and autopsy studies, observed throughout decades, can possibly be explained by the fact that most anatomic variants may not be detected during the surgical procedure or are considered to be clinically irrelevant and therefore not documented. To avoid accidental transsection of small accessory arteries, we emphasize careful preparation of the minor omentum and palpation or even surgical identification of the hepatic artery in the ligamentum hepatoduodenale before cold perfusion.…”

Section: Discussionmentioning

confidence: 99%

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Soliman

Bodingbauer

Langer

et al. 2003

Liver Transplantation

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The goal of this study was to analyze the influence of multiple anastomosis on outcome in orthotopic liver transplantation (OLT) and its implications for split-liver and living related liver transplantation programs. In a retrospective study, 683 first OLTs in adults were analyzed. Complex hepatic artery reconstruction was defined as revascularization of the graft requiring additional anastomosis between donor hepatic arteries. OLT was performed in a standard manner. All patients had daily ultrasound examination. In this series we found 72 grafts (10.5%) with anatomic arterial variations that required complex hepatic artery reconstruction. There was no difference in primary organ function and demographic data compared with patients with simple arterial reconstruction. However, hepatic artery thrombosis (HAT) occurred in 9.7% of patients (7 of 72) with complex reconstruction in contrast to 2.0% in the control group (12 of 638; P < .001). Statistical analysis identified multiple anastomoses (P < .002) and primary nonfunction (P < .02) as significant risk factors for HAT. Three patients underwent successful thrombectomy for HAT, all others had to undergo retransplantation. Although in the group with complex arterial reconstruction increased graft loss caused by HAT was found early postoperatively, the overall 5-year patient and graft survival was not different for both groups. Although complex reconstruction is a risk factor for HAT, early diagnosis of HAT by daily ultrasound and early repeat OLT can provide similar 5-year survival as for patients with simple reconstruction. We conclude that complex hepatic artery reconstruction challenges conventional OLT as well as split-liver and living related liver transplantation, but does not necessarily affect its longterm outcome. O rthotopic liver transplantation (OLT) is one of the outstanding innovations in the treatment of end-stage liver diseases in recent decades. The enormous success of this new surgical procedure resulted in an increasing organ shortage, which is the main challenge for OLT nowadays. Great efforts have been made to enlarge the donor pool, and especially split-liver transplantation and living related liver transplantation were to contribute to the solution of this problem. However, because these new surgical techniques are determined by their technical feasibility and limits, concepts that have been considered controversial since the early period of OLT have become of particular interest. [1][2][3][4] In this context, the vascular reconstruction of the hepatic artery and factors related to hepatic artery thrombosis (HAT), one of the most life-threatening complication in liver transplantation, are still being discussed. Many reports on the incidence of anatomic variations of the hepatic artery have been published and risk factors for HAT have been identified, 5-8 but an actual systematic analysis assessing exclusively the role of graft revascularization on outcome is rare. Therefore, the goal of this study is to analyze the results of complex hepatic ...

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“…The respective incidence in our population was consistent with that reported in the literature. [6][7][8] Of equal representation, 2 (2.1%) donors had a replaced CHA, replaced LHA from the GDA, and a common origin of the CA and the superior mesenteric artery. The remaining 10 (10.5%) patients had unique aberrant anatomy.…”

Section: Resultsmentioning

confidence: 99%

Hepatic arterial reconstruction in 95 adult right lobe living donor liver transplants: Evolution of anastomotic technique

Marcos

Killackey

Orloff

et al. 2003

Liver Transplantation

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The success of adult right-lobe living donor liver transplants (RLDLT) would not have been possible without the experience of the early pioneers of pediatric living donor liver transplants (LDLT). Our experience with 95 RLDLTs from July, 2000 to May, 2002 at a single institution is reported with specific emphasis on arterial reconstruction. The evolution of technique using the autogenous Y extension graft and the reverse extension bifurcated graft for arterial revascularization, which we believe has reduced the incidence of hepatic artery thrombosis, is described. Outcome and the incidence of hepatic artery thrombosis are reported. (Liver Transpl 2003;9: 570-574.)

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The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases

Cited by 120 publications

References 8 publications

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Hepatic arterial reconstruction in 95 adult right lobe living donor liver transplants: Evolution of anastomotic technique

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