Before arterial reconstruction in LDLT, you find the graft HA completely dissected. Going up till the hepatic hilus, you find the whole length of the artery is dissected. Will you call for an organ retrived from a deceased donor? And if you have no deceased organ donation, what should be done?
First is this a left or a right lobe graft? Second does the dissection involve just one side of the artery or is it circumferential? Plus does it involve the branches?
Options are-
a) minor dissection -tack the wall of the artery preferably on the backtable prior to implantation or resect the artery and replace with an autogenous graft eg spahenous vein. On occasion you may be able to replace a segment of the hepatic artery with a segment of deceased donor iliac artery
b) major dissection and you have already partially implanted the graft, ie reperfused via the portal vein. Do you have any backbleeding down the artery and can you identify the lumen? If so try tacking the wall together with fine sutures and then anastamose. You may get lucky. If you cannot anstamose the artery then yes you have to hope the recipient can survive on portal venous inflow alone untill another graft becomes available.
It was a right lobe graft. The dissection was circumfrential, the intima was completely dissected and any attempt for intimal fixation failed.
Fortunately, we had this problem in a hospital having the option of deceased organ donation. But what I was thinking about, we don't have in Egypt a deceased organ program, what shall we do in such a case? I heard about portal vein arterialization, can it be an option?
Portal vein arterializarion would be an option if you had enough viable artery to be able to suture it to the portal vein
Interpositional graft from the recipient, reconstruction under operating microscope before implantation: radial artery, right gastroepiploic artery, etc.
Thanks Dr Chan for the answer. But what I mean is complete dissection of the hepatic artery of the right lobe graft and there is no healthy extrahepatic segement to do the anastomosis. If there is no option to have a deceased donor liver, what will be the solution?
Here s a movie made by me. It s the procedure of a Dual Living Donor Liver Transplant.
Left lobe + left lateral section.
HA was made with interposition of a deceased donor iliac artery graft. - minute 7:40 in the movie.
https://www.youtube.com/watch?v=CoPIbBIwYgE
- Badges
- Science topic
- Similar topics
- Biological Science
- Anatomy
- Tissue