Abstract
The replaced common hepatic artery (RCHA) is an uncommon arterial anomaly that, when present, makes hepatic arterial reconstruction during liver transplantation technically challenging. At our institution, the reconstruction of the recipient RCHA consists of 2 techniques that include either an infrarenal donor iliac artery aortic conduit or a direct donor celiac trunk anastomosis to the proximal RCHA. Our experience demonstrates that the direct anastomosis to the RCHA provides a reliable source of arterial inflow, allows preservation of the recipient arterial anatomy, and minimizes the dissection required to create an infrarenal aortic conduit. Between September 1998 and April 2019, we performed 1782 liver transplants (1230 adults, >18 years; 552 pediatric, <18 years). There were 36 (2.92%) adult and 20 (3.07%) pediatric liver transplant recipients that possessed a RCHA. Allograft and patient survivals were 94.70% and 94.10%, in both the infrarenal conduit and direct Type-V anastomosis cohorts at 1 year, respectively. To date, hepatic artery thrombosis (HAT) has not occurred in the 2 cohorts of pediatric transplant recipients. In conclusion, the direct donor celiac trunk to RCHA anastomosis is a safe and effective way to perform arterial reconstruction with low hepatic artery thrombosis and biliary complication rates.
Highlights
The replaced common hepatic artery (RCHA) is an uncommon arterial anomaly that most commonly arises from the superior mesenteric artery (SMA)
Of the 17 pediatric recipients with RCHA, hepatic artery reconstruction was achieved in 9 patients utilizing an infrarenal donor iliac artery aortic conduit, whereas, 8 patients had their hepatic artery reconstruction completed via a direct donor celiac trunk to recipient RCHA anastomosis (Figure 2)
The RCHA needs to be dissected free of all of the surrounding soft and pancreatic tissue and the small arterial branches encountered need to be ligated and divided to create adequate length on the RCHA. We feel that this dissection needs to be carried deep enough so that the proximal RCHA may be used for the anastomosis
Summary
The replaced common hepatic artery (RCHA) is an uncommon arterial anomaly that most commonly arises from the superior mesenteric artery (SMA). Classified by Hiatt et al [1] as type V, its incidence is reported to be from 9-15% of the population [1, 2] While unusual, this arterial variation when present may make the hepatic arterial reconstruction during liver transplantation technically challenging [3, 4]. The reconstruction of the recipient RCHA has evolved and consists of 2 techniques that include either an infrarenal donor iliac artery aortic conduit or a direct donor celiac trunk anastomosis to the proximal RCHA (Figure 1). The direct RCHA anastomosis allows a sized matched arterial anastomosis as the donor celiac trunk and recipient RCHA are usually similar in diameter and eliminates the extra arterial anastomosis required in the creation of the aortic conduit
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