Recipient Splenic Artery Research Articles

Splenic Artery Transposition for Liver Transplantation: An Underutilized Technique?

Background.Successful liver transplantation is dependent on restoration of hepatic arterial (HA) flow. Although uncommon, some native recipient HAs are not suitable or inadequate for anastomosis, thereby necessitating extra-anatomic HA reconstruction. Splenic artery transposition (SAT) is 1 method of HA reconstruction, in which the recipient splenic artery is transposed to reestablish perfusion of the donor liver. Due to the rarity of the technique, literature describing outcomes is limited. In the current report, we describe 3 patients (2 adults, 1 pediatric) who underwent complex upper abdominal surgery before whole-organ deceased donor liver transplantation with SAT.Methods.The demographic and patient care information was collected prospectively and subsequently reviewed retrospectively. Given the de-identified nature of the data included, this study was exempt from approval from an ethics board.Results.Recipient splenic arteries were dissected from their origin at the celiac trunk, for approximately 3–5 cm to ensure a gentle anterior-cranial curve toward the right upper quadrant, allowing anastomosis to the donor celiac trunk in an end-to-end fashion. Postoperatively, all 3 patients had rapid normalization of liver function tests and brisk HA flow demonstrated by Doppler ultrasound. Longer-term follow-up, ranging from 1 to 3 years, reveals continued patency of the reconstructed HAs and liver function tests within normal limits.Conclusions.Our experience points to SAT as a safe and effective technique for extra-anatomic HA reconstruction.

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

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.

Management of difficult hepatic artery anastomosis in living donor liver transplantation: mansoura experience

Background One of the most difficult and important procedure in living donor liver transplantation (LDLT) is hepatic artery reconstruction. Difficult hepatic artery reconstruction may be because of pathological factor such as intimal dissection (ID) and anatomical variation. Difficult hepatic artery reconstruction is a risk factor for hepatic artery complications. This study was done to evaluate difficult hepatic artery reconstruction in LDLT at our center and its surgical outcomes. Patient and methods Consecutive patients who were treated for end-stage liver cirrhosis by LDLT were retrospectively reviewed. The management of hepatic artery with ID is carried out according to the extent of ID. Results Hepatic artery ID was found in 21/375 (5.6%) cases. Overall, seven (33%) cases were reconstructed with the graft hepatic artery after trimming the edge until reaching a healthy segment. A total of 11 (52.4%) cases were reconstructed with the graft hepatic artery after intimal fixation of ID. Moreover, three (14.3%) cases had severe ID and failed intimal fixation and were reconstructed with the recipient splenic artery. Biliary stricture developed in two patients who had severe ID, and three patients developed transient bile leak. No hepatic artery complications, graft failure, or mortality occurred. Conclusion Intimal fixation technique proved to be an effective technique in most of the cases, with good short-term and long-term follow-up results. In severe ID or failure of intimal fixation, alternative recipient arteries other than hepatic artery can be used.

Development of a new auxiliary heterotopic partial liver transplantation technique using a liver cirrhosis model in minipigs: Preliminary report of eight transplants

This study aimed to develop a new auxiliary heterotopic partial liver transplantation (AHPLT) technique in minipigs using a model of liver cirrhosis. Based on our previous study, 14 minipigs were induced to cirrhosis by administration of carbon tetrachloride (CCl(4)) through intraperitoneal injection. All of the cirrhotic animals were utilized as recipients. The donor's liver was placed on the recipient's splenic bed, and the anastomosis was performed as follows: end-to-end anastomosis between the donor's portal vein and the recipient's splenic vein, end-to-side anastomosis between the donor's suprahepatic vena cava and the recipient's suprahepatic vena cava, and end-to-end anastomosis between the donor's hepatic artery and the recipient's splenic artery. The common bile duct of the donor was intubated and bile was collected with an extracorporeal bag. Vital signs, portal vein pressure (PVP), hepatic venous pressure (HVP) and portal vein pressure gradient (PVPG) were monitored throughout the transplantation. All 8 minipigs that developed liver cirrhosis were utilized to establish the new AHPLT; 7 cases survived. Following the surgical intervention, the PVP and PVPG of the recipients were lower than those prior to the operation (P<0.05), whereas the PVP and PVPG of the donors increased significantly compared to those of the normal animals (P<0.05). A new operative technique for AHPLT has been successfully described herein using a model of liver cirrhosis.

Recipient Splenic Artery Utilization for Arterial Re-Anastomosis in Living Donor Liver Transplantation: Single-Center Experience

Thrombosis of recipient hepatic artery is a life threatening complication for liver transplantation. The etiology of hepatic arterial thrombosis is multi-factorial and can be caused by intimal dissection, poor surgical technique and coagulopathies. The patency of hepatic arterial flow is very important for both graft survival and patient survival. Intraoperative diagnosis of inadequate hepatic arterial flow found with Doppler ultrasonography is essential in order to achieve good results after liver transplantation. Urgent re-anastomosis is necessary when the arterial blood flow is insufficient. We performed 317 living donor liver transplantations from July 2004 to July 2011. We used recipient splenic artery for hepatic artery reconstruction in six patients. These six patients were included in this study. Using the recipient splenic artery is a simple, safe and practical alternative for hepatic artery re-anastomosis in living donor liver transplantations.

Hepatic artery reconstruction with the jejunal artery of the Roux‐en‐Y limb in pediatric living donor liver re‐transplantation

When re-anastomosis and re-transplantation becomes necessary after LDLT, arterial reconstruction can be extremely difficult because of severe inflammation and lack of an adequate artery for reconstruction. Frequently, the recipient's HA is not in good condition, necessitating an alternative to the HA. In such cases, the recipient's splenic artery, right gastroepiploic artery or another vessel can be safely used for arterial reconstruction. There have, however, been few reports on using the jejunal artery. Herein, we report our experience with arterial reconstruction using the jejunal artery of the Roux-en-Y limb as an alternative to the HA. A three-yr-old girl who had developed graft failure due to early HA thrombosis after LDLT required re-transplantation. At re-transplantation, an adequate artery for reconstruction was lacking. We reconstructed the artery by using the jejunal artery of the Roux-en-Y limb, as we judged it to be the most appropriate alternative. After surgery, stent was deployed because hepatic blood flow had reduced due to kinking of the anastomosed site, and a favorable outcome was obtained. In conclusion, when an alternative to the HA is required, using the jejunal artery is a feasible alternative.

Experience with recipient splenic artery inflow in adult liver transplantation: a case series

IntroductionHepatic artery thrombosis following orthotopic liver transplant is one of the most common reasons for early graft failure. Meticulous reconstitution of hepatic artery flow remains essential for good outcomes. Prior surgery, body habitus, hepatic artery inadequacy and anatomic differences can complicate hepatic artery revascularization.Case presentationWe report a single institution's experience, from January 1996 to January 2007, using splenic artery inflow in seven patients with inadequate native hepatic arteries.ConclusionEnd-to-side anastomosis was associated with postanastomotic intimal hyperplasia. End-to-end anastomosis provided effective hepatic inflow, demonstrated splenic and pancreatic safety, and was not associated with the intimal hyperplasia experienced with end-to-side anastomosis.

Use of the Splenic Artery for Arterial Reconstruction in Living Donor Liver Transplantation

Background The present study sought to evaluate the possibility of using the splenic artery for arterialization of a living donor liver graft. Patients and Methods In the period between August 2004 and April 2006, we performed 31 adult-to-adult living donor liver transplantations. In 27 patients (group A), the right or left hepatic artery was used to arterialize the graft, whereas in the other four cases (group B), we used the recipient splenic artery. Results The Model for End-stage Liver Disease (MELD) score of the patients averaged 17 (17.2 and 15.2 for groups A and B, respectively) ranging between 7 and 28. We did not observe pancreatitis, splenic infarction, or other complications related to ligation of the splenic artery. Two cases (6.4%) of arterial complication were observed, both in group A patients. Conclusion The use of the splenic artery is a safe, practical alternative for arterial reconstruction in living donor liver transplantation procedures, when the hepatic artery is not adequate or in cases of portal hypertension with splenomegaly.

The use of radial artery interpositional graft between recipient splenic artery and graft artery in living donor liver transplantation

The use of radial artery interpositional graft between recipient splenic artery and graft artery in living donor liver transplantation

Successful adult-to-adult living donor liver transplantation combined with a cadaveric split left lateral segment

Successful adult-to-adult living donor liver transplantation combined with a cadaveric split left lateral segment

Urgent Revascularization of a Liver Allograft with a Saphenous Vein Interposition Graft Between the Hepatic Artery and the Recipient Splenic Artery After Late Hepatic Artery Thrombosis

Urgent Revascularization of a Liver Allograft with a Saphenous Vein Interposition Graft Between the Hepatic Artery and the Recipient Splenic Artery After Late Hepatic Artery Thrombosis

Rescue for rare complications of the hepatic artery in living donor liver transplantation using grafts of autologous inferior mesenteric artery

This report describes two rescued cases with rare complications of the hepatic artery in living-donor liver transplantation (LDLT). In both cases a segment of the autologous inferior mesenteric artery (IMA) was successfully used as an arterial graft for re-vascularization under microsurgery. The first case was that of a pseudoaneurysm of the hepatic artery, which caused massive gastrointestinal bleeding. The hepatic arteries of the pre- and post-aneurysm were divided, and the arterial graft from the recipient's IMA was interposed for reconstruction. The second case was that of an intimal dissection of the recipient's hepatic artery. Because the dissection extended to the root of the common hepatic artery, the autologous IMA was interposed between the donor's hepatic artery and the proximal stump of the recipient's splenic artery. Reconstruction using the arterial graft of the autologous IMA is feasible for re-vascularization of the hepatic artery in liver transplantation.

Editorial on “diagnosis and treatment of arterial steal syndromes in liver transplantation recipients”

Liver TransplantationVolume 9, Issue 6 p. 603-604 EditorialFree Access Editorial on “diagnosis and treatment of arterial steal syndromes in liver transplantation recipients” Olivier Farges, Olivier Farges Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Hospital Beaujon, Clichy, FranceSearch for more papers by this authorJacques Belghiti, Corresponding Author Jacques Belghiti [email protected] Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Hospital Beaujon, Clichy, FranceDepartment of Digestive Surgery, Hospital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy-France. Telephone: 331-4087-5895; FAX: 331-4087-1724Search for more papers by this author Olivier Farges, Olivier Farges Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Hospital Beaujon, Clichy, FranceSearch for more papers by this authorJacques Belghiti, Corresponding Author Jacques Belghiti [email protected] Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Hospital Beaujon, Clichy, FranceDepartment of Digestive Surgery, Hospital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy-France. Telephone: 331-4087-5895; FAX: 331-4087-1724Search for more papers by this author First published: 30 December 2003 https://doi.org/10.1053/jlts.2003.50127Citations: 10AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Manner M, Otto G, Senninger N, Kraus T, Goerich J, Herfarth C. Arterial steal: An unusual cause for hepatic hypoperfusion after liver transplantation. Transpl Int 1991; 4: 122– 124. 2 Langer R, Langer M, Scholz A, Felix R, Neuhaus P, Keck H. Splenohepatic steal syndrome and gastroduodenal steal syndrome in patients before and after liver transplantation. Aktuelle Radiol 1992; 2: 55– 58. 3 Bolognesi M, Sacerdoti D, Bombonato G, Merkel C, Sartori G, Merenda R, et al. Change in portal flow after liver transplantation: Effect on hepatic arterial resistance indices and role of spleen size. Hepatology 2002; 35: 601– 608. 4 Marcos A, Olzinski AT, Ham JM, Fisher RA, Posner MP. The interrelationship between portal and arterial blood flow after adult to adult living donor liver transplantation. Transplantation 2000; 70: 1697– 1703. 5 Smyrniotis V, Kostopanagiotou G, Kondi A, Gamaletsos E, Theodo K, Kehagias K, Contis J. Hemodynamic interaction between portal vein and hepatic artery flow in small-for-size split liver transplantation. Transpl Int 2002; 15: 355– 360. 6 Boillot O, Delafosse B, Mechet I, Boucaud C, Pouyet M. Small-for-size partial liver graft in an adult recipient; A new transplant technique. Lancet 2002; 359: 406– 407. 7 De Carlis L, Sansalone CV, Rondinara GF, Belli LS, Rimoldi P, Romani F, et al. Splenic artery steal syndrome after orthotopic liver transplantation: Diagnosis and treatment. Transplant Proc 1993; 25: 2594– 2596. 8 Cherqui D, Riff Y, Rotman N, Julien M, Fagniez PL. The recipient splenic artery for arterialization in orthotopic liver transplantation. Am J Surg 1994; 167: 327– 330. Citing Literature Volume9, Issue6June 2003Pages 603-604 ReferencesRelatedInformation

Arterial reconstruction using vein graft from the common iliac artery after hepatic artery thrombosis in living-related liver transplantation

VASCULAR complications in liver transplantation sometimes occur and may be lethal both for the transplant graft and the patient. Thrombosis at the anastomosis of the hepatic artery is the most common complication in children. Several methods of hepatic arterial reconstruction have been reported, including use of recipient splenic artery, interposition of vessel graft between common hepatic artery and graft artery, and use of conduit between aorta and the graft. We report herein the case of a patient with hepatic arterial reconstruction using vein graft between the common iliac artery and the graft artery after hepatic artery thrombosis in living-related liver transplantation.

The recipient splenic artery for arterialization in orthotopic liver transplantation

Adequate hepatic arterial reconstruction is essential for successful liver transplantation. In the case of insufficient recipient hepatic arterial flow, most surgeons recommend the use of the aorta for arterialization of the graft. We report here on a technique in which the recipient splenic artery is used in such a setting. The splenic artery is dissected from its origin on a 3-to-4 cm segment and divided. The proximal segment is flipped to the right and anastomosed to the graft's celiac axis in an end-to-end fashion. This technique was used in 7 of 79 orthotopic liver transplantations (9%) because the native hepatic artery was deemed to be inadequate for anastomosis. There were no complications related to the use of this technique and no arterial thromboses. Arterialization of hepatic grafts using the recipient proximal splenic artery is a simple, safe, and efficient technique that can be recommended in the presence of an inadequate recipient hepatic arterial flow.