Microvascular hepatic artery reconstruction

Vascular reconstruction technique for pediatric liver transplant



01:37  Exposure

03:10  Anterior wall

05:32  Posterior wall

Technique description
  • During living donor liver transplantation, microsurgical techniques in arterial reconstruction greatly reduce the incidence of hepatic artery thrombosis.
  • This video will demonstrate the technique for an end-to-end arterial anastomosis for a living donor left lateral segment liver graft implantation into a pediatric recipient.
Key points
  • The anastomosis will be completed with 8 interrupted stitches of 9-0 nylon sutue
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  • In pediatric recipients of adult left lateral segment grafts, the recipient right hepatic artery is often a better choice for arterial revascularization of the graft since it is longer, larger, and has better inflow than the recipient left hepatic artery.
  • As with portal vein reconstruction, redundancy in the arterial anastomosis is permitted to prevent kinking and twisting when the graft is oriented in its final resting position.
  • Prior to suturing, the recipient hepatic artery will be gently dilated to reduce spasm.
  • When tying, gentle lateral tension should applied to the sutures in a direction perpendicular to the axis of the vessels; the amount of tension should be equal on both ends.
  • Intermittent counter-tension should be applied in the direction of the axis of the vessels; this helps distribute tension evenly along the suture.
  • An alternative method for hepatic artery reconstruction, when deemed appropriate, is the parachute technique.