Hepatic artery dissection with retrograde extension to the celiac trunk and splenic artery after liver transplantation: A clinical challenge

2015 ◽  
Vol 47 (9) ◽  
pp. e15 ◽  
Author(s):  
Giovanni Vennarecci ◽  
Nicola Guglielmo ◽  
Elisa Busi Rizzi ◽  
Giuseppe Maria Ettorre
Keyword(s):  
Liver Transplantation ◽  
Hepatic Artery ◽  
Splenic Artery ◽  
Celiac Trunk ◽  
Artery Dissection ◽  
Clinical Challenge

scholarly journals Providing Arterial Supply to the Liver Graft with Recipient Splenic Artery in Living Donor Liver Transplantation: Case Report

2020 ◽  
pp. 1-3
Author(s):  
Kaleem Ullah ◽  
Shams Uddin ◽  
Hala Izzu ◽  
Kaleem Ullah ◽  
Abdul Wahab Dogar ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Case Report ◽  
Hepatic Artery ◽  
Splenic Artery ◽  
Surgical Techniques ◽  
Arterial Blood Flow ◽  
Liver Graft ◽  
Artery Dissection ◽  
Arterial Blood ◽  
Operative Recovery

Hepatic arterial reconstruction is an important step in graft implantation in liver transplant procedure. Hepatic arterial anastomosis always demands meticulous and highly skilled surgical techniques to provide adequate blood supply to the graft. Hepatic arterial intimal dissection in liver transplantation is although a rare but documented complication, with incidence of less than 5%, but having dreadful complications. To overcome this complication of Recipient hepatic artery dissection, various techniques have been described by different authors. Here, in this case report we are describing technique of utilization of transposed recipient splenic artery for graft arterial inflow where native hepatic artery was dissected up to common hepatic artery. Post-operative recovery was uneventful and on follow up, patient was absolutely fine. So, recipient splenic artery is a safe alternative option in such complex situations for providing arterial blood flow to the graft and moreover it avoids the burden of extra anastomosis which is required in conduit technique.

scholarly journals The recipient celiac trunk as an alternative to the native hepatic artery for arterial reconstruction in adult liver transplantation

2015 ◽  
Vol 21 (9) ◽  
pp. 1133-1141 ◽  
Author(s):  
Safi Dokmak ◽  
Béatrice Aussilhou ◽  
Filippo Landi ◽  
Fédérica Dondéro ◽  
Salah Termos ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Artery ◽  
Celiac Trunk ◽  
Arterial Reconstruction ◽  
Adult Liver

scholarly journals Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Keita Shimata ◽  
Yasuhiko Sugawara ◽  
Tomoaki Irie ◽  
Yuzuru Sambommatsu ◽  
Masashi Kadohisa ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Artery ◽  
False Lumen ◽  
Celiac Artery ◽  
Artery Dissection ◽  
Left Hepatic Artery ◽  
Donor Liver Transplantation ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

Abstract Background Hepatic artery dissection after liver transplantation is an uncommon morbidity. The onset mechanism and management for this disorder remain unclear. The present report describes the cases of two patients with hepatic artery dissection after living-donor liver transplantation (LDLT) with simultaneous splenectomy and provides new insight into the onset mechanism of this disorder. Case presentation: Case 1 A 51-year-old man with liver cirrhosis caused by hepatitis B virus underwent LDLT with a right lobe graft and splenectomy simultaneously. The recipient’s right hepatic artery had partial dissection at the anastomosis site; therefore, his left hepatic artery was anastomosed. Contrast-enhanced computed tomography (CT) on postoperative day (POD) 27 showed dissection from his celiac artery to his left hepatic artery with bleeding in the false lumen. There was a risk of rupture of the false lumen; therefore, emergency interventional radiology and coil embolization of the false lumen were performed. The patient was doing well at 6 months after LDLT. Case 2 A 58-year-old woman with liver cirrhosis caused by primary biliary cholangitis underwent LDLT with a left lobe graft and splenectomy simultaneously. Her hepatic artery had a dissection that extended from her left hepatic artery to the proper hepatic artery. The gastroduodenal artery was anastomosed. Contrast-enhanced CT on POD 8 revealed dissection from the celiac artery to the common hepatic artery as well as a pseudoaneurysm at the celiac artery. We managed the patient with conservative treatment and performed daily follow-ups with Doppler ultrasonography examination and serial contrast-enhanced CT. At the time of writing this report, the patient was doing well at 34 months after LDLT. Conclusions Patients who have an intimal dissection at the anastomosis site and/or simultaneous splenectomy are at a higher risk of hepatic artery dissection. Most patients with asymptomatic hepatic artery dissections can be treated conservatively. Blood flow in the intrahepatic artery should be checked frequently using Doppler ultrasonography or contrast-enhanced CT soon after diagnosis.

scholarly journals The recipient celiac trunk as an alternative to the native hepatic artery for arterial reconstruction in adult liver transplantation

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e792
Author(s):  
S. Dokmak ◽  
B. Aussilhou ◽  
F. Landi ◽  
F. Dondéro ◽  
S. Termos ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Artery ◽  
Celiac Trunk ◽  
Arterial Reconstruction ◽  
Adult Liver

Endovascular Treatment of a Recipient Celiac Trunk Stenosis after Orthotopic Liver Transplantation

2003 ◽  
Vol 10 (2) ◽  
pp. 376-380 ◽  
Author(s):  
Saim Yilmaz ◽  
Kağan Çeken ◽  
Alihan Gürkan ◽  
Okan Erdoğan ◽  
Alper Demirbaş ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Endovascular Treatment ◽  
Flow Pattern ◽  
Hepatic Artery ◽  
Orthotopic Liver Transplantation ◽  
Doppler Ultrasound ◽  
Doppler Ultrasonography ◽  
Celiac Trunk ◽  
Angioplasty And Stenting

Purpose: To present the successful endovascular treatment of a severe recipient celiac trunk stenosis that led to allograft ischemia following liver transplantation. Case Report: A 56-year-old woman underwent orthotopic liver transplantation because of hepatitis C—induced cirrhosis. After the operation, routine hepatic Doppler ultrasonography showed a tardus parvus flow pattern in the hepatic artery, suggesting an impending hepatic artery thrombosis. Digital subtraction angiography (DSA), however, showed severe stenosis of the recipient celiac trunk and moderate splenic artery steal. The stenosis was dilated and stented in the same session. The postprocedural DSA showed good dilation of the lesion with immediate improvement of hepatic opacification. Follow-up Doppler ultrasound scans showed normal flow patterns in the hepatic artery at 3 and 6 months. Conclusions: In the presence of a tardus parvus flow pattern on Doppler ultrasound after liver transplantation, the possibility of an undetected recipient celiac stenosis should be considered in the differential diagnosis. Such lesions can successfully be treated with angioplasty and stenting.

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